JabRef references

Author	Title	Year	Journal/Proceedings	Reftype	DOI/URL
Choung, Y.-H., Shin, Y.R., Kahng, H., Park, K. and Choi, S.J.	'Bow and lean test' to determine the affected ear of horizontal canal benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2006	The Laryngoscope Vol. 116(10), pp. 1776-1781	article	DOI
Abstract: One of the problems in the management of horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV) is the difficulty in determining the affected ear using Ewald's second law. The purpose of this study is to develop the new "bow and lean test (BLT)" to easily determine the affected ear of HSC-BPPV and evaluate its efficiency. We compared the efficiency between the classic method and BLT in 26 patients with HSC-BPPV. The classic method is based on Ewald's second law comparing the intensity of nystagmus or symptoms in the head roll test. BLT is based on the direction of both "bowing nystagmus" and "leaning nystagmus" at the head's bowing and leaning state in a sitting position. The affected ear is the same direction of bowing nystagmus in canalolithiasis and the same direction of leaning nystagmus in cupulolithiasis. In 26 patents (15 canalolithiasis, 11 cupulolithiasis), 3 (11.5%) patients did not show a prominent affected ear in the classic method, and 7 (26.9%) patients showed the different affected ear between the two methods. All 10 patients were successfully treated with just one trial of barbecue rotation based on the affected ear in BLT. Three patients did not show any bowing or leaning nystagmus. The side with canal paresis in all four patients, who showed significant canal paresis in bithermal caloric tests, was equal to the affected ear based on BLT. The "bow and lean test" (also called "Choung's test") is a new method that can easily determine the affected ear of HC-BPPV.
BibTeX: @article{Choung2006, author = {Choung, Yun-Hoon and Shin, You Ree and Kahng, Hison and Park, Keehyun and Choi, Sung Jun}, title = {'Bow and lean test' to determine the affected ear of horizontal canal benign paroxysmal positional vertigo.}, journal = {The Laryngoscope}, year = {2006}, volume = {116}, issue = {10}, pages = {1776--1781}, doi = {https://doi.org/10.1097/01.mlg.0000231291.44818.be}, keywords = {Adolescent; Adult; Aged; Caloric Tests; Diagnostic Techniques, Otological; Electronystagmography; Female; Head Movements, physiology; Humans; Lithiasis, diagnosis, physiopathology; Male; Middle Aged; Nystagmus, Pathologic, physiopathology; Otolithic Membrane, physiopathology; Posture, physiology; Semicircular Canals, physiopathology; Vertigo, diagnosis, physiopathology}, pmid = {17003735} }
Califano, L.	"A safe-repositioning maneuver for the management of benign paroxysmal positional vertigo: Gans vs. Epley maneuver; a randomized comparative clinical trial": something else about Gans maneuver. [BibTeX]	2017	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 274(8), pp. 3259-3260	article	DOI
BibTeX: @article{Califano2017, author = {Califano, Luigi}, title = {"A safe-repositioning maneuver for the management of benign paroxysmal positional vertigo: Gans vs. Epley maneuver; a randomized comparative clinical trial": something else about Gans maneuver.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2017}, volume = {274}, issue = {8}, pages = {3259--3260}, doi = {https://doi.org/10.1007/s00405-016-4406-6}, pmid = {27975133} }
Furman, J.M. and Hain, T.C.	"Do try this at home": self-treatment of BPPV. [BibTeX]	2004	Neurology Vol. 63(1), pp. 8-9	article
BibTeX: @article{Furman2004, author = {Furman, Joseph M and Hain, Timothy C}, title = {"Do try this at home": self-treatment of BPPV.}, journal = {Neurology}, year = {2004}, volume = {63}, issue = {1}, pages = {8--9}, keywords = {Exercise Movement Techniques; Humans; Nystagmus, Pathologic, etiology; Otolithic Membrane; Physical Therapy Modalities; Posture; Self Care; Semicircular Canals, physiopathology, ultrastructure; Vertigo, complications, therapy}, pmid = {15249602} }
Kim, C.-H., Shin, J.E., Shin, D.H., Kim, Y.W. and Ban, J.H.	"Light cupula" involving all three semicircular canals: A frequently misdiagnosed disorder. [Abstract] [BibTeX]	2014	Medical hypotheses Vol. 83(5), pp. 541-544	article	DOI
Abstract: Though benign paroxysmal positional vertigo (BPPV) is the most common vestibular disorder causing positional vertigo, patients with typical positional vertigo in which the findings of positional nystagmus do not meet the diagnostic criteria for BPPV are often encountered in the clinic. Recently a concept of the light cupula was introduced, which accounts for some of positional vertigo. Under a normal condition in which the specific gravity of the cupula is same as that of the surrounding endolymph, semicircular canals (SCCs) are not influenced by the gravity. The light cupula, which indicates cupula with lower specific gravity than the surrounding endolymph, is characterized by persistent geotropic direction-changing positional nystagmus (DCPN) without latency on the supine head-roll test and the presence of a null plane. Unless the duration and pattern of positional nystagmus are carefully examined, the light cupula can be misdiagnosed as other types of BPPV. We present a patient with light cupula on the right side who reported recurrent episodes of positional vertigo and had been diagnosed as BPPV with multiple canal involvement (posterior and lateral SCCs) on the opposite side. In this study, we present the mechanism of typical positional nystagmus patterns in patients with light cupula involving all of the unilateral SCCs, and discuss the possible causes of misdiagnosis of the light cupula.
BibTeX: @article{Kim2014, author = {Kim, Chang-Hee and Shin, Jung Eun and Shin, Dong Hyuk and Kim, Yong Won and Ban, Jae Ho}, title = {"Light cupula" involving all three semicircular canals: A frequently misdiagnosed disorder.}, journal = {Medical hypotheses}, year = {2014}, volume = {83}, issue = {5}, pages = {541--544}, doi = {https://doi.org/10.1016/j.mehy.2014.09.002}, keywords = {Adult; Benign Paroxysmal Positional Vertigo, diagnosis; Diagnosis, Differential; Endolymph; Female; Humans; Nystagmus, Pathologic, diagnosis; Semicircular Canals, physiopathology; Vestibular Diseases, complications, diagnosis; Vestibular Function Tests}, pmid = {25249441} }
Ribeiro, K.M.O.B.d.F., Ferreira, L.M.d.B.M., Freitas, R.V.d.M., Silva, C.N.d., Deshpande, N. and Guerra, R.O.	"Positive to Negative" Dix-Hallpike test and Benign Paroxysmal Positional Vertigo recurrence in elderly undergoing Canalith Repositioning Maneuver and Vestibular Rehabilitation. [Abstract] [BibTeX]	2016	International archives of otorhinolaryngology Vol. 20(4), pp. 344-352	article	DOI
Abstract: Benign Paroxysmal Positional Vertigo is the most common cause of dizziness in elderly people. Recent studies have shown that the elderly present higher Benign Paroxysmal Positional Vertigo recurrence and that vertiginous symptomatology remission varies according to comorbidities and the therapeutic techniques applied. To assess the short-term effectiveness of Vestibular Rehabilitation in addition to Canalith Repositioning Maneuver on positive to negative Dix-Hallpike test, on recurrence and number of maneuvers to achieve a negative test in elderly patients with chronic Benign Paroxysmal Positional Vertigo. In this randomized controlled trial, 7 older adults (median age: 69 years, range 65-78) underwent Canalith Repositioning Maneuver and Vestibular Rehabilitation for thirteen weeks. Seven older adults (median age: 73 years, range 65-76) in the control group received only Canalith Repositioning Maneuver. The participants were assessed at baseline (T0), one (T1), five (T5), nine (T9), and thirteen weeks (T13). We assessed the differences between the groups by Mann-Whitney and Fisher exact tests, and used the Friedman and Wilcoxon tests to determine the intragroup differences. No significant differences were found between groups for the positive to negative Dix-Hallpike test, recurrence, and number of maneuvers to achieve a negative test. The number of maneuvers to achieve negative Dix-Hallpike test was lower in intragroup comparisons in the experimental group. The findings suggest that additional Vestibular Rehabilitation did not influence the positive to negative Dix-Hallpike test, recurrence, or number of maneuvers to achieve a negative test in elderly patients with chronic Benign Paroxysmal Positional Vertigo.
BibTeX: @article{Ribeiro2016, author = {Ribeiro, Karyna M O B de Figueiredo and Ferreira, Lidiane Maria de Brito Macedo and Freitas, Raysa Vanessa de Medeiros and Silva, Camila Nicácio da and Deshpande, Nandini and Guerra, Ricardo Oliveira}, title = {"Positive to Negative" Dix-Hallpike test and Benign Paroxysmal Positional Vertigo recurrence in elderly undergoing Canalith Repositioning Maneuver and Vestibular Rehabilitation.}, journal = {International archives of otorhinolaryngology}, year = {2016}, volume = {20}, issue = {4}, pages = {344--352}, doi = {https://doi.org/10.1055/s-0036-1572528}, keywords = {elderly; rehabilitation; vestibular diseases}, pmid = {27746838} }
Califano, L., Melillo, M.G., Mazzone, S. and Vassallo, A.	"Secondary signs of lateralization" in apogeotropic lateral canalolithiasis. [Abstract] [BibTeX]	2010	Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale Vol. 30(2), pp. 78-86	article
Abstract: The diagnosis of lateral canalolithiasis is based on the typical finding of the horizontal paroxysmal positional nystagmus induced by the Pagnini-Mc Clure manoeuvre. This technique usually identifies also the affected side, namely, the side where the paroxysmal nystagmus is more intense in geotropic forms and the side where the paroxysmal nystagmus is less intense in apogeotropic forms. However, this method is not always applicable since, especially in apogeotropic forms, the intensity of the nystagmus is not so distinctly different between the two sides. Further useful signs to identify the affected side have been described in the Literature: Pseudo-spontaneous nystagmus in the sitting position; Leaning and Bowing nystagmus; Null-point in the vertical plane; Sitting to supine positioning nystagmus; Null-point in the horizontal plane. They are fully explained at pathophysiological level by the mechanism of canalolithiasis, as they are caused by otoliths moving in the ampullopetal direction in the non-ampullary segment (geotropic canalolithiasis) of the lateral canal or in ampullofugal direction in the ampullary segment (apogeotropic canalolithiasis) of the lateral canal. In other words, the movement of otoliths determines excitatory or inhibitory endolymphatic flow that generates specific nystagmic eye-movements. Authors analyse the characteristics of these signs, that they define as "Secondary signs of lateralization", in 64 cases of apogeotropic lateral canalolithiasis. A decisive contribution of the "Secondary signs of lateralization" to diagnose the pathological side has been verified in 13 out of 64 cases, whereas, in all other cases, Pagnini-Mc Clure diagnostic manoeuvre proved successful in correctly identifying the affected side by itself. Among the "Secondary signs of lateralization", the Pseudo-spontaneous nystagmus in the sitting position and the Sitting to the supine positioning nystagmus were particularly useful, due to both their frequency and their easy detection, as they do not require additional manoeuvres besides those usually performed during health examination of a patient affected by lateral canalolithiasis. In conclusion, the Authors propose a decision-making algorithm to diagnose and treat lateral canalolithiasis based on the attempt to obtain as much information as possible for a correct diagnosis, with the least trouble and inconvenience for patients.
BibTeX: @article{Califano2010a, author = {Califano, L and Melillo, M G and Mazzone, S and Vassallo, A}, title = {"Secondary signs of lateralization" in apogeotropic lateral canalolithiasis.}, journal = {Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale}, year = {2010}, volume = {30}, issue = {2}, pages = {78--86}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Female; Gravitation; Humans; Lithiasis, diagnosis, physiopathology; Male; Middle Aged; Vestibular Diseases, diagnosis, physiopathology; Young Adult; Benign paroxysmal positional vertigo; Lateral canalolithiasis; Paroxysmal nystagmus}, pmid = {20559477} }
Asprella Libonati, G., Gagliardi, G., Cifarelli, D. and Larotonda, G.	"Step by step" treatment of lateral semicircular canal canalolithiasis under videonystagmoscopic examination. [Abstract] [BibTeX]	2003	Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale Vol. 23(1), pp. 10-15	article
Abstract: Aim of the work was to describe a new physical therapeutic approach for benign paroxysmal positional vertigo determined by canalolithiasis of the lateral semicircular canal. A review is made of the literature, and personal experience is reported. A total of 55 cases were observed, 40 geotropic forms, 15 apogeotropic forms. Liberatory manoeuvres were carried out observing the nystagmus during videonystagmoscopic examination, thus attempting to solve the problem in the first treatment session. Monitoring the patient under videonystagmoscopic examination, progression of the otolithic mass towards the non-ampullary segment is documented by the appearance of a nystagmus directed towards the healthy side (and, therefore, inhibitory, due to ampullofugal deflection of the ampullary cupula) during the individual steps of the rehabilitation treatment. Of the 40 geotropic forms, 30 were successfully treated with the Vannucchi-Asprella technique, and the other 10 with the Vannucchi-Asprella manoeuvre followed by a Lempert barbecue rotation. Of the 15 apogeotropic forms, 6 were solved with the Vannucchi-Asprella manoeuvre, 2 with the Vannucchi-Asprella technique followed by Lempert, 6 with the inverted Gufoni technique, followed by Lempert, 1 transformed into geotropic with inverted Gufoni plus Lempert and then resolved by means of a Vannucchi-Asprella manoeuvre. In all cases, therapeutic success was achieved in the first session. Treatment of benign paroxysmal positional vertigo of the lateral semicircular canal does not allow every case to be fully solved at the first attempt with any technique proposed up to now, in particular, for the apogeotropic forms. Being aware of the different techniques, choosing that most appropriate for the patient's "physical" needs, and, above all, verifying under videonystagmoscopic examination the progression in an ampullofugal direction of the otolithic mass during treatment enable excellent therapeutic results to be obtained in the treatment of benign paroxysmal positional vertigo of the lateral semicircular canal, by modifying the rehabilitation strategy while it is being carried out. Videonystagmoscopic examination monitoring of the nystagmus during treatment of benign paroxysmal positional vertigo of the lateral semicircular canal, is taking the place of the rigid schematism of the manoeuvres proposed, so far, allowing the treatment programme to be adapted to the individual case, thus enabling a solution to be reached in the first rehabilitation session by means of tailored therapy.
BibTeX: @article{AsprellaLibonati2003, author = {Asprella Libonati, G and Gagliardi, G and Cifarelli, D and Larotonda, G}, title = {"Step by step" treatment of lateral semicircular canal canalolithiasis under videonystagmoscopic examination.}, journal = {Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale}, year = {2003}, volume = {23}, issue = {1}, pages = {10--15}, keywords = {Humans; Nystagmus, Pathologic, etiology; Posture; Rotation; Semicircular Canals, physiopathology; Vertigo, physiopathology, therapy; Videotape Recording}, pmid = {12812129} }
Koch, E.	[A new positioning maneuver for treating a subtype of postural unsteadiness - based on a modified model of the utricular macula]. [Abstract] [BibTeX]	2017	Laryngo- rhino- otologie Vol. 96(10), pp. 678-684	article	DOI
Abstract: A new method for the treatment of a subtype of postural unsteadiness frequently seen in the medical office is proposed. Ten years of successful practical application and continuous refining of this new treatment lead to the definition of symptom-criteria, which are useful to distinguish patients, who get benefit by this new procedure and to a modified model of the utricular macula. In a retrospective collection, the data of 15 patients with postural unsteadiness (mean duration of symptoms 61.7 months) successfully treated with the new maneuver are reported. Before treatment, all patients showed normal results in testing the caloric responses of the labyrinth, normal neurological investigation and no signs for cervical vertigo. Before and after treatment the DHI-score (Dizziness Handicap Index) was achieved by using the German version of the DHI-questionnaire. In all groups before and after treatment balance testing was performed using a posturography platform. Application of the new treatment lead to a significant improvement of the DHI-scores and of the posturographic results (significant reduction of body sway). The patients, who were successfully treated by the new maneuver have had presented the same symptoms like patients with a proven utricular dysfunction. This leads to a slightly modified model of the utricular macula. Beyond correctly positioned otoconia in the utricular macula and free otoconia in the endolymphatic utricular space, a third fraction of dysfunctional partially detached otoconia is postulated (causing the unsteadiness). Based on this theory, the single hair-cell with its accompanied otoconium might be the smallest receptor-unit of the macula-organ. This smallest receptor-unit might represent a biological mass-spring-system. According to technical mass-spring-systems used as accelerometers, the different sizes of the otoconia for a distinct direction of acceleration are necessary for covering different frequency-bands. Finally, a many years successfully tested modified variation of the new maneuver for treatment in the medical office and for self-treatment is proposed.
BibTeX: @article{Koch2017, author = {Koch, Erich}, title = {[A new positioning maneuver for treating a subtype of postural unsteadiness - based on a modified model of the utricular macula].}, journal = {Laryngo- rhino- otologie}, year = {2017}, volume = {96}, issue = {10}, pages = {678--684}, doi = {https://doi.org/10.1055/s-0043-118632}, keywords = {Acoustic Maculae, physiopathology; Aged; Contraindications; Dizziness, diagnosis, physiopathology, therapy; Female; Follow-Up Studies; Humans; Male; Orientation; Otolithic Membrane, physiopathology; Patient Positioning, methods; Physical Therapy Modalities; Postural Balance; Retrospective Studies; Saccule and Utricle, physiopathology; Surveys and Questionnaires; postural unsteadiness; BPPV; utricular macula; modell}, pmid = {29017229} }
Guo, X., Wang, Q., Li, Y., Zhang, Z. and Yang, X.	[A pre- and post-treatment study of quality of life in patients with benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2011	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 25(16), pp. 729-731	article
Abstract: To explore the effect of canalith repositioning procedure (CRP) on the quality of life (QOL) in patients with benign paroxysmal positional vertigo(BPPV). The clinical data of 86 patients with BPPV (treatment group) and 120 normal ones (control group) were reviewed through the medical outcomes study short form (SF-36)and the dizziness handicap inventory (DHI), and the results of two groups were analyzed. With SF-36 scales for evaluation of QOL, the results showed that the scores of treatment group before CRP were significantly lower than that of the control group (P < 0.05). While using of DHI scales in evaluation of the treatment group patients before CRP, the results were significantly higher than that of the control group (P < 0.05). After CRP for 3 months, not only with SF-36 scales but also with DHI scales, there were no significant difference between the two groups (P > 0.05). CRP may obviously improve the clinical symptom of BPPV patients. The SF-36 and DHI scales could reflect the change of BPPV patient's QOL.
BibTeX: @article{Guo2011, author = {Guo, Xiangdong and Wang, Qinglin and Li, Ying and Zhang, Zhicheng and Yang, Xiao}, title = {[A pre- and post-treatment study of quality of life in patients with benign paroxysmal positional vertigo].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2011}, volume = {25}, issue = {16}, pages = {729--731}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo; Case-Control Studies; Female; Humans; Male; Middle Aged; Quality of Life; Surveys and Questionnaires; Treatment Outcome; Vertigo, therapy}, pmid = {22070078} }
Zou, S.Z., Li, J.R., Tian, S.Y., Ju, J. and Jia, M.Y.	[A randomized controlled trial on short-term efficacy of the modified Semont maneuver for the treatment of posterior canal benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2017	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 31(19), pp. 1468-1472	article	DOI
Abstract: To observe the short-term efficacy of modified Semont maneuver for posterior canal benign paroxysmal positional vertigo (PC-BPPV) This was a prospective randomized controlled trial on 130 PC-BPPV patients. Subjects were randomized divided into two groups: modified Semont (65 patients),and Epley(65 patients).Each maneuver was repeated twice,and the presence of sequelae,nystagmus and vertigo on positional testing were evaluated 3rd day and 1 week after treatment. Five patients were lost to follow up (all five in the modified Semont group),and three patients failed to complete treatment (all three in the Epley group). The sequelae at the 3rd day and one week after modified Semont maneuver were 27 and 9,while 41 and 15 in Epley group. The efficacy rates at the 3rd day and one week after modified Semont maneuver were 91.7% and 98.3%,and 91.9% and 96.8% in Epley group retrospectively. The sequelae and short-term effective rate of patients in modified Semont group was no difference when compared with that in Epley group ( >0.05). Modified Semont maneuver represents a simple rapid and effective approach to the treatment of posterior canal benign paroxysmal positional vertigo.
BibTeX: @article{Zou2017, author = {Zou, S Z and Li, J R and Tian, S Y and Ju, J and Jia, M Y}, title = {[A randomized controlled trial on short-term efficacy of the modified Semont maneuver for the treatment of posterior canal benign paroxysmal positional vertigo].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2017}, volume = {31}, issue = {19}, pages = {1468--1472}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2017.19.002}, keywords = {Benign Paroxysmal Positional Vertigo, therapy; Exercise Movement Techniques, methods; Humans; Nystagmus, Pathologic, complications, rehabilitation; Patient Positioning, methods; Physical Therapy Modalities; Prospective Studies; Treatment Outcome; Vertigo, therapy; posterior canal; repositioning maneuver; vertigo; vestibular disease}, pmid = {29798096} }
Skatvedt, O., Mjøen, S. and Sealy, A.	[A ten-year-old girl with dizziness]. [Abstract] [BibTeX]	2009	Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke Vol. 129(7), pp. 634-635	article	DOI
Abstract: Childhood dizziness may take many forms; most often it presents as acute short-lived spinning attacks associated with headaches and nausea and less frequently as long-lasting symptoms with unsteadiness. Migrainous vertigo and middle ear infections are considered to be the most common causes of childhood dizziness, while head injury and pathology of the central nervous system are less common causes. We present a case history of a 10-year-old girl with acute positional vertigo attacks. Investigations and treatment demonstrated that this patient had canalithiasis variant Benign Paroxysmal Positional Vertigo (BPPV) in the lateral canal of the inner ear. The conventional view among many vestibular specialists is that childhood BPPV does not exist. We have demonstrated the opposite, and propose that childhood BPPV is more widespread than previously thought. We believe that children often spontaneously reposition dislodged otoconia through normal childhood play activities (e. g. tumbling, running, jumping, rolling etc.) thus avoiding the need to present for treatment with Epley and/ or Barbecue manoeuvres.
BibTeX: @article{Skatvedt2009, author = {Skatvedt, Olav and Mjøen, Svein and Sealy, Alan}, title = {[A ten-year-old girl with dizziness].}, journal = {Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke}, year = {2009}, volume = {129}, issue = {7}, pages = {634--635}, doi = {https://doi.org/10.4045/tidsskr.09.33787}, keywords = {Child; Diagnosis, Differential; Dizziness, diagnosis, etiology, therapy; Female; Humans; Migraine Disorders, complications; Nystagmus, Physiologic; Vertigo, diagnosis, etiology, therapy; Vestibular Function Tests; Video Recording}, pmid = {19337333} }
Bont, A. and Früh, J.	[Acute vertigo]. [Abstract] [BibTeX]	1995	Therapeutische Umschau. Revue therapeutique Vol. 52(3), pp. 174-178	article
Abstract: Among all patients presenting with acute vertigo, majority will be suffering from benign paroxysmal positional vertigo, vestibular neuritis or Meniere's disease. One of the most important central vestibular disorder that imitates labyrinthine dysfunction is vertebrobasilar artery disease. To differentiate this condition from peripheral vestibular lesions, particular attention should be directed to the type of nystagmus which is present. Additionally, duration of vertigo and further neurological symptoms and signs are crucial for correct localization and etiology of the underlying disorder.
BibTeX: @article{Bont1995, author = {Bont, A and Früh, J}, title = {[Acute vertigo].}, journal = {Therapeutische Umschau. Revue therapeutique}, year = {1995}, volume = {52}, issue = {3}, pages = {174--178}, keywords = {Acute Disease; Aged; Diagnosis, Differential; Humans; Meniere Disease, complications, diagnosis; Middle Aged; Neurologic Examination; Nystagmus, Pathologic, diagnosis; Vertebrobasilar Insufficiency, complications, diagnosis; Vertigo, diagnosis, etiology}, pmid = {7725272} }
Zamergrad, M.V., Grachev, S.P. and Gergova, A.A.	[Acute vestibular disorder in the elderly: stroke or peripheral vestibulopathy]. [Abstract] [BibTeX]	2018	Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova Vol. 118(6. Vyp. 2), pp. 46-49	article	DOI
Abstract: Acute vestibular disorder is a frequent cause of urgent hospitalization in elderly patients. A CNS vascular disorder is often thought to be a cause of vertigo and a patient is diagnosed with stroke or transitory ischemic attack (TIA) or vertebral-basilar insufficiency. Despite the higher risk of cerebrovascular disease in the elderly, stroke and TIA are not the only cause of acute vestibular disorder. Hyperdiagnosis of cerebrovascular diseases in patients with acute vertigo often leads to underdiagnosis of peripheral vestibular disorders that could be successfully treated if timely diagnosed. The differential diagnosis of the lesions of central and peripheral vestibular systems is based on clinical examination of patients with acute vertigo including an analysis of cerebrovascular risk factors, characteristics of vertigo, nystagmus and careful identification of focal neurological symptoms.
BibTeX: @article{Zamergrad2018, author = {Zamergrad, M V and Grachev, S P and Gergova, A A}, title = {[Acute vestibular disorder in the elderly: stroke or peripheral vestibulopathy].}, journal = {Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova}, year = {2018}, volume = {118}, issue = {6. Vyp. 2}, pages = {46--49}, doi = {https://doi.org/10.17116/jnevro201811806246}, keywords = {Halmagyi test; benign paroxysmal positional vertigo; nystagmus; peripheral vestibulopathy; stroke; transitory ischemic attack; vertical torsional strabismus; vertigo; vestibular neuritis}, pmid = {30346433} }
Volgger, V. and Gürkov, R.	[Acute vestibular syndrome following cerebellar stroke : Case report and literature review. German version]. [Abstract] [BibTeX]	2017	HNO Vol. 65(11), pp. 933-936	article	DOI
Abstract: The current paper reports on a patient with recurrent rotational vertigo and persistent dizziness and imbalance lasting weeks, who underwent extensive neurootological and radiological examination. Pathological findings initially included right-sided benign paroxysmal positional vertigo (BPPV), persistent horizontal spontaneous nystagmus (SPN) to the left and a pathological bedside and video head impulse test (HIT) on the left. The pathological HIT on the left and SPN to the left indicated a central genesis. Therefore, cMRI was performed and revealed a left-sided cerebral infarction in the territory of the medial branch of the posterior inferior cerebellar artery (mPICA).
BibTeX: @article{Volgger2017a, author = {Volgger, V and Gürkov, R}, title = {[Acute vestibular syndrome following cerebellar stroke : Case report and literature review. German version].}, journal = {HNO}, year = {2017}, volume = {65}, issue = {11}, pages = {933--936}, doi = {https://doi.org/10.1007/s00106-016-0316-6}, keywords = {Benign paroxysmal positional vertigo; Cerebellar diseases; Cerebellar stroke; Magnetic resonance imaging; Pathologic nystagmus}, pmid = {28150010} }
Shi, T. and Geng, Y.	[Advances in diagnosis and treatment of horizontal semicircular canal benign paroxysmal positional vertigo]. [BibTeX]	2014	Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery Vol. 49(8), pp. 693-697	article
BibTeX: @article{Shi2014, author = {Shi, Tianming and Geng, Yu}, title = {[Advances in diagnosis and treatment of horizontal semicircular canal benign paroxysmal positional vertigo].}, journal = {Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery}, year = {2014}, volume = {49}, issue = {8}, pages = {693--697}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis, therapy; Humans; Semicircular Canals; Vertigo}, pmid = {25351131} }
	[Advances in peripheral vestibular diseases with downbeat nystagmus]. [Abstract] [BibTeX]	2018	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 32(13), pp. 1034-1037	article	DOI
Abstract: Downbeat nystagmus is not rare and usually considered as a central nervous system disease. However, there are a lot of diseases that present with downbeat nystagmus only or downbeat component in nystagmus, including peripheral and central vestibular diseases and Chiari malformations. This review will briefly summarize the vestibulo ocular reflexes and the mechanisms of the downbeat nystagmus with a peripheral origin, and then common vestibular disease such as the anterior semicircular canal benign paroxysmal positional vertigo,posterior semicircular canal benign paroxysmal positional vertigo, posterior semicircular canal light cupula, Meniere's disease and inferior vestibular neuritis are reviewed.
BibTeX: @article{2018,, title = {[Advances in peripheral vestibular diseases with downbeat nystagmus].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2018}, volume = {32}, issue = {13}, pages = {1034--1037}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2018.13.020}, keywords = {Benign Paroxysmal Positional Vertigo, complications; Humans; Nystagmus, Pathologic, etiology; Semicircular Canals; Vestibular Diseases, complications; Vestibular Neuronitis, complications; Meniere's disease; benign paroxysmal positional vertigo; nystagmus; vestibular disease}, pmid = {29986573} }
Bai, Q.	[Advances in the therapy of benign paroxysmal positional vertigo]. [BibTeX]	1997	Lin chuang er bi yan hou ke za zhi = Journal of clinical otorhinolaryngology Vol. 11(12), pp. 580-582	article
BibTeX: @article{Bai1997, author = {Bai, Q}, title = {[Advances in the therapy of benign paroxysmal positional vertigo].}, journal = {Lin chuang er bi yan hou ke za zhi = Journal of clinical otorhinolaryngology}, year = {1997}, volume = {11}, issue = {12}, pages = {580--582}, keywords = {Humans; Vertigo, therapy}, pmid = {10323028} }
Li, T., Liu, J.X., Bi, W., Xing, Y.Z. and Wu, F.	[Affected side location and clinical value of horizontal semicircular canal benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2017	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 31(8), pp. 612-615	article	DOI
Abstract: To explore the clinical value of rolling test（HRT）, bow and lean test（BLT） and subjective vertigo sensation(SVS) for affected side localization of patients with horizontal semicircular canal benign paroxysmal positional vertigo（HSC-BPPV）. One hundred and thirty-eight patients（94 HSC-Can and 44 HSC-Cup）with HSC-BPPV were enrolled. Patients were tested with HRT and then were asked about SVS, followed by BLT. According to the results of HRT, SVS and BLT, HSC-Can and HSC-Cup were repositioned by Barbecue method and modified Kim method respectively. The detection rate of the affected side of HRT, BLT, SVS and the curative effect were analyzed. In 94 HSC-Can patients and 44 HSC-Cup patients,BN and / or LN were induced by BLT to be 81.91% and 84.09% respectively. HRT induced bilateral asymmetric nystagmus 90.43%, 88.64%, SVS told vertigo symptoms worse side 60.64%,63.64%. There was no significant difference in the detection rate of HRT and BLT( >0.05)，but have significant difference with SVS( <0.05). Excluding four patients in whom the comparison among HRT,BLT,SVS were inconclusive，we compared the curative effect of first treatment in 92 HSC-Can patients and 42 HSC-Cup patients. The curative effect of HRT positive only were 66.67% and 60.00% respectively , BLT positive only were 71.43% and 66.67% respectively , HRT and BLT both positive with ipsilateral affected side were 70.37% and 65.50% respectively , HRT and BLT both positive with contralateral affected side were 37.50% and 30.00% respectively. The curative effect of HRT positive only and BLT positive only had no significant difference with that of HRT and BLT both positive with ipsilateral affected side , but they both had significant difference with that of HRT and BLT both positive with contralateral affected side . HRT is the most effective method for detecting affected side of HSC-BPPV, but BLT and SVS also have auxiliary diagnostic value as HSC-BPPV localization method.
BibTeX: @article{Li2017, author = {Li, T and Liu, J X and Bi, W and Xing, Y Z and Wu, F}, title = {[Affected side location and clinical value of horizontal semicircular canal benign paroxysmal positional vertigo].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2017}, volume = {31}, issue = {8}, pages = {612--615}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2017.08.010}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis, physiopathology; Dizziness; Humans; Nystagmus, Pathologic, physiopathology; Posture, physiology; Semicircular Canals, physiopathology; Sensation; canalithiasis; cupulolithiasis; semicircular canals; vertigo}, pmid = {29871326} }
Manrique Lipa, R.D., Soto Varela, A., Santos Pérez, S., Manrique Lipa, R.K., Lorenzo Lorenzo, A.I. and Labella Caballero, T.	[Alterations of balance in patients under 16 years of age distributed by age groups]. [Abstract] [BibTeX]	2008	Acta otorrinolaringologica espanola Vol. 59(9), pp. 455-462	article
Abstract: To evaluate the prevalence and clinical characteristics of children with altered balance, as well as to establish the level of importance of the audiological, balance and imaging studies in the diagnosis of infantile vestibular pathology. We report a descriptive, retrospective and non-randomized study performed at the Otorhinolaryngology Department of the Complejo Hospitalario Universitario de Santiago de Compostela (Santiago de Compostela University Hospital, Santiago de Compostela, Spain). The study included 125 patients under 16 years of age who consulted due to alterations in their balance over a period of twelve years (1996 to 2007); they are distributed into three groups based on age: 0 to 5, 6 to 10, and 11 to 15 years. Childhood benign paroxysmal vertigo (64 %) is the most frequent syndrome in our series, with 32.5 % of patients associating common migraine. Together with diagnoses of infantile positional vertigo and psychogenic vertigo, was more frequently found in the 11 to 15 year-old age group (P< .05). Age, gender and the results of the imaging studies (computerized tomography of the brain and magnetic resonance of the head) were not related to the presentation of associated migraine nor to the diagnosis (P>.05). Clinical history and the neuro-otological examination are the key elements of the diagnosis of infantile vestibular pathology; it is also important to standardize and group patients by age. Imaging studies only contribute high diagnostic performance in children presenting neurological symptoms, persistent headache or who have sustained head trauma.
BibTeX: @article{ManriqueLipa2008, author = {Manrique Lipa, Rubén Duilio and Soto Varela, Andrés and Santos Pérez, Sofía and Manrique Lipa, Roslyn Kathryn and Lorenzo Lorenzo, Ana Isabel and Labella Caballero, Torcuato}, title = {[Alterations of balance in patients under 16 years of age distributed by age groups].}, journal = {Acta otorrinolaringologica espanola}, year = {2008}, volume = {59}, issue = {9}, pages = {455--462}, keywords = {Adolescent; Age Distribution; Child; Child, Preschool; Cross-Sectional Studies; Female; Humans; Male; Migraine Disorders, epidemiology; Retrospective Studies; Vertigo, diagnosis, epidemiology, physiopathology; Vestibule, Labyrinth, physiopathology}, pmid = {19080777} }
Qiu, F. and Qi, X.-K.	[An etiological analysis of 367 neurological outpatients with complaint of vertigo]. [Abstract] [BibTeX]	2012	Zhonghua nei ke za zhi Vol. 51(5), pp. 350-352	article
Abstract: To explore the etiology of patients with chief complaint of vertigo in the department of neurology in order to reduce the rate of misdiagnosis. A total of 367 patients with chief complaint of vertigo in our department of neurology were followed up. The associated medical history, symptoms and physical examination were obtained. The main diagnoses for the 367 patients were benign paroxysmal positional vertigo (BPPV) (219, 59.7%), posterior circulation ischemia (PCI) (65, 17.7%), migraine (31, 8.4%), hypertension (18, 4.9%) and psychogenic vertigo (17, 4.6%). Presentation of vertigo can be clinically diagnosed in most diseases, with the most common cause of BPPV. Combination of the prominent clinical features, physical examinations and especially Dix-Hallpike maneuver may guide the general physicians to a most proper cause of vertigo.
BibTeX: @article{Qiu2012, author = {Qiu, Feng and Qi, Xiao-Kun}, title = {[An etiological analysis of 367 neurological outpatients with complaint of vertigo].}, journal = {Zhonghua nei ke za zhi}, year = {2012}, volume = {51}, issue = {5}, pages = {350--352}, keywords = {Adult; Female; Humans; Hypertension, complications, diagnosis; Ischemic Attack, Transient, complications, diagnosis; Male; Middle Aged; Migraine Disorders, complications, diagnosis; Outpatients; Vertigo, diagnosis, etiology}, pmid = {22883331} }
Mei, X.F., Ji, S.F., Lü, X.B. and Kuang, L.	[An introduction of different positioning tests of benign paroxysmal positional vertigo and their clinical values]. [Abstract] [BibTeX]	2010	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 24(19), pp. 872-5, 879	article
Abstract: To explore the clinical value of different positioning tests for different benign paroxysmal positional vertigo (BPPV). This research applies Dix-Hallpike test and Side-lying test for PC-BPPV, Roll test and WRW test for HC-BPPV, Dix-Hallpike test, Side-lying test and Rahko T maneuvers for SC-BPPV. Six hundred and thirteen cases, who were tested with different positioning tests in the sequence of firstly PC-BPPV then HC-BPPV and finally SC-BPPV, were randomly divided into 2 groups. The order of positioning tests for PC-BPPV and HC-BPPV in the two groups was reversed. There's no significant difference between the detection rate of Dix-Hallpike test and Side-lying test for PC-BPPV (P > 0.05). Similarly, there's no difference in statistics between the detection rate of Roll test and WRW test for HC-BPPV (P > 0.05). However, the detection rate of Rahko T maneuver was higher than the other two tests for SC-BPPV and the differences were statistically significant (P < 0.05). The detection rates of different positioning tests for PC-BPPV and HC-BPPV between the two groups were not different in statistics (P > 0.05), which implies that the different order had no effect on the sensitivity of each positioning test. Dix-Hallpike test is recommended as the first choice for PC-BPPV for its more efficient stimulus to the posterior semicircular canal, and Side-lying test is recommended as a prior choice to the patients with suspected PC-BPPV but unable to receive Dix-Hallpike test because of its similar sensitivity and more convenient manipulation. The detection rate of Both Roll test and WRW test were higher than 90% and there's no significant difference between the two tests. In addition, Roll test is easier to perform and helpful for the therapy, so its considered as the preferred test for HC-BPPV with WRW test as the supplement test. Nevertheless, for SC-BPPV the sensitivity of Rahko T maneuver was higher than that of the other two tests, so it can be used to confirm the suspected SC-BPPV patients detected or missed diagnosed by the two other tests. To avoid misdiagnosis or missed diagnosis, the judgment of affected semicircular canal is determined not only by positioning test but also by the feature of nystagmus.
BibTeX: @article{Mei2010, author = {Mei, Xiao Feng and Ji, Shu Fang and Lü, Xue Bing and Kuang, Liwen}, title = {[An introduction of different positioning tests of benign paroxysmal positional vertigo and their clinical values].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2010}, volume = {24}, issue = {19}, pages = {872--5, 879}, keywords = {Adolescent; Adult; Aged; Benign Paroxysmal Positional Vertigo; Female; Humans; Male; Middle Aged; Patient Positioning; Retrospective Studies; Vertigo, diagnosis; Young Adult}, pmid = {21174746} }
Hansen, S., Ninn-Pedersen, M. and Cayé-Thomasen, P.	[An oto-neurological approach to the acutely dizzy patient]. [Abstract] [BibTeX]	2011	Ugeskrift for laeger Vol. 173(40), pp. 2497-2503	article
Abstract: Benign paroxysmal positional vertigo, vestibular neuronitis and Menière's disease cause most cases of acute vertigo. However, doctors must consider central neurological reasons to vertigo. If it is determined that a patient has oto-neurological vertigo, the next task is to determine whether the patient has a peripheral or a central cause of vertigo, if the condition is potentially lethal and if there is a need for acute radiological imaging and/or medical intervention. This review highlights the oto-neurological approach to the dizzy patient with particular focus on the patient's history, clinical tests and treatment.
BibTeX: @article{Hansen2011, author = {Hansen, Søren and Ninn-Pedersen, Mirjana and Cayé-Thomasen, Per}, title = {[An oto-neurological approach to the acutely dizzy patient].}, journal = {Ugeskrift for laeger}, year = {2011}, volume = {173}, issue = {40}, pages = {2497--2503}, keywords = {Acute Disease; Diagnosis, Differential; Diagnostic Techniques, Otological; Dizziness, diagnosis, etiology, therapy; Humans; Meniere Disease, diagnosis; Migraine Disorders, complications, physiopathology; Vertigo, diagnosis, etiology, therapy; Vestibular Function Tests; Vestibular Neuronitis, diagnosis}, pmid = {21975186} }
Xue, H.L., Li, C.X., Duan, L.X. and Jing, Y.L.	[Analysis of 118 cases of benign paroxysmal positional vertigo after trauma]. [Abstract] [BibTeX]	2017	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 31(10), pp. 774-775	article	DOI
Abstract: The aim of this study is to retrospective analysis the clinic features of 118 cases of benign paroxysmal positional vertigo after trauma. Analyzes clinic features of injury in 118 cases of benign paroxysmal positional vertigo after trauma, and classified and localized the craniocerebral trauma. The 118 cases were tested with different positioning tests in the sequence of Dix hallpike test and rolling test. Then, proper otolith manual reduction was given. In 118 cases of BPPV after trauma including 35 cases of skull fracture, 6 cases of concussion, 17 cases of scalp hematoma, 28 cases of scalp laceration, 14 cases of mild brain contusion and 18 cases of head combined injury. The distributions of head injury were 57 at front temporal, 24 at top, 22 at occipital and 15 at maxillofacial region. The latency of BPPV after head injury varies from 1day to 1month. The incidence of 3-7 day after head injury was the highest, followed by 7-14 days, 0-3 days, and the lowest incidence rate of 14 day to 1 month. Canal type 118 BPPV patients after head injury accounting for up to 57.6% of the horizontal semicircular canal accounted for 33.1%, mixed 9.3%. The patients with front temporal trauma and skull fracture were prone to have BPPV. The peak incidence of BPPV was 3-14 days after head injury. The most common type of BPPV was PC BPPV, and the HC BPPV was the second type. A good curative effect can be manipulative reduction after trauma BPPV..
BibTeX: @article{Xue2017, author = {Xue, H L and Li, C X and Duan, L X and Jing, Y L}, title = {[Analysis of 118 cases of benign paroxysmal positional vertigo after trauma].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2017}, volume = {31}, issue = {10}, pages = {774--775}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2017.10.009}, keywords = {Benign Paroxysmal Positional Vertigo, etiology, physiopathology; Humans; Otolithic Membrane, injuries; Retrospective Studies; Scalp; Semicircular Canals, injuries; Wounds and Injuries, complications; benign paroxysmal positional vertigo; otolith manual reduction; trauma}, pmid = {29771041} }
Zhai, X.Y., Liu, B., Zhang, Y.H., Zhang, Y., Xu, Y., Guo, L.M., Sun, T.T., Han, H.J. and Wang, Y.F.	[Analysis of BPPV in patients with bone mineral density results]. [Abstract] [BibTeX]	2016	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 30(23), pp. 1865-1869;1872	article	DOI
Abstract: Analyze BPPV in patients with ultrasonic bone mineral density to investigate the relationship between the BPPV and bone density. A total of 88 included subjects were selected from patients admitted to the Otolaryngological Department of Renhe Hospital, Beijing. Meanwhile, 76 healthy persons were included as control. The control group had similar age and gender distributions to the test group, and all healthy subjects had no history of vertigo in recent one year. Both groups underwent regular otolaryngological examinations, videonystagmography（VNG）,ultrasound bone densitometer test. According to gender, age, listening to group. ①Bone density of the test group was significantly lower than the control group（-2.010±1.658 vs 0.3605±0.875）,the difference was statistically significant（ <0.01）；②Incidence rates of bone mass loss（35 in 88,39.77%）and osteoporosis（26 in 88, 29.55%）bone mineral density decreased incidence of 69.32%, in the test group was significantly higher than that in the control group（bone mass loss, 13 in 76, 17.10%; osteoporosis 6 in 76,7.89%）, bone mineral density decreased incidence of 25.00%,the difference was statistically significant（ <0.01）；③The test group and control group according to different age groups, the test group all ages bone density T values significantly lower than the control group（ <0.01）,the difference was statistically significant. In the age groups, the incidence of bone loss was higher in the test group than that in the control group, the difference was statistically significant( <0.01).④In the gender group, bone density of the test group women were significantly lower than the control group, the difference was statistically significant（ <0.05）； especially after the age of 60.⑤In the test group, 27 cases of bone mineral density is normal, with normal hearing 19 cases (70.37%), hearing loss 8 cases(29.63%);61 cases of bone loss, including normal hearing 48 cases (78.69%),hearing loss 13 cases (21.31%). The difference between hearing loss and bone loss had no statistical significance( >0.05).⑥The logistic regression results showed that the prompt Higher bone mineral density T value was BPPV protection factors, =0.686,( <0.01,95% : 1.32-5.85). BPPV in patients with bone mineral density value is lower than the normal control group, there is a higher incidence of bone loss, at the same time, along with the age increasing on the rise, especially women.
BibTeX: @article{Zhai2016, author = {Zhai, X Y and Liu, B and Zhang, Y H and Zhang, Y and Xu, Y and Guo, L M and Sun, T T and Han, H J and Wang, Y F}, title = {[Analysis of BPPV in patients with bone mineral density results].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2016}, volume = {30}, issue = {23}, pages = {1865--1869;1872}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2016.23.007}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo; Bone Density; Female; Humans; Incidence; Male; Middle Aged; Osteoporosis; bone mass density; bone mass loss; osteoporosis; otolith; vertigo}, pmid = {29798014} }
Wu, Z.-m., Zhang, S.-z., Liu, X.-j., Lan, L., Yang, W.-y. and Han, D.-y.	[Analysis of clinical features of concomitant vertigo in idiopathic sudden deafness]. [Abstract] [BibTeX]	2010	Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery Vol. 45(11), pp. 916-918	article
Abstract: To analyze the clinical characteristics of concomitant vertigo in patients with sudden deafness (SD). Ninety-six cases of SD were reviewed retrospectively from January 2005 to July 2009. SD and benign paroxysmal positional vertigo (BPPV) were diagnosed according to the guides of China Medical Association. The characteristics of vestibular function and the order of the onset of cochlear and vestibular symptoms were analyzed. Of all 96 cases, 23 (24.0%) cases presented with BPPV; 58 (60.4%) cases took the form of unilateral vestibular hypofunction and 15 (15.6%) cases had normal vestibular function. Time interval between cochlear and vestibular symptoms was as follows: 46 patients could tell the exact time of onset of cochlear and vestibular symptoms, of which 6 (13.0%) cases occurred simultaneously; 4 (8.7%) cases presented vertigo within 1 hour after onset of cochlear symptom hypofunction; 21 (45.7%) cases showed time interval between 1 hour and 24 hours; and 13 (28.3%) cases presented vertigo at several days (less than 10 days) after cochlear symptoms. And only in 2 (4.3%) cases did vertigo occur before cochlear symptoms. Concomitant vertigo in idiopathic SD took the forms of normal or abnormal vestibular function, some of which were BPPV. Occurrence of vertigo was after cochlear symptoms.
BibTeX: @article{Wu2010, author = {Wu, Zi-ming and Zhang, Su-zhen and Liu, Xing-jian and Lan, Lan and Yang, Wei-yan and Han, Dong-yi}, title = {[Analysis of clinical features of concomitant vertigo in idiopathic sudden deafness].}, journal = {Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery}, year = {2010}, volume = {45}, issue = {11}, pages = {916--918}, keywords = {Adolescent; Adult; Aged; Female; Hearing Loss, Sudden, complications, diagnosis; Humans; Male; Middle Aged; Prognosis; Retrospective Studies; Vertigo, complications, diagnosis; Young Adult}, pmid = {21215206} }
Xia, F., Wang, Y. and Wang, N.	[Analysis of clinical features with benign paroxysmal positional vertigo in elderly patients and precautions for canalith repositioning procedure treatment]. [Abstract] [BibTeX]	2015	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 29(1), pp. 12-16	article
Abstract: To analyze clinical features with benign paroxysmal positional vertigo (BPPV) and discuss the attentions in the canalith repositioning procedures. A total of 76 male and female patients aged 80 and over with BPPV (elderly group) and 76 patients aged 60-65 years old with BPPV (older group) was retrospectively analyzed. (1)Semicircular canal condition: in elderly group, posterior semicircular canal was involved in 72 cases, whereas the horizontal semicircular 4 cases. In older group, posterior semicircular canal was involved in 70 cases, whereas the horizontal semicircular and multiple canals in 5 cases and 1 case respectively. (2) Precipitating factors: precipitating factors of elderly were variety. Its closely related with emotion, infection, seasonal alternation surgery, and trauma. There were significant differences between the two groups (P<0. 05). (3) The symptoms of undergoing treatment and post-treatment: the duration of dizziness and carebaria were significant difference after canalith repositioning procedure treatment between two groups (P<0. 05), the duration of balance disturbance and symptoms of vegetative nerve functional disturbance like nausea and sweating were significant difference (P<0. 05). (4) Treatment and outcomes: the remission, partial remission rate were 34. 2 %, 81. 6% re- spectively, after the first or second time of repositioning treatment. The efficacy of repositioning treating at the first time was significantly different between two groups (P<0. 05). It was poor efficacy in elderly group. There is no difference in efficacy for repositioning treatment at the second or third time (P>0. 05). (5) The elderly always accompanied with other medical condition and had risk factors of cerebrovascular disease. The efficacy was not associated with the complication(P>0.05). However, it was most likely to overtreatment caused by emphasizing other medical conditions treatment. BPPV was easy to ignore and misdiagnose, meanwhile, delayed the diagnosis and increased the medical costs. (6) Many elderly were accompanied cervical spondylosis, lumbar spondylosis body stiffness and fear of vertigo which increased the difficulty of repositioning treatment. (7) Recurrence: we followed up 2 years after treatment. In older group, 11 patients (14. 5%)were relapsed. In elderly group, 29 patients (38. 2%) relapsed. There were significant differences between the two groups (P<0. 05). There are various precipitating factors in elderly patients with BPPV, the most frequent precipitating factors were related to psychological factor and overfatigue. The symptoms of the patients attack BPPV was always mask with other diseases, but do not impact on the efficacy of Canalith repositioning at the first time; Even the efficacy of repositioning is poor at the first time, it's effective and safety after multiple treatments of repositioning; It prolonged the symptoms including carenaria, dizziness and nausea after treatment.
BibTeX: @article{Xia2015, author = {Xia, Fei and Wang, Yanjun and Wang, Ningyu}, title = {[Analysis of clinical features with benign paroxysmal positional vertigo in elderly patients and precautions for canalith repositioning procedure treatment].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2015}, volume = {29}, issue = {1}, pages = {12--16}, keywords = {Aged; Benign Paroxysmal Positional Vertigo, complications, diagnosis, psychology, therapy; Dizziness; Emotions; Female; Humans; Male; Masks; Patient Positioning, adverse effects, methods; Recurrence; Retrospective Studies; Semicircular Canals; Spondylosis; Vertigo}, pmid = {25966546} }
Jin, Z., Zhuang, J.-h., Zhao, Z.-x., Chen, Y. and Li, Y.-c.	[Analysis of misdiagnosed cases with benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2012	Zhonghua yi xue za zhi Vol. 92(19), pp. 1346-1348	article
Abstract: To analyze the misdiagnosed cases with benign paroxysmal positional vertigo (BPPV). During October 2010 to January 2011, a total of 287 patients with dizziness visited the Dizziness Clinic at Changzheng Hospital, Second Military Medical University. Forty-eight misdiagnosed cases with BPPV were collected and their clinical data were analyzed. All 48 cases were diagnosed by the Dix-Hallpike or Roll test maneuver. (1) CLINICAL FEATURES: there were 38 females and 10 males with an average age of 54 ± 12 years old (range: 31 - 87). Posterior semicircular canal was involved in 75.0% (36/48) whereas the horizontal semicircular and multiple canals in 20.8% (10/48) and 4.2% (2/48) respectively. All patients were treated successfully. And 41 cases (85.4%) were cured on the first visiting day. Recurrences of BPPV occurred in 6 cases during the follow-up. (2) The initial visiting departments consisted of the department of general internal medicine 43.8% (21/48), department of neurology 27.1% (13/48), department of osteology 18.7% (9/48), ear, nose & throat (ENT) department 2.1% (1/48) and other departments 8.3% (4/48). In addition, 68.7% (33/48) of them frequented the general out-patient clinics during their initial visits and the other 31.3% (15/48) used the emergency services. (3) The initial diagnoses included vertebrobasilar insufficiency/cerebral circulation insufficiency 27.1% (13/48), cervical spondylosis 27.1% (13/48), cerebral infarction 4.2% (2/48), Meniere's disease 2.1% (1/48) and others 10.4% (5/48); Besides, 29.1% (14/48) of them had no diagnosis. (4) The average clinic visits per patient were 3.4 times (164 visits/48 cases). (5) The most commonly performed tests included brain computed tomography (CT) (28 person-times), cervical magnetic resonance imaging (MRI) (19 person-times), brain MRI (18 person-times), cervical radiography (18 person-times) and cervical CT (8 person-times). In these misdiagnosed cases of BPPV, most of them were middle-aged women. They were most likely to have their first consultations in the departments of general internal medicine and neurology. Therefore these two departments should pay more attention to applying the maneuver of Dix-Hallpike or Roll test so as to reduce the misdiagnosis of BPPV and the waste of healthcare resources.
BibTeX: @article{Jin2012, author = {Jin, Zhe and Zhuang, Jian-hua and Zhao, Zhong-xin and Chen, Ying and Li, Yan-cheng}, title = {[Analysis of misdiagnosed cases with benign paroxysmal positional vertigo].}, journal = {Zhonghua yi xue za zhi}, year = {2012}, volume = {92}, issue = {19}, pages = {1346--1348}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Diagnostic Errors; Dizziness, diagnosis; Female; Humans; Male; Middle Aged; Vertigo, diagnosis}, pmid = {22883126} }
Lin, Y.J., Wu, X.Q., Shan, H.J., Ma, X., Yu, L.S. and Lai, R.C.	[Analysis of nystagmus and medical history of 121 patients positive with positional test]. [Abstract] [BibTeX]	2018	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 32(19), pp. 1491-1494	article	DOI
Abstract: To observe the characteristics of positional nystagmus and clinical profile of patients with positive positional test, and to explore its possible pathogenesis. One hundred and twenty-one patients with positive positional test in the vestibular function examination were enrolled in the Peking University International Hospital from January to June in 2017. According to the 2017 BPPV guidelines, patients with test positive positional nystagmus were divided into two groups: definite BPPV and the controversial syndrome. Analyses of gender, age and characteristics of nystagmus, with or without recurrent dizziness, headache, and motion sickness were undertaken between the two groups, as well as response to the repositioning maneuver. Of the total 121 cases, 49 cases were diagnosed as definite BPPV, accounting for 40.5%, 72 cases as controversial syndrome, accounting for 59.5%. The proportion of women in the two group was 76.2% and 78.9%, respectively. The average age of definite BPPV and the controversial syndrome was 51.2±16.8 and 51.3±15.7, respectively.There were significant differences in nystagmus duration, spontaneous nystagmus and nystagmus after headshaking between the two groups by chi square test( <0.01). The mean intensity of horizontal and vertical nystagmus in posterior semicircular canal BPPV was(10.2±7.4) °/s and(36.6±17.5) °/respectively. And the mean intensity of nystagmus in the strong and weak side in horizontal semicircular canal BPPV was(40.8±25.1) °/s and(20.7±11.1) °/respectively. The intensity of horizontal and vertical nystagmus of the controversial syndrome group was(7.2±7.7) °/s and(7.2±4.3) °/s respectively. The incidence of headache in the controversial syndrome group was significantly higher than that in the BPPV group, =0.013. According to the guidelines, patients were evaluated one day after the initial treatment. The cure rate and effective rate of the definite BPPV group was 75%(36/48) and 87.5%(42/48),and was 0 and 30.4% in the controversial syndrome group respectively. The patients in controversial syndrome group have a preponderance of exhibiting positive nystagmus during positional test. Nystagmus were usually of low velocity and sustained. Most of these cases presented spontaneous nystagmus and headshaking induced nystagmus, as well as headache and lacunar infarctions in history, and the response to the repositioning maneuver were often poor. It may be related to vestibular migraine and central nervous system. The diagnosis of BPPV must be prudent.Both characteristics of nystagmus and medical history should be carefully analyzed to avoid overdiagnosis.
BibTeX: @article{Lin2018, author = {Lin, Y J and Wu, X Q and Shan, H J and Ma, X and Yu, L S and Lai, R C}, title = {[Analysis of nystagmus and medical history of 121 patients positive with positional test].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2018}, volume = {32}, issue = {19}, pages = {1491--1494}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2018.19.012}, keywords = {benign paroxysmal positional vertigo; electronystagmography; migraine disorders}, pmid = {30550195} }
Jia, J., Sun, X., Dai, S. and Sang, Y.	[Analysis of relation between the development of study and literatures about benign positional paroxysmal vertigo published international and domestic]. [Abstract] [BibTeX]	2016	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 30(1), pp. 21-26	article
Abstract: Benign paroxysmal positional vertigo (BPPV) is a common vestibular disorder that causes vertigo. Study of BPPV has dramatically rapid progress in recent years. We analyze the BPPV growth We searched the international data quantity year by year in database of PubMed, ScienceDirect and WILEY before 2014 respectively, then we searched the domestic data quantity year by year in database of CNKI, VIP and Wanfang Data before 2015 by selecting "Benign paroxysmal positional vertigo" as the keywords. Then we carried out regression analysis with the gathered results in above databases to determine data growth regularity and main factors that affect future development of BPPV. Also, we analyzes published BPPV papers in domestic and international journals. PubMed database contains 808 literatures, ScienceDirect contains 177 database and WILEY contains 46 literatures, All together we collected 1 038 international articles. CNKI contains 440 literatures, VIP contains 580 literatures and WanFang data contains 449 literatures. All together we collected 1 469 domestic literatures. It shows the rising trend of the literature accumulation amount of BPPV. The scattered point diagram of BPPV shows an exponential growing trend, which was growing slowly in the early time but rapidly in recent years. It shows that the development of BPPV has three stages from international arical: exploration period (before 1985), breakthrough period (1986-1998). The deepening stage (after 1998), Chinese literature also has three stages from domestic BPPV precess. Blank period (before the year of 1982), the enlightenment period (1982-2004), the deepening stage (after the year of 2004). In the pregress of BPPV, many outsantding sccholars played an important role in domestic scitifction of researching, which has produced a certain influence in the worldwide.
BibTeX: @article{Jia2016, author = {Jia, Jianping and Sun, Xiaohui and Dai, Song and Sang, Yuehong}, title = {[Analysis of relation between the development of study and literatures about benign positional paroxysmal vertigo published international and domestic].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2016}, volume = {30}, issue = {1}, pages = {21--26}, keywords = {Benign Paroxysmal Positional Vertigo; Bibliometrics; Databases, Factual; Humans}, pmid = {27197449} }
Gong, Q.P., Zhang, Y., Li, Y.J., Xu, X.R. and Luo, J.Y.	[Analysis of repositioning nystagmus in patients with posterior canal benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2018	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 32(4), pp. 260-263	article	DOI
Abstract: To conclude the four types of nystagmus in the final position during canalith repositioning procedure (CRP) for posterior canal benign paroxysmal positional vertigo (PC-BPPV), and predict the outcome of CRP therapy. Nystagmus were recorded by an infrared charge-coupled devicecamera when underwent CRP therapy, which observed in the final position and concluded into four types. Two hundred and twenty-three patients were included in our research and the results as follow. ①The nystagmus replicates the initial nystagmus during the Hallpike maneuver, which suggests therapeutic outcome,128 cases in total (57.4%). ②The direction of vertical component is composite while the rotary component is the same, also deeming a successful trial, 35 cases (15.7%). ③The direction of both vertical component and rotary component isreverse to the initial, which indicates a poor response, 36 cases (16.1%). ④Twenty-four cases (10.8%) showed no certain nystagmus but exhibit horizontal nystagmus in roll-test, denoting that the otolith moves to the lateral semicircular. At this appointment, the horizontal nystagmus can resolute after several times of barbecue maneuver. There is a significant difference of the one-time success rate ( ²=46.198, <0.01) and the mean treatment times ( =10.048, <0.01) between cupulolithiasis and canalolithiasis PC-BPPV. Different nystagmus in the final position of CRP maneuver is important in predicting the repositioning outcome. The one-time success rate of canalolithiasis is better than cupulolithiasis.
BibTeX: @article{Gong2018, author = {Gong, Q P and Zhang, Y and Li, Y J and Xu, X R and Luo, J Y}, title = {[Analysis of repositioning nystagmus in patients with posterior canal benign paroxysmal positional vertigo].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2018}, volume = {32}, issue = {4}, pages = {260--263}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2018.04.005}, keywords = {Benign Paroxysmal Positional Vertigo, complications, therapy; Humans; Nystagmus, Pathologic, etiology; Otolithic Membrane; Patient Positioning; Posture; Semicircular Canals, physiopathology; nystagmus; posterior canal; prognosis; vertigo}, pmid = {29798501} }
Chen, T.-s., Li, S.-s., Dong, H., Lin, P., Wen, C., Cheng, Y., Zhao, H. and Ma, Y.-x.	[Analysis of the dysfunction frequency and characteristics of semicircular canal in benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2012	Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery Vol. 47(10), pp. 793-798	article
Abstract: To assess the characteristics of the dysfunction of semicircular canal in benign paroxysmal positional vertigo and the relationship with the ectopic otoconia. There were 214 patients with benign paroxysmal positional vertigo (BPPV), including 107 cases of posterior semicircular canal canalithiasis (PSC-Can) 80 cases of horizontal semicircular canal canalithiasis (HSC-Can), 27 cases of horizontal semicircular canal cupulolithiasis (HSC-Cup). One hundred and ninety (88.8%) patients were accompany with relevant diseases while 24 (11.2%) cases were not. They accepted low, middle and high frequency vestibular function tests, including caloric test (CT), head shaking test (HST) and video head impulse test (vHIT) respectively. The parameters of the unilateral weakness (UW), head shaking nystagmus (HSN) and video head impulse test gain (vHIT-G) were observed. Patients classified into three groups (PSC-Can, HSC-Can, HSC-Cup) according to the involvement semicircular canal. The results of the three tests were analyzed with SPSS16.0 software. The positive cases of the three tests were vHIT: 15 (7.0%), HST: 52 (24.3%), CT: 152 (71.0%), a statistically significant difference (P < 0.05) was found between the three tests. When compared the Caloric Test, HST and vHIT between the BPPV patients with and without relevant diseases, there were no significant differences (P > 0.05). The variance without statistical significance (P > 0.05) was showed between three tests' results in each groups, it was also showed that the variance between the three groups in each tests reached no statistical significance (P > 0.05). The test of affected side UW between PSC-Can, HSC-Can and HSC-Cup showed the variance without statistical significance (F = 0.970, P = 0.383). The lesion of semicircular canals has the same etiological factors with the utricle pathological change in benign paroxysmal positional vertigo, and the dysfunction mostly happens in low frequency range of semicircular canal frequency band. The ectopic otoconia is not the main etiological factors for that. HST and vHIT of middle and high frequency can not be ultimately used for the screening test evaluating due to the semicircular canal function in BPPV.
BibTeX: @article{Chen2012a, author = {Chen, Tai-sheng and Li, Shan-shan and Dong, Hong and Lin, Peng and Wen, Chao and Cheng, Yan and Zhao, Hui and Ma, Yuan-xu}, title = {[Analysis of the dysfunction frequency and characteristics of semicircular canal in benign paroxysmal positional vertigo].}, journal = {Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery}, year = {2012}, volume = {47}, issue = {10}, pages = {793--798}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Female; Humans; Male; Middle Aged; Otolithic Membrane, physiopathology; Semicircular Canals, physiopathology; Semicircular Ducts, physiopathology; Vertigo, physiopathology; Vestibular Function Tests; Young Adult}, pmid = {23302157} }
Alzuphar, S.J. and Maire, R.	[Anterior semicircular canal Benign Paroxysmal Positional Vertigo]. [Abstract] [BibTeX]	2016	Revue medicale suisse Vol. 12(533), pp. 1665-1669	article
Abstract: Anterior semicircular canal Benign Paroxysmal Positional Vertigo (antBPPV) is the rarest form of semicircular canalolithiasis, corresponding to about 1-2 % of the BPPV. The diagnosis is obtained by either the Dix-Hallpike maneuver or the straight head hanging positioning maneuver, which provoke a characteristic positional down-beating nystagmus. This vertical nystagmus can be associated with a torsional component that helps in localizing the affected side. The differential diagnosis of antBPPV includes the various central lesions that produce vertical down beating nystagmus (posterior fossa). Several liberatory maneuvers have been proposed for the treatment of antBPPV, but still need standardization.
BibTeX: @article{Alzuphar2016, author = {Alzuphar, Stephen Jacques and Maire, Raphaël}, title = {[Anterior semicircular canal Benign Paroxysmal Positional Vertigo].}, journal = {Revue medicale suisse}, year = {2016}, volume = {12}, issue = {533}, pages = {1665--1669}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis, physiopathology, therapy; Diagnosis, Differential; Humans; Nystagmus, Pathologic, etiology; Physical Examination, methods; Semicircular Canals, physiopathology; Vestibular Function Tests, methods}, pmid = {28686379} }
Jung, H.J., Koo, J.-W., Kim, C.S., Kim, J.S. and Song, J.-J.	[Anxiolytics reduce residual dizziness after successful canalith repositioning maneuvers in benign paroxysmal positional vertigo]. [BibTeX]	2013	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 27(5), pp. 259-263	article
BibTeX: @article{Jung2013, author = {Jung, Hahn Jin and Koo, Ja-Won and Kim, Chong Sun and Kim, Ji Soo and Song, Jae-Jin}, title = {[Anxiolytics reduce residual dizziness after successful canalith repositioning maneuvers in benign paroxysmal positional vertigo].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2013}, volume = {27}, issue = {5}, pages = {259--263}, keywords = {Adult; Aged; Anti-Anxiety Agents, therapeutic use; Benign Paroxysmal Positional Vertigo; Dizziness, drug therapy, etiology; Female; Humans; Male; Middle Aged; Otolithic Membrane; Semicircular Canals; Vertigo, therapy}, pmid = {23729113} }
Wang, L.Y., Peng, H., Huang, W.N. and Gao, B.	[Application of the dizziness handicap inventory in the patients with benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2016	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 30(8), pp. 595-597	article	DOI
Abstract: This study was designed to observe the dizziness handicap inventory (DHI) scores in patients with BPPV (benign paroxysmal positional vertigo) before and after maneuver repositioning and aimed to discuss the values of DHI scores in the diagnosing and treatment of BPPV. Charts of 72 patients with BPPV diagnosed by positioning test were reviewed. Four DHI scores were used including the total score (DHIT), the functional score (DHIF), the emotional score (DHIE), and the physical score (DHIP). We compared the pre-repositioning DHI scores and post-repositioning scores of patients, and also compared the DHI scores of patients with and without residual dizziness. All of the 72 patients were underwent maneuver repositioning and recorded the DHI scores. The mean post-repositioning scores were dramatically decreased compared with pre-repositioning scores, and the difference was significant ( <0.01). The differences of the DHIP scores between the residual dizziness group and the non-residual dizziness group was not significant, while the DHIF scores, the DHIE scores and the DHIT scores between the two groups were statistically different. After maneuver repositioning the dizziness handicap of BPPV patients could be significantly improved. The next treatment program for residual dizziness patients after successful repositioning could be aimed at the functional and emotional dizziness.
BibTeX: @article{Wang2016b, author = {Wang, L Y and Peng, H and Huang, W N and Gao, B}, title = {[Application of the dizziness handicap inventory in the patients with benign paroxysmal positional vertigo].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2016}, volume = {30}, issue = {8}, pages = {595--597}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2016.08.002}, keywords = {Benign Paroxysmal Positional Vertigo, complications, etiology, therapy; Disabled Persons; Dizziness, classification, etiology; Humans; Patient Positioning; Severity of Illness Index; dizziness; dizziness handicap inventory; vertigo}, pmid = {29871084} }
Gao, B., Song, H., Zhou, J. and Huang, W.	[Application of vestibular autorotation test in diagnosis of benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2010	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 24(19), pp. 865-869	article
Abstract: The objective of this study was to evaluate the utility of vestibular autorotation test in the diagnosis of BPPV. VAT and caloric test were performed on 41 patients with BPPV. VAT results were analyzed according to the affected semicircular canal. Results of VAT were abnormal in 34 (82.93%) patients with BPPV. Fourteen cases were found with abnormal vertical phase, 1 case with abnormal vertical gain in a total of 21 vertical semicircular canal BPPV patients. Six cases with abnormal horizontal phase lead, 5 cases with abnormal horizontal gain, 2 cases with asymmetry were found in 12 patients with horizontal semicircular canal BPPV. Phase lead was abnormal in all frequencies in 4 patients, and in 2-3 Hz in 21 patients. 24 (58.54%) patients showed abnormal canal paresis (CP) and direction preference (DP) in caloric test. VAT can indicate information of vestibular function in both vertical and horizontal semicircular canal. Phase of VAT is constantly enhanced in BPPV, especially in 2-3 Hz. As the supplement of caloric test, VAT may prove helpful in assessment of semicircular canal function.
BibTeX: @article{Gao2010, author = {Gao, Bo and Song, Haitao and Zhou, Jinmei and Huang, Weining}, title = {[Application of vestibular autorotation test in diagnosis of benign paroxysmal positional vertigo].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2010}, volume = {24}, issue = {19}, pages = {865--869}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo; Female; Humans; Male; Middle Aged; Vertigo, diagnosis, physiopathology; Vestibular Function Tests}, pmid = {21174744} }
Young, P., Castillo-Bustamante, M., Almirón, C.J., Bruetman, J.E., Finn, B.C., Ricardo, M.A. and Binetti, A.C.	[Approach to patients with vertigo]. [Abstract] [BibTeX]	2018	Medicina Vol. 78(6), pp. 410-416	article
Abstract: Vertigo is defined as an abnormal sensation of body motion or of its surrounding objects. It is a common chief complaint in emergency departments comprising 2 to 3% of these consultations worldwide. Vertigo is classified as peripheral or central, according to its origin, and can also be occasionally mixed, the most common cause of peripheral involvement being benign paroxysmal positional vertigo. The initial findings on clinical evaluation of patients are the clues for making a correct diagnosis. The differentiation between central and peripheral vertigo can be optimized by analysing nystagmus, by using the skew test and the head impulse test (HINTS), as also by performing the appropriate tests to evaluate the integrity of the vestibular-cerebellar pathway. In addition, tonal threshold audiometry could raise the diagnostic sensibility from 71 to 89% on initial approach. Appropriate diagnosis is the principal key for managing this clinical condition.
BibTeX: @article{Young2018, author = {Young, Pablo and Castillo-Bustamante, Melissa and Almirón, Carlos J and Bruetman, Julio E and Finn, Bárbara C and Ricardo, María A and Binetti, Ana C}, title = {[Approach to patients with vertigo].}, journal = {Medicina}, year = {2018}, volume = {78}, issue = {6}, pages = {410--416}, keywords = {dizziness; falls; neuritis; nystagmus; vertigo; vestibular migraine}, pmid = {30504108} }
Kalkişim, C., Ozkul, M.D., Cukurova, I. and Arslan, I.B.	[Arterial blood gas abnormalities during attacks of dizziness]. [Abstract] [BibTeX]	2007	Kulak burun bogaz ihtisas dergisi : KBB = Journal of ear, nose, and throat Vol. 17(3), pp. 143-147	article
Abstract: We investigated arterial blood gas abnormalities in patients presenting with dizziness. The study included 58 patients (39 females, 19 males; mean age 46 years; range 22 to 74 years) who presented during attacks of dizziness. The duration of vertigo complaints ranged from one day to 30 years. Arterial gas measurements were performed at presentation and one month after treatment. The patients were examined in five groups according to the diagnoses: Meniere's disease (n=14), benign paroxysmal positional vertigo (n=13), vertebrobasilar insufficiency (n=12), vestibular neuritis (n=4), and craniocervical myofascial syndromes (n=15). At presentation, pH was low (acidosis) in two patients (3.5%), and high (alkalosis) in 15 patients (25.9%). After treatment, all abnormal pH values returned to normal. Twenty-four patients had high or low HCO3- values. High HCO3- values persisted in three patients together with dizziness. Patients with vestibular neuritis had significantly higher PO2 values compared to those with craniocervical myofascial syndrome and vertebrobasilar insufficiency (p<0.05). However, one month after treatment, there were no significant differences between five groups with respect to PO2 levels (p>0.05). Consecutive blood gas measurements did not differ significantly within each diagnosis group (p>0.05). Our results suggest that arterial blood gas abnormalities may be related to vertigo attacks.
BibTeX: @article{Kalkisim2007, author = {Kalkişim, Celal and Ozkul, M Doğan and Cukurova, Ibrahim and Arslan, Ilker Burak}, title = {[Arterial blood gas abnormalities during attacks of dizziness].}, journal = {Kulak burun bogaz ihtisas dergisi : KBB = Journal of ear, nose, and throat}, year = {2007}, volume = {17}, issue = {3}, pages = {143--147}, keywords = {Acidosis, blood, complications, diagnosis; Adult; Aged; Alkalosis, blood, complications, diagnosis; Blood Gas Analysis; Dizziness, epidemiology, etiology; Facial Neuralgia, blood, complications, diagnosis; Female; Humans; Hydrogen-Ion Concentration; Male; Meniere Disease, blood, complications, diagnosis; Middle Aged; Turkey, epidemiology; Vertebrobasilar Insufficiency, blood, complications, diagnosis; Vertigo, blood, complications, diagnosis; Vestibular Neuronitis, blood, complications, diagnosis}, pmid = {17873504} }
Babić, B. and Arsović, N.	[Assessment of senses of hearing and balance in chronic suppurative otitis media]. [Abstract] [BibTeX]	2008	Srpski arhiv za celokupno lekarstvo Vol. 136(5-6), pp. 307-312	article
Abstract: Chronic suppurative otitis media is among the most frequent illnesses treated in ENT wards. To establish the diagnosis, otomicroscopy alone usually suffice. Assessing the sense of hearing, often the sense of balance, too, is mandatory. Assessment of hearing will show the extent of conductive and sensorineural hearing loss. Apart from this, sometimes, when the finding is not obvious, it is necessary to conduct audiological investigation in more detail in order to establish whether the diagnosis of chronic suppurative otitis media is correct. Existence and extent of conductive hearing loss or confirmation of tympanic membrane perforation by tympanometry can help a great deal. Also, some new results about the site of perforation and the middle ear volume influence on conductive hearing loss may help have a better insight into chronic suppurative otitis media. Assessing the sense of balance may show dysfunctions with not yet necessarily permanent damage: perilymphatic fistula and benign paroxysmal positional vertigo (BPPV). Unilateral or bilateral damage may be diagnosed with appropriate tests of vestibuloocular reflex (VOR): spontaneous nystagmus, head impulse test, head shaking test. These bedside tests do not require bulky, expensive equipment for stimulus delivery or special equipment for recording nystagmus. In addition, their significance is their ability to provide enough information without performing caloric testing which is contraindicated in chronic suppurative otitis media.
BibTeX: @article{Babic2008, author = {Babić, Borivoj and Arsović, Nenad}, title = {[Assessment of senses of hearing and balance in chronic suppurative otitis media].}, journal = {Srpski arhiv za celokupno lekarstvo}, year = {2008}, volume = {136}, issue = {5-6}, pages = {307--312}, keywords = {Chronic Disease; Hearing Loss, Conductive, diagnosis, etiology; Hearing Loss, Sensorineural, diagnosis, etiology; Humans; Otitis Media, Suppurative, complications; Postural Balance; Sensation Disorders, diagnosis, etiology; Tympanic Membrane Perforation, diagnosis, etiology}, pmid = {18792633} }
Rossi Izquierdo, M., Soto Varela, A., Santos Pérez, S. and Labella Caballero, T.	[Association between endolymphatic hydrops and benign paroxysmal positional vertigo: coincidence or causality?]. [Abstract] [BibTeX]	2009	Acta otorrinolaringologica espanola Vol. 60(4), pp. 234-237	article	DOI
Abstract: The aim of this study was to determine the prevalence of benign paroxysmal positional vertigo (BPPV) in patients diagnosed with endolymphatic hydrops (EH) and to analyze whether this association is a factor for poor prognosis in these patients. A retrospective study was carried out in our department among the patients definitively diagnosed as having Ménière's disease according to the criteria of the American Academy of Otolaryngology and BPPV by the usual triggering manoeuvres. The prevalence of BPPV in our patients with EH was 5.1%. The rate of cure with the repositioning manoeuvres is 90.9%, however success with the first manoeuvre was only 63.36%. Recurrences occurred in up to 22.22%. We found a lower success rate with the first manoeuvre in relation to the rest of the patients with BPPV without EH. This difference is statistically significant (P=0.042). We did not find that these patients to have a lower rate of cure with the repositioning manoeuvres or a higher rate of recurrence. But in our protocol the first manoeuvre had a lower success rate than in the rest of the patients.
BibTeX: @article{RossiIzquierdo2009, author = {Rossi Izquierdo, Marcos and Soto Varela, Andrés and Santos Pérez, Sofía and Labella Caballero, Torcuato}, title = {[Association between endolymphatic hydrops and benign paroxysmal positional vertigo: coincidence or causality?].}, journal = {Acta otorrinolaringologica espanola}, year = {2009}, volume = {60}, issue = {4}, pages = {234--237}, doi = {https://doi.org/10.1016/j.otorri.2009.02.003}, keywords = {Endolymphatic Hydrops, complications; Humans; Prognosis; Retrospective Studies; Vertigo, complications, epidemiology}, pmid = {19814969} }
Wu, Z.-m., Zhang, S.-z., Zhou, N., Liu, X.-j., Yang, W.-y. and Han, D.-y.	[Audio-vestibular function in patients with benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2006	Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery Vol. 41(9), pp. 669-672	article
Abstract: To investigate the audio-vestibular function and the possible mechanism of benign paroxysmal positional vertigo (BPPV) and to raise the therapeutic strategy. Patients with BPPV were tested with pure tone audiometry, high frequency ABR audiometry, bithermal caloric test and vestibular evoked myogenic potential test (VEMP). The positive rate of these otologic function test were analyzed. Primary BPPV comprised 82 percent (70/86) of patients with BPPV. Among all of the patients, the results of pure tone audiometry were abnormal in 52 percent (45/86) of the cases. High frequency auditory brainstem response (ABR) was abnormal in 60 percent (30/50) of cases. Vestibular evoked myogenic potential (VEMP) was abnormal in 34 percent (11/32) of cases who had this examination. And bithermal caloric test were abnormal in 28 percent (20/72) of cases. In the abnormal cases, 67 percent (12/18) of cases were ipsilateral with BPPV. The majority of the BPPV with abnormal results of bithermal caloric test (89%, 16/18) belong to posterior semicircular canal BPPV. The incidence of primary BPPV was higher than that of secondary BPPV. The abnormality in superior labyrinth was much more correlated with the occurrence of BPPV. The inner ear ischemia might be a factor in the morbidity of BPPV, especially for the primary BPPV.
BibTeX: @article{Wu2006, author = {Wu, Zi-ming and Zhang, Su-zhen and Zhou, Na and Liu, Xing-jian and Yang, Wei-yan and Han, Dong-yi}, title = {[Audio-vestibular function in patients with benign paroxysmal positional vertigo].}, journal = {Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery}, year = {2006}, volume = {41}, issue = {9}, pages = {669--672}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Caloric Tests; Female; Humans; Male; Middle Aged; Vertigo, diagnosis, etiology, physiopathology; Vestibular Evoked Myogenic Potentials; Vestibular Function Tests; Vestibule, Labyrinth, physiopathology; Young Adult}, pmid = {17111807} }
Sémont, A., Freyss, G. and Vitte, E.	[Benign paroxysmal positional vertigo and provocative maneuvers]. [Abstract] [BibTeX]	1989	Annales d'oto-laryngologie et de chirurgie cervico faciale : bulletin de la Societe d'oto-laryngologie des hopitaux de Paris Vol. 106(7), pp. 473-476	article
Abstract: Main features of the benign paroxysmal positional vertigo (B.P.P.V.) are: latency before the onset of vertigo, nystagmus of the rotatory type beating toward the lower ear, nystagmus tires out, nystagmus gets inverted when the head is brought back to orthostatism, nystagmus is reproducible as many times as the position is taken. B.P.P.V. is due to a deposit of heavy material on the cupula of the posterior semi circular canal. In this unusual condition, the cupula moves under the effect of gravity acceleration. The goal of the treatment is to free the cupula. The manoeuvre consists after determination of the position that elicits the vertigo to move the whole head and body together of the patient to a 180 degree opposite position in which the addition to the endolymph flow forces and weight forces of the material will unstick it from the cupula. The positive result of the manoeuvre is instantly proved by the arising of a rotatory nystagmus beating again toward the sick ear. In other words it is not the inversion of the primary nystagmus but a nystagmus beating the same direction. This is explained by the dynamic of the cupula: in the prime position the density modified cupula moves toward the canal. At the end of the manoeuvre when the velocity of the head is zero, the cupula has to support different forces. First the addition of the endolymph flow forces and the inertia of the heavy material makes the cupula move toward the ampulla. Secondly when the superficial tension forces are too high the heavy material unstick from the cupula and it goes back to its normal position. En this very moment the cupula moves toward the canal. The results are of more than 90% positive in one ore two sessions 4,2% of recurrence. The manoeuvre is unsuccessful in spontaneous nystagmus revealed by a position, in torsional nystagmus as in fistulas or in central position nystagmus.
BibTeX: @article{Semont1989, author = {Sémont, A and Freyss, G and Vitte, E}, title = {[Benign paroxysmal positional vertigo and provocative maneuvers].}, journal = {Annales d'oto-laryngologie et de chirurgie cervico faciale : bulletin de la Societe d'oto-laryngologie des hopitaux de Paris}, year = {1989}, volume = {106}, issue = {7}, pages = {473--476}, keywords = {Humans; Methods; Nystagmus, Pathologic, physiopathology; Posture; Recurrence; Vertigo, physiopathology, therapy}, pmid = {2589749} }
Guo, X., Wang, Q., Mei, X., Zhang, Z., Yang, X. and He, P.	[Benign paroxysmal positional vertigo associated with Meniere's disease: analysis of 36 cases]. [Abstract] [BibTeX]	2015	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 29(10), pp. 925-927	article
Abstract: To compare the clinical features and outcomes of benign paroxysmal positional vertigo (BPPV) associated with Meniere's disease and idiopathic BPPV. Reviewing the clinical records of 372 patients with BPPV, 289 patients with idiopathic BPPV and 36 patients with BPPV accompanied by Meniere's disease and were enrolled in this study. All patients were diagnosed by using the Dix-Hallpike test or roll test and treated with the canalith repositioning procedure. The outcomes were compared between the two groups. The patients with BPPV associated with Meniere's disease presented the following features, in which they differed from the patients with idiopathic BPPV (P < 0.05): (1) a higher percentage of female patients; (2) a longer duration of symptoms; (3) frequent involvement of the horizontal semicircular canal; (4) a greater incidence of canal paresis; (5) more therapeutic sessions needed for cure and a higher rate of recurrence. The BPPV associated with Meniere's disease differs from idiopathic BPPV in clinical features, treatment response recurrence tendency.
BibTeX: @article{Guo2015b, author = {Guo, Xiangdong and Wang, Qinglin and Mei, Xiangsheng and Zhang, Zhicheng and Yang, Xiao and He, Peiju}, title = {[Benign paroxysmal positional vertigo associated with Meniere's disease: analysis of 36 cases].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2015}, volume = {29}, issue = {10}, pages = {925--927}, keywords = {Benign Paroxysmal Positional Vertigo, complications; Female; Humans; Incidence; Male; Meniere Disease, complications; Paresis, complications; Patient Positioning; Recurrence; Retrospective Studies; Semicircular Canals, pathology}, pmid = {26596010} }
Yang, X.M., Lu, Y.D., Xie, D.H. and Shu, J.B.	[Benign paroxysmal positional vertigo following radiotherapy for nasopharyngeal carcinoma (report of 3 cases)]. [Abstract] [BibTeX]	2000	Lin chuang er bi yan hou ke za zhi = Journal of clinical otorhinolaryngology Vol. 14(4), pp. 164-165	article
Abstract: To investigate the effect of ionizing radiation on the vestibule of the inner ear. Three patients with benign paroxysmal positional vertigo (BPPV) accompanied by hearing loss following radiotherapy for nasopharyngeal carcinoma (NPC) were reported. Particle repositioning maneuver (PRM) was used as treatment for BPPV, and salvia miltiorrhiza tablets were taken orally to treat hearing loss. Two of three cases with BPPV recovered and one was effective; Mean phone frequency hearing increased 10 dB compared with that before therapy. Occurrence of BPPV in this series may be related to radiation damage on the vestibule; PRM is a effective modality for the patients with BPPV.
BibTeX: @article{Yang2000, author = {Yang, X M and Lu, Y D and Xie, D H and Shu, J B}, title = {[Benign paroxysmal positional vertigo following radiotherapy for nasopharyngeal carcinoma (report of 3 cases)].}, journal = {Lin chuang er bi yan hou ke za zhi = Journal of clinical otorhinolaryngology}, year = {2000}, volume = {14}, issue = {4}, pages = {164--165}, keywords = {Adult; Female; Hearing Disorders, drug therapy, etiology; Humans; Male; Middle Aged; Nasopharyngeal Neoplasms, radiotherapy; Posture; Radiation Injuries, etiology; Radiotherapy, adverse effects; Vertigo, etiology, therapy}, pmid = {12541491} }
Bestuzheva, N.V., Parfenov, V.A. and Zamergrad, M.V.	[Benign paroxysmal positional vertigo in a female with arterial hypertension and meningioma]. [Abstract] [BibTeX]	2014	Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova Vol. 114(4), pp. 100-104	article
Abstract: Diagnosis of benign paroxysmal positional vertigo (BPPV) often causes difficulties, in particular, in elderly people with concomitant diseases. The article presents a case of a 77 year-old woman with BPPV. A patient's complaint on vertigo was mistakenly diagnosed as brain ischemia because the patient had long suffered from uncontrolled arterial hypertension. MRI-study revealed leucoaraiosis and one lacuna as well as a meningioma which was mistakenly linked to vertigo. The diagnosis of BPPV, use of Epley maneuver with the following vestibular exercises resulted in complete stopping of vertigo. Effective treatment of arterial hypertension with the normalization of arterial pressure, use of aspirin and statins reduced the risk of stroke. Exclusion of BPPV is needed in all cases of vertigo with unclear etiology.
BibTeX: @article{Bestuzheva2014, author = {Bestuzheva, N V and Parfenov, V A and Zamergrad, M V}, title = {[Benign paroxysmal positional vertigo in a female with arterial hypertension and meningioma].}, journal = {Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova}, year = {2014}, volume = {114}, issue = {4}, pages = {100--104}, keywords = {Aged; Aspirin, therapeutic use; Benign Paroxysmal Positional Vertigo, complications, diagnosis, therapy; Brain, pathology; Exercise Movement Techniques; Female; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors, therapeutic use; Hypertension, complications, drug therapy; Leukoaraiosis, diagnosis; Magnetic Resonance Imaging; Meningeal Neoplasms, complications; Meningioma, complications}, pmid = {24874329} }
Nørgaard, M.S., Rokkjær, M.S., Berg, J. and Lüscher, M.	[Benign paroxysmal positional vertigo in children after head trauma]. [Abstract] [BibTeX]	2015	Ugeskrift for laeger Vol. 177(25)	article
Abstract: We present an eight-year-old boy with benign paroxysmal positional vertigo (BPPV) after a head trauma, successfully treated with Epley's manoeuvre. BPPV is a common cause of vestibular vertigo in adults, but it is rarely seen in children. Diagnostic work-up is challenging as children often lack the ability to describe their symptoms accurately and to cooperate in clinical examination. The diagnosis should be suspected in children with a relevant medical history and verified by positional testing. BPPV of childhood is treated with otolith repositioning manoeuvres, and the prognosis is good.
BibTeX: @article{Noergaard2015, author = {Nørgaard, Maria Schøler and Rokkjær, Malene Sine and Berg, Jette and Lüscher, Michael}, title = {[Benign paroxysmal positional vertigo in children after head trauma].}, journal = {Ugeskrift for laeger}, year = {2015}, volume = {177}, issue = {25}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis, etiology, therapy; Child; Craniocerebral Trauma, complications; Humans; Male; Patient Positioning, methods; Semicircular Canals, physiopathology}, pmid = {26101130} }
Obrebowski, A., Wiskirska-Woźnica, B., Maciejewska, B., Krzyzaniak, A. and Gajewska, M.	[Benign paroxysmal positional vertigo in the own material]. [Abstract] [BibTeX]	2006	Otolaryngologia polska = The Polish otolaryngology Vol. 60(6), pp. 839-843	article
Abstract: The complaint of dizziness can be caused by a variety of disorders affecting central or peripheral vestibular system. Benign paroxysmal positional vertigo BPPV is the most common cause of vertigo. It is a syndrom characterized by short-lasted episodes of true vertigo, induced by a rapid head position change and associated with a positional, transient nystagmus. It is classically identified by the Dix-Hallpike test. Vestibular and audiology function tests are usually normal. Patient is succesfully treated with physical maneuvres (Canalith Repositioning Procedure CRP). This raport presents eight patients (four are described in details) suffered from BPPV-PSC, hospitalized in the Department of Phoniatric and Audiology, Poznan University of Medical Sciences. Methods include laryngologic examination, audiology and vestibular tests, Dix-Hallpike'a maneuver. All patients presented characteristic history and results of performed diagnostic tests. The efficacy of physical maneuvers were confirmed. BPPV is usually easy to diagnose and physical maneuvers are very effective.
BibTeX: @article{Obrebowski2006, author = {Obrebowski, Andrzej and Wiskirska-Woźnica, Bozena and Maciejewska, Barbara and Krzyzaniak, Andrzej and Gajewska, Marta}, title = {[Benign paroxysmal positional vertigo in the own material].}, journal = {Otolaryngologia polska = The Polish otolaryngology}, year = {2006}, volume = {60}, issue = {6}, pages = {839--843}, keywords = {Adult; Dizziness, etiology, therapy; Electronystagmography, methods; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, etiology, therapy; Physical Therapy Modalities; Posture; Treatment Outcome; Vertigo, complications, diagnosis, therapy; Vestibular Function Tests}, pmid = {17357660} }
Susanne, K.	[Benign paroxysmal positional vertigo is the Gufoni maneuver actually effective?]. [BibTeX]	2014	Laryngo- rhino- otologie Vol. 93(4), pp. 226-227	article
BibTeX: @article{Susanne2014, author = {Susanne, Krome}, title = {[Benign paroxysmal positional vertigo is the Gufoni maneuver actually effective?].}, journal = {Laryngo- rhino- otologie}, year = {2014}, volume = {93}, issue = {4}, pages = {226--227}, keywords = {Female; Humans; Male; Physical Therapy Modalities; Vertigo, therapy}, pmid = {24809071} }
Lorin, P.	[Benign paroxysmal positional vertigo of the anterior semicircular canal: clinical aspects and treatment]. [Abstract] [BibTeX]	2005	Revue de laryngologie - otologie - rhinologie Vol. 126(4), pp. 263-266	article
Abstract: To describe the videonystagmographic characteristics and the treatment of the patients reached with a canalolithiasis or a cupulolithiasis of the anterior semicircular canal. Retrospective study concerning patients treated for a Benign Paroxysmal Positional Vertigo (BPPV) of the anterior semicircular canal. Each patient after analysis under videonystagmoscopy (VNS) and under videonystagmography (VNG) was treated by maneuvers. On 462 observations of typical BPPV 6 cases of VPPB of the anterior semicircular canal were treated concerning 5 patients (1.3%). The BPPV of the anterior semicircular canal are rare. We modified our method of diagnosis, and our therapeutic techniques could be validated with the help of the two-dimensional videonystagmography.
BibTeX: @article{Lorin2005, author = {Lorin, P}, title = {[Benign paroxysmal positional vertigo of the anterior semicircular canal: clinical aspects and treatment].}, journal = {Revue de laryngologie - otologie - rhinologie}, year = {2005}, volume = {126}, issue = {4}, pages = {263--266}, keywords = {Electronystagmography; Female; Humans; Labyrinth Diseases, complications, diagnosis, therapy; Lithiasis, complications, diagnosis, therapy; Male; Middle Aged; Nystagmus, Pathologic, etiology; Physical Therapy Modalities; Retrospective Studies; Rotation; Semicircular Canals, pathology; Treatment Outcome; Vertigo, diagnosis, etiology, pathology, physiopathology, therapy; Vestibular Function Tests; Video Recording}, pmid = {16496555} }
Sauvage, J.P., Aubry, K. and Codron, S.	[Benign paroxysmal positional vertigo of the horizontal and superior semicircular canals]. [Abstract] [BibTeX]	2005	Revue de laryngologie - otologie - rhinologie Vol. 126(4), pp. 257-262	article
Abstract: The incidence of benign paroxysmal positional vertigo (BPPV) of the horizontal and superior semicircular canals is much less than that of BPPV due to affection of the posterior semicircular canal. Their diagnosis is however much more difficult and still prone to controversies. The provocative manoeuvre of the BPPV of the horizontal canal (BPPV-HSC) is the manoeuvre of rotation of the head in dorsal position. A horizontal positional nystagmus is obtained. There are two forms of BPPV-HSC: the geotropic form and the ageotropic form. In the geotropic form, the liberatory manoeuvre is a "barbecue" rotation of 180 with 360 degrees towards the healthy side. In the ageotropic form, there is no universal liberatory manoeuvre. Moreover as some cases of neurological aetiology have been recognized, it is not appropriate to apply ineffective manoeuvres. The BPPV of the superior canal (BPV-SSC) is very rare. The provocative manoeuvre is the Dix and Hallpike's manoeuvre. It causes positional torsional and vertical nystagmus with an opposite direction to that obtained for a BPPV of the contra-lateral posterior canal. The liberatory manoeuvre is a Semont manoeuvre, which is identical to that we would make for a contra-lateral BPPV of the posterior canal.
BibTeX: @article{Sauvage2005, author = {Sauvage, J P and Aubry, K and Codron, S}, title = {[Benign paroxysmal positional vertigo of the horizontal and superior semicircular canals].}, journal = {Revue de laryngologie - otologie - rhinologie}, year = {2005}, volume = {126}, issue = {4}, pages = {257--262}, keywords = {Caloric Tests; Head Movements; Humans; Nystagmus, Physiologic; Posture; Semicircular Canals, physiopathology; Vertigo, diagnosis, etiology, physiopathology; Vestibular Function Tests, methods}, pmid = {16496554} }
Amor Dorado, J.C., Martín, E., Arán, I., Barreira, P. and Barona, R.	[Benign paroxysmal positional vertigo of the horizontal canal: A multicenter study]. [Abstract] [BibTeX]	2006	Acta otorrinolaringologica espanola Vol. 57(5), pp. 217-222	article
Abstract: BPPV localized in the horizontal semicircular canal is an infrequent entity. Nowadays there are controversies about the different treatments available. The objective of this study is to present our results. A multicenter and retrospective study was performed in 31 patients diagnosed of BPPV-HSC between January 1996 and May 2004. cupulolithiasis was diagnosed in 48% on the patients. Symptoms disappeared before signs (p<0.05). Global cure rate was 85%, while relapses were 16% at one year. No relations were found between cure rate and relapses and age, gender, duration of symptoms, canalithiasis and cupulolithiasis. Our results support that there are not differences between the treatments performed in the BPPV-HSC. Symptoms disappeared before signs when canalith repositioning particles (CRP) maneuver was performed.
BibTeX: @article{AmorDorado2006, author = {Amor Dorado, J C and Martín, E and Arán, I and Barreira, P and Barona, R}, title = {[Benign paroxysmal positional vertigo of the horizontal canal: A multicenter study].}, journal = {Acta otorrinolaringologica espanola}, year = {2006}, volume = {57}, issue = {5}, pages = {217--222}, keywords = {Female; Humans; Lithiasis, complications; Male; Middle Aged; Retrospective Studies; Vertigo, diagnosis, etiology, therapy; Vestibular Diseases, complications}, pmid = {16768199} }
Bertholon, P., Faye, M.B., Tringali, S. and Martin, C.	[Benign paroxysmal positional vertigo of the horizontal canal. Clinical features in 25 patients]. [Abstract] [BibTeX]	2002	Annales d'oto-laryngologie et de chirurgie cervico faciale : bulletin de la Societe d'oto-laryngologie des hopitaux de Paris Vol. 119(2), pp. 73-80	article
Abstract: To review the clinical features of benign paroxysmal positional vertigo of the horizontal canal (HC-BPPV). Retrospective study (September 1999 to March 2001) of 25 patients with HC-BPPV. Patients complained of positional vertigo associated with direction changing horizontal positional nystagmus, either geotropic or ageotropic. The horizontal nystagmus was triggered in all patients when rolled to either side in a supine position (head raised 30 degrees) and in 14 patients by the Dix Hallpike manoeuvre. The nystagmus was geotropic in 15 patients and ageotropic in 10. It varies in time in 4 patients with one change in 3 (from geotropic to ageotropic in 2 and ageotropic to geotropic in 1) and 4 changes in 10 days in another patient. In one patient with head trauma, the HC-BPPV was currently associated with ipsilateral posterior canal benign paroxysmal positional vertigo (PC-BPPV), and its characteristic rotatory-up beat nystagmus. Interestingly, 4 patients had a previous history of ipsilateral PC-BPPV and in 5 others an ipsilateral PC-BPPV occurred after the HC-BPPV. Although spontaneous recovery of HC-BPPV was common in most patients, a 270 degrees "barbecue rotation" or a "prolonged position on the healthy side" was effective in some patients. Patients with positional vertigo should undergo Dix Hallpike positioning and supine lateral head turns as this latter manoeuvre is more efficient to diagnose an HC-BPPV. Both the transformation of the positional horizontal nystagmus (geotropic-ageotropic) and the association with a PC-BPPV support the diagnosis of an HC-BPPV.
BibTeX: @article{Bertholon2002, author = {Bertholon, P and Faye, M B and Tringali, S and Martin, Ch}, title = {[Benign paroxysmal positional vertigo of the horizontal canal. Clinical features in 25 patients].}, journal = {Annales d'oto-laryngologie et de chirurgie cervico faciale : bulletin de la Societe d'oto-laryngologie des hopitaux de Paris}, year = {2002}, volume = {119}, issue = {2}, pages = {73--80}, keywords = {Adult; Aged; Aged, 80 and over; Diagnosis, Differential; Female; Follow-Up Studies; Head Movements, physiology; Humans; Male; Middle Aged; Nystagmus, Pathologic, diagnosis, etiology, physiopathology, therapy; Orientation, physiology; Posture, physiology; Retrospective Studies; Vertigo, diagnosis, etiology, physiopathology}, pmid = {12015491} }
Ballester, M.	[Benign paroxysmal positional vertigo of the horizontal canal]. [Abstract] [BibTeX]	2003	Revue de laryngologie - otologie - rhinologie Vol. 124(1), pp. 71-72	article
Abstract: The benign positional vertigo of the horizontal canal seems to find its origins in a canalolithiasis. The diagnosis is usually easy when its characteristics are perfectly known. A horizontal nystagmus does not always mean that the vertigo is of a central origin. This canal is exclusively connected, via the brainstem, to the external and internal oculomotor muscles so that the movement obtained by its stimulation can only be horizontal! This is quite different from what is obtained for the posterior canal, which is connected to various oculomotor muscles. Specific therapeutic maneuvers have to be carried out to be efficient: if properly performed, the otoconias, heavy particles sensitive to gravity, are easily mobilized. This paper describes the pathophysiology of the positional vertigo of the horizontal canal, diagnosis of its two presentations, and therapeutic possibilities.
BibTeX: @article{Ballester2003, author = {Ballester, Michel}, title = {[Benign paroxysmal positional vertigo of the horizontal canal].}, journal = {Revue de laryngologie - otologie - rhinologie}, year = {2003}, volume = {124}, issue = {1}, pages = {71--72}, keywords = {Adult; Ear Canal, physiopathology; Humans; Male; Middle Aged; Nystagmus, Pathologic, etiology; Posture; Rotation; Vertigo, complications, physiopathology, therapy}, pmid = {12934446} }
Doménech Campos, E., Armengot Carceller, M. and Barona de Guzmán, R.	[Benign paroxysmal positional vertigo of the horizontal semicircular canal]. [Abstract] [BibTeX]	2006	Acta otorrinolaringologica espanola Vol. 57(10), pp. 446-449	article
Abstract: Assesment of 8 new cases of benign paroxysmal positional vertigo of the horizontal semicircular canal (BPPV-HC), since this variant of benign positional vertigo occurs rarely. An oculographic study of features in the positional response was carried out. Electrooculograpy (EOG) allows an exhaustive study of positional nystagmus. We have studied retrospectively 8 patients with BPPV-HC and positive head rotation manoeuvre registered by EOG techniques. Possible alterations in other EOG tests in the group of patients were analyzed. Most of the patients (7/8) expressed bilateral horizontal geotropic changing-direction nystagmus. One patient exhibited apogeotropic horizontal nystagmus. 5/8 cases showed caloric hypofunction. We have proven that BPPV-HC is an uncommon disorder. In most of the cases, provocative manoeuver generates bilateral horizontal geotropic changing-direction nystagmus that probably is due to canalitiasis of the horizontal semicircular canal. The rest, a few cases, exhibit apogeotropic horizontal response that can be secondary to cupulolitiasis or location particles in the anterior portion of the horizontal canal. A caloric test showed abnormal in many and can help to locatize the affected ear.
BibTeX: @article{DomenechCampos2006, author = {Doménech Campos, E and Armengot Carceller, M and Barona de Guzmán, R}, title = {[Benign paroxysmal positional vertigo of the horizontal semicircular canal].}, journal = {Acta otorrinolaringologica espanola}, year = {2006}, volume = {57}, issue = {10}, pages = {446--449}, keywords = {Adult; Aged; Electrooculography; Female; Humans; Male; Middle Aged; Nystagmus, Physiologic, physiology; Retrospective Studies; Rotation; Semicircular Canals, physiopathology; Severity of Illness Index; Vertigo, complications, physiopathology}, pmid = {17228643} }
Pérez Garrigues, H., Mateos Fernández, M. and Peñarrocha, M.	[Benign paroxysmal positional vertigo secondary to surgical maneuvers on superior maxilla]. [Abstract] [BibTeX]	2001	Acta otorrinolaringologica espanola Vol. 52(4), pp. 343-346	article
Abstract: The benign paroxysmal positional vertigo (BPPV) is a common vestibular end organ disorder. BPPV may be idiopathic or secondary to head traumas, viral labyrinthitis, otology surgery and many others conditions. We report two cases of BPPV secondary to surgical maneuvers on superior maxillary. We have not found this etiology in scientific literature but, the increase of this kind of surgery, can produce an increase of its frequency. For this reason the otoneurologists and oral surgeons must bear in mind this possibility to make a right diagnostic and treatment of the syndrome.
BibTeX: @article{PerezGarrigues2001, author = {Pérez Garrigues, H and Mateos Fernández, M and Peñarrocha, M}, title = {[Benign paroxysmal positional vertigo secondary to surgical maneuvers on superior maxilla].}, journal = {Acta otorrinolaringologica espanola}, year = {2001}, volume = {52}, issue = {4}, pages = {343--346}, keywords = {Female; Humans; Male; Maxilla, surgery; Middle Aged; Oral Surgical Procedures, adverse effects; Time Factors; Vertigo, etiology}, pmid = {11526631} }
West, N., Hansen, S., Bloch, S.L., Møller, M.N. and Klokker, M.	[Benign paroxysmal positional vertigo treatment]. [Abstract] [BibTeX]	2017	Ugeskrift for laeger Vol. 179(23)	article
Abstract: Benign paroxysmal positional vertigo (BPPV) remains the most frequent cause of vertigo. The TRV chair is a mechanical device suited for optimization of managing complex cases of BPPV. Although the use of repositioning devices in the management of BPPV is increasing, no applicable guide for the TRV management of the different BPPV subtypes exists. This article presents the techniques for addressing canalolithiasis and cupulolithiasis in the TRV chair for each affected semicircular canal. In a tertiary referral centre like our unit the TRV chair is an asset in the management of BPPV.
BibTeX: @article{West2017, author = {West, Niels and Hansen, Søren and Bloch, Sune Land and Møller, Martin Nue and Klokker, Mads}, title = {[Benign paroxysmal positional vertigo treatment].}, journal = {Ugeskrift for laeger}, year = {2017}, volume = {179}, issue = {23}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis, therapy; Humans; Patient Positioning, methods; Physical Therapy Modalities}, pmid = {28606300} }
Anagnostou, E., Mandellos, D., Patelarou, A. and Anastasopoulos, D.	[Benign paroxysmal positional vertigo with and without manifest positional nystagmus: an 18-month follow-up study of 70 patients]. [Abstract] [BibTeX]	2007	HNO Vol. 55(3), pp. 190-194	article	DOI
Abstract: In this follow-up study of approximately 18 months we assessed parameters of medical management in a sample of 70 patients suffering from benign paroxysmal positional vertigo. Apart from demographic data, we evaluated the time interval from the appearance of the first symptoms until a diagnostic positional manoeuvre was performed, the efficacy of liberatory manoeuvres, the prescription of medication, the use of technical diagnostic resources and the relapse rate. None of the patients had received a diagnostic positioning test until then. Moreover, in one out of three cases a further unnecessary technical diagnostic procedure was carried out. There was a tendency for the right labyrinth to be more frequently affected, a fact that was statistically independent from age and sex, as well as from overall prognosis, which was characterized by a 15.6% recurrence rate. All patients with manifest positional nystagmus were successfully treated: 87.2% immediately after the repositioning manoeuvre and the rest within 10 days by self-performing Brandt-Daroff exercises. Our retrospective analysis revealed that, given a normal neuro-otological examination, a typical medical history without manifest positioning nystagmus leads safely to the correct diagnosis. The delay between the onset of symptoms and the diagnosis of BPPV is very often unduly long. A focused medical history may be diagnostic even in the absence of nystagmus during the Dix-Hallpike manoeuvre.
BibTeX: @article{Anagnostou2007, author = {Anagnostou, E and Mandellos, D and Patelarou, A and Anastasopoulos, D}, title = {[Benign paroxysmal positional vertigo with and without manifest positional nystagmus: an 18-month follow-up study of 70 patients].}, journal = {HNO}, year = {2007}, volume = {55}, issue = {3}, pages = {190--194}, doi = {https://doi.org/10.1007/s00106-006-1458-8}, keywords = {Adult; Aged; Aged, 80 and over; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nystagmus, Pathologic, complications, diagnosis; Nystagmus, Physiologic; Prognosis; Reproducibility of Results; Sensitivity and Specificity; Vertigo, complications, diagnosis; Vestibular Function Tests, methods}, pmid = {17106753} }
Domínguez-Durán, E., Gandul-Merchán, A., Abrante-Jiménez, A., Medinilla-Vallejo, A. and Esteban-Ortega, F.	[Benign paroxysmal positional vertigo: analysis of our population and role of caloric tests]. [Abstract] [BibTeX]	2011	Acta otorrinolaringologica espanola Vol. 62(1), pp. 40-44	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo in those patients who seek medical care. Although videonystagmography seems the most indicated diagnostic test, we tried to decrease the requested caloric tests to optimise resources and reduce associated costs. We developed a diagnostic-therapeutic algorithm for patients with suspected BPPV whose provocation tests are positive to evaluate the need for caloric testing. We analysed the results of its application on 98 patients who were referred to our Neuro-otology Unit over 15 months requesting videonystagmography and caloric tests. Only 24% of the requested tests were performed. No significant difference was found in our recurrence rate compared with other series of Spanish patients. Videonystagmography and caloric tests are not strictly necessary in most patients with BPPV and they should be performed only in patients whose diagnosis is unclear.
BibTeX: @article{Dominguez-Duran2011, author = {Domínguez-Durán, Emilio and Gandul-Merchán, Antonio and Abrante-Jiménez, Antonio and Medinilla-Vallejo, Antonio and Esteban-Ortega, Francisco}, title = {[Benign paroxysmal positional vertigo: analysis of our population and role of caloric tests].}, journal = {Acta otorrinolaringologica espanola}, year = {2011}, volume = {62}, issue = {1}, pages = {40--44}, doi = {https://doi.org/10.1016/j.otorri.2010.08.002}, keywords = {Adult; Aged; Aged, 80 and over; Algorithms; Benign Paroxysmal Positional Vertigo; Caloric Tests; Electronystagmography; Female; Humans; Male; Middle Aged; Prospective Studies; Vertigo, diagnosis}, pmid = {21112581} }
Ghilardi, P.L. and Casani, A.	[Benign paroxysmal positional vertigo: clinical aspects and medico-legal considerations]. [Abstract] [BibTeX]	1989	Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale Vol. 9(1), pp. 79-85	article
Abstract: Benign paroxysmal positional vertigo (BPPV) is quite frequently found as an otological consequence of cranial traumas; thus leading to medico-legal implications. An attempt has herewith been made to evaluate these implications on the basis of data available. Therefore, 158 patients suffering from BPPV were examined between 1984-1986. Of these 23% of the total were post-traumatic forms (of medico-legal interest). Among patients suffering from post-traumatic vestibular disturbances in the broad sense, the incidence of BPPV proved to be greater in the ages ranging from 50 to 70. In those under 30 years of age BPPV was hardly ever present (5% of the total) although when it was its origin was always post-traumatic. The temporal evolution of paroxysmal positional vertigo, which tends to spontaneously disappear, is paralleled in BPPV patients whether it is of post-traumatic origin or not. On the other hand, the subjective sensation of positional vertigo takes longer to clear up in post-traumatic BPPV patients, most likely due to factors stemming from the so-called "compensation syndrome". Any medico-legal evaluation of BPPV must, therefore, take into account its natural favorable evolution. This makes it necessary to examine the patient several times over a period of at least six months from the moment of trauma. In medico-legal terms, the features of BPPV (i.e. position setting it off, duration of vertigo, frequency with which it appears when that position is assumed, presence and duration of the positional nystagmus) lead to inability to work in from 2 to 10% of the cases.
BibTeX: @article{Ghilardi1989, author = {Ghilardi, P L and Casani, A}, title = {[Benign paroxysmal positional vertigo: clinical aspects and medico-legal considerations].}, journal = {Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale}, year = {1989}, volume = {9}, issue = {1}, pages = {79--85}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Craniocerebral Trauma, complications; Disability Evaluation; Female; Humans; Male; Middle Aged; Posture; Vertigo, diagnosis, etiology}, pmid = {2728900} }
Coppo, G.F., Singarelli, S. and Fracchia, P.	[Benign paroxysmal positional vertigo: follow-up of 165 cases treated by Semont's liberating maneuver]. [Abstract] [BibTeX]	1996	Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale Vol. 16(6), pp. 508-512	article
Abstract: The purpose of the present work has been to evaluate the effectiveness of the Semont's liberatory maneuver in treating benign paroxysmal positional vertigo (BPPV) stemming from lithiasis of the posterior semicircular canal. After taking an overview of the history, epidemiology and clinical manifestation of this pathology, the cases studied are presented: 165 cases of BPPV of the posterior semicircular canal diagnosed between September 1992 and December 1994 at the Audiology and E.N.T. Clinic of the Santo Spirito Hospital in Casale Monferrato, Italy. Diagnosis was based on careful examination of the case history and the finding of typical paroxysmal positional vertigo. Among the 1096 patients who came under observation for vertigo or instability, the incidence of BPPV was rather high: approximately 23%, predominantly females (64% of the cases). In 56% of the cases the right labyrinth was involved while the left labyrinth was involved in 39% (in 5% the form was bilateral). The average age of the patients was 60 years, with incidence being greatest in the 6th and 7th decades of life. In 10% of the cases the etiology was traumatic (cranial, cervical trauma or post otological or general surgery), in 5% it was of viral origin, in 1% of vascular origin; however, in the vast majority of cases (84%) it was idiopathic. All the patients were treated with the Semont's liberatory maneuver (repeated 1-3 times in subsequent sessions at 48 hour intervals). A full 62% of the patients treated were freed of the disorder after a single maneuver and 95.5% after 3 treatments. In 5% of the cases (3 very elderly patients), the disorder persisted even after rehabilitation with Brand Daroff's exercises. To evaluate the evolution in time, all the patients were sent a written questionnaire aimed at determining the progression of symptoms, any recurrences, the number of recurrences, and the length of time from the date of treatment. In the case of positive response, the patients were invited in for a clinical-instrumental check-up. This follow-up ranged from 6 to 30 months. At the end of May 1995 the case breakdown was as follows: 80.7% of the patients were still symptom free, most being quite satisfied with the results; 18% had had one or more recurrence of the paroxysmal positional vertigo which were successfully treated by one or more application of the Semont's maneuver.
BibTeX: @article{Coppo1996, author = {Coppo, G F and Singarelli, S and Fracchia, P}, title = {[Benign paroxysmal positional vertigo: follow-up of 165 cases treated by Semont's liberating maneuver].}, journal = {Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale}, year = {1996}, volume = {16}, issue = {6}, pages = {508--512}, keywords = {Aged; Female; Follow-Up Studies; Humans; Male; Middle Aged; Retrospective Studies; Sex Factors; Vertigo, diagnosis, pathology, therapy; Vestibule, Labyrinth, pathology}, pmid = {9381920} }
Hegemann, S. and Helling, K.	[Benign paroxysmal positional vertigo: frequent misdiagnosis]. [BibTeX]	2014	Laryngo- rhino- otologie Vol. 93(12), pp. 816-817	article
BibTeX: @article{Hegemann2014, author = {Hegemann, Stefan and Helling, Kai}, title = {[Benign paroxysmal positional vertigo: frequent misdiagnosis].}, journal = {Laryngo- rhino- otologie}, year = {2014}, volume = {93}, issue = {12}, pages = {816--817}, keywords = {Delayed Diagnosis, statistics & numerical data; Female; Humans; Male; Patient Positioning, methods; Time-to-Treatment, statistics & numerical data; Vertigo, diagnosis}, pmid = {25594096} }
Kunel'skaya, N.L., Mokrysheva, N.G., Guseva, A.L., Baibakova, E.V. and Manaenkova, E.A.	[Benign paroxysmal positional vertigo: modern concepts of its etiology and pathogenesis]. [Abstract] [BibTeX]	2017	Vestnik otorinolaringologii Vol. 82(3), pp. 75-79	article	DOI
Abstract: The objective of the present review of the literature is the analysis of the currently available data concerning etiology and pathogenesis of benign paroxysmal positional vertigo (BPPV). The special emphasis is placed on the modern hypotheses of BPPV formation that collectively account for not more than 15% of all known cases of this condition. The best explored are the following causes of benign paroxysmal positional vertigo: vestibular neuronitis, head injuries, and disorders in the middle ear. During the recent years, much attention has been given to the role of disturbances of calcium metabolism and osteoporosis in etiology of benign paroxysmal positional vertigo. It is supposed that pathogenesis of vertiginous attacks can be explained in terms of the canalolithiasis and cupulolithiasis theories.
BibTeX: @article{Kunelskaya2017a, author = {Kunel'skaya, N L and Mokrysheva, N G and Guseva, A L and Baibakova, E V and Manaenkova, E A}, title = {[Benign paroxysmal positional vertigo: modern concepts of its etiology and pathogenesis].}, journal = {Vestnik otorinolaringologii}, year = {2017}, volume = {82}, issue = {3}, pages = {75--79}, doi = {https://doi.org/10.17116/otorino201782375-79}, keywords = {Benign Paroxysmal Positional Vertigo, etiology, metabolism, physiopathology; Calcinosis, metabolism, physiopathology; Humans; Osteoporosis, metabolism, physiopathology; Vestibule, Labyrinth, pathology, physiopathology; benign paroxysmal positional vertigo; calcium metabolism; canalolithiasis; cupulolithiasis; osteoporosis; vitamin D}, pmid = {28631688} }
Wang, E., Shan, X. and Tan, Z.	[Benign paroxysmal positional vertigo: not an unusual complication secondary to operation]. [BibTeX]	2015	Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery Vol. 50(9), pp. 787-789	article
BibTeX: @article{Wang2015, author = {Wang, Entong and Shan, Xizheng and Tan, Zulin}, title = {[Benign paroxysmal positional vertigo: not an unusual complication secondary to operation].}, journal = {Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery}, year = {2015}, volume = {50}, issue = {9}, pages = {787--789}, keywords = {Benign Paroxysmal Positional Vertigo, complications; Humans; Otologic Surgical Procedures, adverse effects}, pmid = {26696360} }
Herreros Fernández, M.L., Beato Martínez, A., Barja Tur, J., Moreno Juara, A. and González Laguillo, A.	[Benign paroxysmal positional vertigo: provocation and freeing manoeuvres]. [Abstract] [BibTeX]	2008	Anales de pediatria (Barcelona, Spain : 2003) Vol. 69(2), pp. 167-170	article
Abstract: The benign paroxystic positional vertigo (BPPV) is defined by brief episodic vertigo attacks and accompanied by a rotary-linear nystagmus, triggered by head position changes and is always produced in that position. The theory that better explains the BPPV is canalithiasis: free-floating particles leave the utricular macula and enter one of the semicircular canals, producing an endolymphatic movement that stimulates the cupula and produces vertigo and nystagmus. The diagnosis is based on a typical clinical history, normal ear and neurological examination and provocation maneuvers, such as the Dix-Hallpike test, reproduce the vertigo attacks. The treatments are the liberatory maneuvers, such as the Epley maneuver which makes the vertigo disappear. We present two cases of vertigo with a compatible clinic history of BPPV, where the Dix-Hallpike maneuver confirmed the diagnosis. The treatment in both cases was the Epley maneuver.
BibTeX: @article{HerrerosFernandez2008, author = {Herreros Fernández, M L and Beato Martínez, A and Barja Tur, J and Moreno Juara, A and González Laguillo, A}, title = {[Benign paroxysmal positional vertigo: provocation and freeing manoeuvres].}, journal = {Anales de pediatria (Barcelona, Spain : 2003)}, year = {2008}, volume = {69}, issue = {2}, pages = {167--170}, keywords = {Child; Child, Preschool; Humans; Male; Physical Therapy Modalities; Vertigo, diagnosis, therapy}, pmid = {18755124} }
Gordon, C.R. and Gadoth, N.	[Benign paroxysmal positional vertigo: who can diagnose it, how should it be treated and where?]. [Abstract] [BibTeX]	2005	Harefuah Vol. 144(8), pp. 567-71, 597	article
Abstract: Benign Paroxysmal Positional Vertigo (BPPV) is a very common cause of vertigo that can affect any of the semicircular canals. Posterior canal BPPV, by far the most frequent form of BPPV, can be effectively treated by a number of different physical methods. During the last few years the diagnosis and treatment of BPPV became so popular that in our tertiary referral Dizziness Clinic we encounter many cases of over-diagnosis, misdiagnosis and maltreatment. This review describes the various types of BPPV and the appropriate diagnostic work-up and treatment, emphasizing the adequate management of uncommon presentations. All physicians who receive appropriate training in BPPV should be able to accurately diagnose posterior canal BPPV by performing the Dix-Hallpike positional test and treat it immediately by one of the physical maneuvers with a success rate of 70%-90%. Futhermore, appropriately trained physiotherapists should be able to treat these cases. Repeated physical maneuvers during a single treatment session seem to be clinically superior to a single maneuver. The published post-treatment measures are inconvenient and should be abandoned. Patients who fail to respond to a single treatment session or with frequent recurrences of BPPV can be instructed to perform a "self-treatment" maneuver. The diagnosis of the different subtypes of horizontal canal BPPV (geotropic and apogeotropic nystagmus) requires special skill since cerebellar and brainstem disorders might also cause horizontal positional nystagmus. Two methods of treatment are commonly used: a rolling maneuver of 270 degrees or 360 degrees ("barbecue maneuver") and the "forced prolonged position" with a success rate of about 70% after a few maneuvers. About 20% of cases of horizontal BPPV fail to respond to these treatments. The anterior canal variant of BPPV characterized by torsional downbeat nystagmus is very rare. In such cases a detailed neurological examination is mandatory in order to rule out other causes of downbeat nystagmus. The authors recommend that patients with suspected horizontal or anterior canal BPPV should be immediately examined by a neurologist and if no other neurological abnormality is found a referral to a specialized dizziness clinic should follow.
BibTeX: @article{Gordon2005, author = {Gordon, Carlos R and Gadoth, Natan}, title = {[Benign paroxysmal positional vertigo: who can diagnose it, how should it be treated and where?].}, journal = {Harefuah}, year = {2005}, volume = {144}, issue = {8}, pages = {567--71, 597}, keywords = {Diagnosis, Differential; Humans; Physical Therapy Modalities; Posture; Vertigo, diagnosis, therapy}, pmid = {16146156} }
Dumas, G., Charachon, R. and Ghozali, S.	[Benign paroxysmal positional vertigo. Apropos of 51 cases]. [Abstract] [BibTeX]	1994	Annales d'oto-laryngologie et de chirurgie cervico faciale : bulletin de la Societe d'oto-laryngologie des hopitaux de Paris Vol. 111(6), pp. 301-313	article
Abstract: 51 cases of benign paroxysmal vertigo have been investigated in 3 years. The findings put in evidence: the particular frequency of this pathology (18% of BPPV in a vestibulometry consultation), its opportunist character and the possible association with other more severe pathologies (meningiomas, multiple sclerosis, cerebellar venous angioma, vascular cerebral infarction) or more benign pathologies (labyrinth malformation, middle fossa atrophia). Sémont liberatory maneuver revealed to be much efficient (50% of patients free of disease after a single repositioning manoeuvre). Only 3 cases remaining unchanged after 2 years and intractable were proposed for surgery. We mention 7% of bilateral forms and 5% of alternating recurrent forms (sometimes on the right and sometimes on the left side). The recurrence is noted in 50% of BPPV followed at least during one year. We describe a particular topographic form concerning probably a cupulolithiasis of the external canal. 53% of cases beneficiated of CT-scan or of magnetic resonance imaging. The frequency and the possibility of pathological associations with BPPV bring to a particular vigilance for the diagnosis and to a particular care in the affirmation of the benignity in the case of long lasting vertigo (superior to 6 months), or when the nystagmus duration in Hallpike position is superior to 60 seconds.
BibTeX: @article{Dumas1994, author = {Dumas, G and Charachon, R and Ghozali, S}, title = {[Benign paroxysmal positional vertigo. Apropos of 51 cases].}, journal = {Annales d'oto-laryngologie et de chirurgie cervico faciale : bulletin de la Societe d'oto-laryngologie des hopitaux de Paris}, year = {1994}, volume = {111}, issue = {6}, pages = {301--313}, keywords = {Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Posture; Recurrence; Sex Factors; Vertigo, diagnosis, etiology, physiopathology; Vestibular Function Tests}, pmid = {7785928} }
Sauron, B. and Dobler, S.	[Benign paroxysmal positional vertigo. Diagnosis, course, physiopathology and treatment]. [Abstract] [BibTeX]	1994	La Revue du praticien Vol. 44(3), pp. 313-318	article
Abstract: The benign paroxystic positional vertigo (BPPV) is defined by brief attacks of rotational vertigo and concomitant rotatory-linear nystagmus, triggered by rapid extension and by lateral head tilt toward the affected ear. Cupulolithiasis of the posterior semi-circular canal from one inner ear is responsible of this peculiar type of positional vertigo. Definition diagnostic criteria are based upon the time history of the burst of rotational vertigo associated with the typical positioning nystagmus induced by rapid position changes from the setting to the head hanging right or left position during the Nylen-Barany maneuver. The nystagmus, which is a torsional nystagmus of the eye-balls rolling on the orbit's ground toward the affected and undermost ear, begins a few seconds after the head tilt, is best seen with Frentzel's glasses, preventing the suppression of the nystagmus by fixation, and the repetition of the maneuver will result in everlasting symptoms. According to the largest series of the literature the BPPV is the most frequent recognized cause of vertigo, with more than 30% of the cases of vertigo, explored in a dizziness clinic. In half of the cases, a peculiar etiology can be found, such as head trauma, ototoxic drug, or viral labyrinthitis, with a sex-ratio of one. On the contrary the sex-ratio among the idiopathic forms of BPPV is of two females for one male. The prognosis of BPPV is benign because of its recovery within weeks or months, either spontaneously, or after the liberatory maneuver. In rare cases, the vertigo recurs or persists for months or years. For some very handicapping BPPV, a surgical treatment can be proposed.
BibTeX: @article{Sauron1994, author = {Sauron, B and Dobler, S}, title = {[Benign paroxysmal positional vertigo. Diagnosis, course, physiopathology and treatment].}, journal = {La Revue du praticien}, year = {1994}, volume = {44}, issue = {3}, pages = {313--318}, keywords = {Adult; Child; Female; Humans; Male; Posture; Time Factors; Vertigo, diagnosis, physiopathology, therapy}, pmid = {8178095} }
Steddin, S. and Brandt, T.	[Benign paroxysmal positional vertigo. Differential diagnosis of posterior, horizontal and anterior canalolithiasis]. [Abstract] [BibTeX]	1994	Der Nervenarzt Vol. 65(8), pp. 505-510	article
Abstract: Evidence is presented that all typical features of benign paroxysmal positioning vertigo can be explained by canalolithiasis rather than by cupulolithiasis. A free floating clot of "heavy" inorganic particles gravitates to the most dependent part of the canal as soon as the patient's head is moved in a way that alters the angle between the canal's plane and the gravity vector. Based on the canalolithiasis mechanism we describe how characteristics of the thus elicited nystagmus differ if the posterior, the horizontal or the anterior semicircular canal is causative.
BibTeX: @article{Steddin1994a, author = {Steddin, S and Brandt, T}, title = {[Benign paroxysmal positional vertigo. Differential diagnosis of posterior, horizontal and anterior canalolithiasis].}, journal = {Der Nervenarzt}, year = {1994}, volume = {65}, issue = {8}, pages = {505--510}, keywords = {Calculi, physiopathology; Humans; Meniere Disease, physiopathology; Nystagmus, Pathologic, physiopathology; Orientation, physiology; Posture, physiology; Semicircular Canals, physiopathology}, pmid = {7969646} }
Honoré, B.	[Benign paroxysmal positional vertigo. Easy to diagnose--easy to treat]. [BibTeX]	2004	Ugeskrift for laeger Vol. 166(13), pp. 1236-1238	article
BibTeX: @article{Honore2004, author = {Honoré, Bent}, title = {[Benign paroxysmal positional vertigo. Easy to diagnose--easy to treat].}, journal = {Ugeskrift for laeger}, year = {2004}, volume = {166}, issue = {13}, pages = {1236--1238}, keywords = {Adult; Calcium Carbonate; Female; Humans; Otolithic Membrane, pathology; Posture; Semicircular Canals, pathology; Vertigo, diagnosis, therapy}, pmid = {15088487} }
von Brevern, M. and Lempert, T.	[Benign paroxysmal positional vertigo. Rapid diagnosis, successful treatment]. [BibTeX]	2002	HNO Vol. 50(7), pp. 671-8; quiz 679, 681	article
BibTeX: @article{Brevern2002a, author = {von Brevern, M and Lempert, T}, title = {[Benign paroxysmal positional vertigo. Rapid diagnosis, successful treatment].}, journal = {HNO}, year = {2002}, volume = {50}, issue = {7}, pages = {671--8; quiz 679, 681}, keywords = {Endolymph, physiology; Head Movements, physiology; Humans; Musculoskeletal Manipulations, methods; Otolithic Membrane, physiopathology; Semicircular Canals, physiopathology; Vertigo, etiology, physiopathology, therapy}, pmid = {12219679} }
von Brevern, M. and Lempert, T.	[Benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2004	Der Nervenarzt Vol. 75(10), pp. 1027-35; quiz 1036-7	article	DOI
Abstract: Benign paroxysmal positional vertigo is the most common vestibular disorder, accounting for about 20% of referrals in specialized dizziness clinics. Nowadays, canalolithiasis of the posterior semicircular canal has been widely accepted as the biological basis for typical benign paroxysmal positional vertigo as it is compatible with all clinical features of the disorder. Better understanding of its pathophysiological concepts has led to specific therapeutic strategies, which aim to clear the affected semicircular canal from mobile particles. After a single maneuver both Epley's and Semont's procedures lead to complete recovery in about 60% of patients and in nearly 100% when performed repeatedly. These positioning maneuvers have made benign paroxysmal positional vertigo the most successfully treatable cause of vertigo.
BibTeX: @article{Brevern2004a, author = {von Brevern, M and Lempert, T}, title = {[Benign paroxysmal positional vertigo].}, journal = {Der Nervenarzt}, year = {2004}, volume = {75}, issue = {10}, pages = {1027--35; quiz 1036-7}, doi = {https://doi.org/10.1007/s00115-004-1804-6}, keywords = {Humans; Labyrinth Diseases, complications, diagnosis, rehabilitation; Lithiasis, complications, diagnosis, rehabilitation; Physical Therapy Modalities; Practice Guidelines as Topic; Practice Patterns, Physicians'; Severity of Illness Index; Treatment Outcome; Vertigo, diagnosis, rehabilitation}, pmid = {15368055} }
Dehaene, I.	[Benign paroxysmal positional vertigo]. [BibTeX]	1999	Nederlands tijdschrift voor geneeskunde Vol. 143(5), pp. 276	article
BibTeX: @article{Dehaene1999, author = {Dehaene, I}, title = {[Benign paroxysmal positional vertigo].}, journal = {Nederlands tijdschrift voor geneeskunde}, year = {1999}, volume = {143}, issue = {5}, pages = {276}, keywords = {Female; Humans; Male; Semicircular Canals, physiopathology; Vertigo, diagnosis, physiopathology, therapy}, pmid = {10086161} }
Goplen, F. and Nordahl, S.H.G.	[Benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2002	Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke Vol. 122(15), pp. 1463-1466	article
Abstract: Benign paroxysmal positional vertigo is a disorder of the inner ear causing brief attacks of intense rotatory vertigo and nystagmus occurring shortly after certain well-defined head movements. The present review discusses treatment of this disease in relation to new knowledge about its epidemiology and pathogenesis. A review is given based on our experience and a Medline search of relevant literature published over the last ten years. The disorder is common; prevalence increases with age. There is now general agreement that the symptoms are caused by loose particles in the endolymph of the inner ear. Treatment by repositioning manoeuvres has proven effective. Treatment of benign paroxysmal positional vertigo is safe, effective, and inexpensive. It should start at the time of diagnosis. Management of typical cases should be feasible in a general practice setting.
BibTeX: @article{Goplen2002, author = {Goplen, Frederik and Nordahl, Stein Helge Glad}, title = {[Benign paroxysmal positional vertigo].}, journal = {Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke}, year = {2002}, volume = {122}, issue = {15}, pages = {1463--1466}, keywords = {Humans; Nystagmus, Pathologic, diagnosis, physiopathology, therapy; Physical Therapy Modalities; Posture; Vertigo, diagnosis, physiopathology, therapy}, pmid = {12185734} }
Holtmann, S.	[Benign paroxysmal positional vertigo]. [BibTeX]	1996	Deutsche medizinische Wochenschrift (1946) Vol. 121(4), pp. 113-114	article
BibTeX: @article{Holtmann1996, author = {Holtmann, S}, title = {[Benign paroxysmal positional vertigo].}, journal = {Deutsche medizinische Wochenschrift (1946)}, year = {1996}, volume = {121}, issue = {4}, pages = {113--114}, keywords = {Humans; Otolithic Membrane, physiopathology; Posture; Semicircular Canals, physiopathology; Vertigo, etiology, physiopathology}, pmid = {8631238} }
Komatsuzaki, A.	[Benign paroxysmal positional vertigo]. [BibTeX]	1978	Nihon rinsho. Japanese journal of clinical medicine Vol. Suppl, pp. 1854-1855	article
BibTeX: @article{Komatsuzaki1978, author = {Komatsuzaki, A}, title = {[Benign paroxysmal positional vertigo].}, journal = {Nihon rinsho. Japanese journal of clinical medicine}, year = {1978}, volume = {Suppl}, pages = {1854--1855}, keywords = {Humans; Posture; Vertigo, etiology}, pmid = {691548} }
Kutlubaev, M.A.	[Benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2016	Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova Vol. 116(3), pp. 73-78	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most common cause of vestibular vertigo. It is caused by dislodged otoconia that enters the semicircular canals. Its main symptom is relapsing positional vertigo. The provocative tests, in particular the Dix-Hallpike maneuver, are used to confirm the diagnosis. In case of positive result of the test, one of the maneuvers is peformed depending on the affected semicircular canal, for instance the Epley maneuver. It is important to differentiate BPPV from the vertigo of central origin.
BibTeX: @article{Kutlubaev2016, author = {Kutlubaev, M A}, title = {[Benign paroxysmal positional vertigo].}, journal = {Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova}, year = {2016}, volume = {116}, issue = {3}, pages = {73--78}, doi = {https://doi.org/10.17116/jnevro20161163173-78}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis, therapy; Humans; Patient Positioning; Recurrence; Semicircular Canals, physiopathology}, pmid = {27070476} }
van der Plas, J.P. and Tijssen, C.C.	[Benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	1998	Nederlands tijdschrift voor geneeskunde Vol. 142(49), pp. 2669-2674	article
Abstract: Benign paroxysmal positional vertigo is a common malfunction of the labyrinth, most frequently of the posterior canal, due to clot of debris in the endolymph. The attacks of vertigo are characterised by dependency on position, latency after positioning of the head, short duration, nystagmus, reversibility and fatiguableness. The diagnosis can be based on history, physical examination and provocative tilting of the head as described by Dix and Hallpike. In a typical case further investigations are not necessary. The symptoms often improve spontaneously. Half of the patients can be cured directly by stepwise tilting. This probably removes the clot from the canal of the labyrinth to the utriculus. Specific positional exercises also often have a good result, but not as quickly. Drug therapy has no place in the treatment.
BibTeX: @article{Plas1998, author = {van der Plas, J P and Tijssen, C C}, title = {[Benign paroxysmal positional vertigo].}, journal = {Nederlands tijdschrift voor geneeskunde}, year = {1998}, volume = {142}, issue = {49}, pages = {2669--2674}, keywords = {Cerebellar Diseases, diagnosis; Coriolis Force; Diagnosis, Differential; Dizziness, etiology; Female; Head-Down Tilt; Humans; Labyrinth Diseases, diagnosis, therapy; Male; Meniere Disease, diagnosis; Posture; Semicircular Canals, pathology; Vertigo, etiology}, pmid = {10065222} }
Rotermel', E.V.	[Benign paroxysmal positional vertigo]. [BibTeX]	2007	Vestnik otorinolaringologii(4), pp. 66-69	article
BibTeX: @article{Rotermel2007, author = {Rotermel', E V}, title = {[Benign paroxysmal positional vertigo].}, journal = {Vestnik otorinolaringologii}, year = {2007}, issue = {4}, pages = {66--69}, keywords = {Humans; Vertigo, diagnosis, physiopathology, therapy}, pmid = {17915384} }
Taraldsen, T.	[Benign paroxysmal positional vertigo]. [BibTeX]	2009	Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke Vol. 129(7)	article	DOI
BibTeX: @article{Taraldsen2009, author = {Taraldsen, T}, title = {[Benign paroxysmal positional vertigo].}, journal = {Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke}, year = {2009}, volume = {129}, issue = {7}, doi = {https://doi.org/10.4045/tidsskr.09.07D1}, keywords = {Humans; Nystagmus, Physiologic; Vertigo, diagnosis, etiology, physiopathology, therapy; Vestibular Function Tests; Vestibule, Labyrinth, anatomy & histology, physiopathology; Video Recording}, pmid = {19340992} }
Wolf, M.	[Benign paroxysmal positional vertigo]. [BibTeX]	1995	Harefuah Vol. 129(11), pp. 494-498	article
BibTeX: @article{Wolf1995, author = {Wolf, M}, title = {[Benign paroxysmal positional vertigo].}, journal = {Harefuah}, year = {1995}, volume = {129}, issue = {11}, pages = {494--498}, keywords = {Calculi, complications, physiopathology; Humans; Posture; Semicircular Canals; Vertigo, diagnosis, physiopathology, therapy}, pmid = {8846961} }
Ekvall Hansson, E. and Johansson, L.	[Benign paroxysmal positional vertigo--common cause of dizziness. A simple treatment can give a quick cure]. [BibTeX]	2007	Lakartidningen Vol. 104(40), pp. 2882-2883	article
BibTeX: @article{EkvallHansson2007, author = {Ekvall Hansson, Eva and Johansson, Lennart}, title = {[Benign paroxysmal positional vertigo--common cause of dizziness. A simple treatment can give a quick cure].}, journal = {Lakartidningen}, year = {2007}, volume = {104}, issue = {40}, pages = {2882--2883}, keywords = {Dizziness, diagnosis, etiology, therapy; Female; Humans; Middle Aged; Otolithic Membrane, physiopathology; Physical Therapy Modalities; Posture; Vertigo, complications, diagnosis, physiopathology}, pmid = {17966803} }
Hansen, S. and Karlberg, M.	[Benign paroxysmal positional vertigo--the most common form of otogenic vertigo]. [Abstract] [BibTeX]	2007	Ugeskrift for laeger Vol. 169(21), pp. 1996-2002	article
Abstract: Benign paroxysmal positional vertigo presents with brief, episodic, positioning-provoked vertigo and characteristic findings on Dix-Hallpike and other positional tests. This article is based on a systematic review of the literature and describes epidemiology, etiology, pathogenesis, diagnostic positional tests and treatment using canalith repositioning, liberatory and 360 degrees rotation manoeuvres. Diagnostic pitfalls, mastoid vibration, postmanoeuvre activity restriction and the ideal number of repositioning manoeuvres per treatment session are discussed.
BibTeX: @article{Hansen2007, author = {Hansen, Søren and Karlberg, Michael}, title = {[Benign paroxysmal positional vertigo--the most common form of otogenic vertigo].}, journal = {Ugeskrift for laeger}, year = {2007}, volume = {169}, issue = {21}, pages = {1996--2002}, keywords = {Diagnosis, Differential; Humans; Posture, physiology; Semicircular Canals, physiopathology; Vertigo, diagnosis, etiology, physiopathology, therapy; Vestibular Function Tests}, pmid = {17553377} }
Wu, Z.-M., Zhang, S.-Z., Liu, X.-J., Chen, X., Ji, F., Chen, A.-T., Yang, W.-Y. and Han, D.-Y.	[Benign paroxysmal positioning vertigo related to inner ear disorders]. [Abstract] [BibTeX]	2007	Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery Vol. 42(11), pp. 821-825	article
Abstract: To investigate the incidence of benign paroxysmal positional vertigo(BPPV) and to further understand the possible mechanism of BPPV. To observe the incidence of BPPV among vestibular neuritis, sudden deafness, Meniere's disease and Bell's palsy at vertigo clinic from January at 2004 to November at 2006 and to compare the therapeutic results with that of the primary BPPV. There are 4 types of inner ear disorders involved in the concomitant BPPV, ie, vestibular neuritis, sudden deafness, Meniere's disease and Bell's palsy and the incidence are 9.5% (5/53), 38.9% (35/90) and 0.3% (1/381) respectively; and there was 1 case of BPPV concomitant to Bell's palsy. Among the 42 concomitant BPPV, 5 cases were horizontal canal BPPV, 37 cases were posterior canal BPPV, and 1 cases had complicated anterior BPPV during repositioning maneuver. 39 cases of concomitant BPPV were canalithiasis and 3 cases were cupuliothiathitis, of which 75% (27/36) of concomitant BPPV emerged within 1/2 years after the onset of primary inner ear disorders. The therapeutic efficacy of the concomitant BPPV with canalith repositioning was similar to that of the primary type of BPPV. Following some inner ear disorder, BPPV could emerge, such as sudden deafness, vestibular neuritis and Meniere's disease. The most common type of BPPV was canalithiasis of posterior canal, and the cupulolithiasis of horizontal canal was uncommon. The anterior canal therapeutic efficacy of the concomitant BPPV with canalith repositioning was similar to that of the primary type of BPPV. The therapeutic efficacy of the concomitant BPPV with canalith repositioning was similar to that of the primary type of BPPV.
BibTeX: @article{Wu2007, author = {Wu, Zi-Ming and Zhang, Su-Zhen and Liu, Xing-Jian and Chen, Xi and Ji, Fei and Chen, Ai-Ting and Yang, Wei-Yan and Han, Dong-Yi}, title = {[Benign paroxysmal positioning vertigo related to inner ear disorders].}, journal = {Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery}, year = {2007}, volume = {42}, issue = {11}, pages = {821--825}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Ear Diseases, complications, therapy; Ear, Inner, physiopathology; Female; Humans; Male; Middle Aged; Vertigo, etiology, therapy; Young Adult}, pmid = {18300443} }
Martín Sanz, E. and Barona de Guzmán, R.	[Benign paroxysmal vertigo of childhood: categorization and comparison with benign positional paroxysmal vertigo in adult]. [Abstract] [BibTeX]	2007	Acta otorrinolaringologica espanola Vol. 58(7), pp. 296-301	article
Abstract: The differential diagnosis of vertigo in children is extensive. This implies an additional difficulty in diagnosing dizziness in paediatric population. Twenty-three children consecutively examined for paroxysmal attacks of dizziness and/or vertigo attacks entered our study, and were compared to a 15 adults group with benign positional paroxysmal vertigo. Fifteen healthy paediatric subjects and 18 adults were selected as control groups. The clinical characteristics of vertigo, presence of triggering factors, family history of migraine, presence of motion sickness, migraine, and other accompanying symptoms were considered. Neurological, vestibular, and auditory functions were assessed including the performance of a posturography in every group of patients. The presence of migraine, physical activity prior to vertigo, and positional trigger of vertigo were the clinical elements which differentiated both populations of patients with vertigo. There were significant differences in adult posturography between vertigo and control groups. In paediatric population, there were no differences between vertigo and control group in the posturography study. The benign paroxysmal vertigo of childhood complex is the most frequent aetiology of paediatric dizziness. The duration and triggers of vertigo in children are quite similar to those found in VPPB adults. The instability posterior to vertigo, measured by posturography, were less intense in children than in adult population.
BibTeX: @article{MartinSanz2007, author = {Martín Sanz, Eduardo and Barona de Guzmán, Rafael}, title = {[Benign paroxysmal vertigo of childhood: categorization and comparison with benign positional paroxysmal vertigo in adult].}, journal = {Acta otorrinolaringologica espanola}, year = {2007}, volume = {58}, issue = {7}, pages = {296--301}, keywords = {Adolescent; Adult; Child; Child, Preschool; Female; Humans; Male; Severity of Illness Index; Vertigo, diagnosis, physiopathology}, pmid = {17683696} }
Lillet-Leclercq, C., Lillet, M. and Demanez, J.P.	[Benign paroxysmal vertigo: comparison of 2 rehabilitation methods]. [Abstract] [BibTeX]	1989	Acta oto-rhino-laryngologica Belgica Vol. 43(4), pp. 351-361	article
Abstract: In case of non-self regression of Benign Paroxysmal Positional Vertigo (BPPV), reeducation is mandatory. Two reeducation protocols have been compared on 32 subjects with BPPV. Fourteen were handled by the classic habituation exercises, and 18 by the more recent Semont's manoeuvre. Moreover a specific rotatory nystagmus habituation has been investigated by caloric stimulation in Brunning III position. Semont's technique shows quicker and more efficient results. This manoeuvre doesn't provoke any habituation, in accordance with the hypothesis of mechanical dispersion of otoconia, based on the cupulolithiasis concept.
BibTeX: @article{Lillet-Leclercq1989, author = {Lillet-Leclercq, C and Lillet, M and Demanez, J P}, title = {[Benign paroxysmal vertigo: comparison of 2 rehabilitation methods].}, journal = {Acta oto-rhino-laryngologica Belgica}, year = {1989}, volume = {43}, issue = {4}, pages = {351--361}, keywords = {Adult; Exercise Therapy, methods; Female; Fixation, Ocular; Humans; Male; Middle Aged; Random Allocation; Vertigo, physiopathology, rehabilitation}, pmid = {2631561} }
Marín Garrido, C., Fraile Rodrigo, J.J., Alfaro García, J., Damborenea Tajada, J., Llorente Arenas, E.M., Ortiz García, A., Naya Gálvez, M.J. and Carmen Sampériz, L.	[Benign positional paroxysmal vertigo in the general ear, nose, and throat clinic]. [Abstract] [BibTeX]	2000	Acta otorrinolaringologica espanola Vol. 51(1), pp. 14-18	article
Abstract: Benign positional paroxysmal vertigo is a common disease which may be caused by abnormal movement of utricular debris in the posterior semicircular canal. It is diagnosed by the Dix-Hallpike positional maneuver eliciting vertigo and nystagmus. Treatment generally consists of physical exercises with the Epley or Semont maneuvers. We review 43 consecutive patients diagnosed as BPPV in the last year and treated with physical therapy (Epley maneuvers). Results were very good, with a cure rate of 88.37% (53.5% after a single maneuver). Physical therapy is an effective treatment for BPPV.
BibTeX: @article{MarinGarrido2000, author = {Marín Garrido, C and Fraile Rodrigo, J J and Alfaro García, J and Damborenea Tajada, J and Llorente Arenas, E M and Ortiz García, A and Naya Gálvez, M J and Carmen Sampériz, L}, title = {[Benign positional paroxysmal vertigo in the general ear, nose, and throat clinic].}, journal = {Acta otorrinolaringologica espanola}, year = {2000}, volume = {51}, issue = {1}, pages = {14--18}, keywords = {Adult; Aged; Female; Health Services; Humans; Male; Middle Aged; Otolaryngology; Posture; Semicircular Canals, physiopathology; Severity of Illness Index; Vertigo, physiopathology, rehabilitation}, pmid = {10799926} }
Weng, H.-y., Yu, L.-h. and Xu, Y.-m.	[Benign positional paroxysmal vertigo: report of a family with 5 cases]. [BibTeX]	2013	Zhonghua yi xue yi chuan xue za zhi = Zhonghua yixue yichuanxue zazhi = Chinese journal of medical genetics Vol. 30(4), pp. 503	article	DOI
BibTeX: @article{Weng2013, author = {Weng, Han-yu and Yu, Li-hua and Xu, Yan-ming}, title = {[Benign positional paroxysmal vertigo: report of a family with 5 cases].}, journal = {Zhonghua yi xue yi chuan xue za zhi = Zhonghua yixue yichuanxue zazhi = Chinese journal of medical genetics}, year = {2013}, volume = {30}, issue = {4}, pages = {503}, doi = {https://doi.org/10.3760/cma.j.issn.1003-9406.2013.04.026}, keywords = {Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Female; Humans; Male; Middle Aged; Pedigree; Vertigo, diagnosis, genetics}, pmid = {23926025} }
Waespe, W.	[Benign postural vertigo and nystagmus of the horizontal semicircular canal]. [Abstract] [BibTeX]	1997	Schweizerische medizinische Wochenschrift Vol. 127(8), pp. 287-295	article
Abstract: Benign paroxysmal vertigo and nystagmus are induced not only by the posterior but also by the horizontal semicircular canal. Benign positional nystagmus of the horizontal canal is more often observed than was previously thought. In 10 patients we analyzed the characteristics and the variability of nystagmus which accompanies positional vertigo of the horizontal canal. There are two forms of nystagmus: primary-geotropic, most often paroxysmal nystagmus (7 patients), and primary-apogeotropic, non-paroxysmal nystagmus (3 patients). Interestingly, in 2 patients with the primary-apogeotropic form the nystagmus converted during the examination into the primary-geotropic form. The reverse was not observed. We discuss the possible pathophysiological mechanisms which could be relevant for provoking manoeuvres.
BibTeX: @article{Waespe1997, author = {Waespe, W}, title = {[Benign postural vertigo and nystagmus of the horizontal semicircular canal].}, journal = {Schweizerische medizinische Wochenschrift}, year = {1997}, volume = {127}, issue = {8}, pages = {287--295}, keywords = {Adult; Aged; Aged, 80 and over; Electrooculography, methods; Eye Movements; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, physiopathology; Posture; Semicircular Canals, physiopathology; Signal Processing, Computer-Assisted; Vertigo, physiopathology}, pmid = {9157534} }
Petrone, D., De Candia, N. and Cassano, P.	[Bilateral semicircular canal pathology]. [Abstract] [BibTeX]	1997	Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale Vol. 17(3), pp. 215-218	article
Abstract: The authors report 12 cases of bilateral cupulolithiasis found in 142 subjects diagnosed as having benign paroxysmal positional vertigo. A case history was taken for these patients (4 males, 8 females; average age 28 years) and 10 reported a previous cranial trauma while the remainder did not refer any previous condition of note. All patients had normal cochleovestibular test results and showed no signs of concomitant internal and/or central pathologies. The Hallpike maneuver was able to evoke an intense symmetrical paroxysmal vertigo and this was often accompanied by neurovegetative phenomena while paroxysmal nystagmus always appeared. The patients were treated with a rehabilitative technique: the Brandt-Daroff was preferred as it is better tolerated. Within 15 days all patients had full remission of symptoms and at 6 months after treatment there have been no signs of recurrence. The conclusion is, thus, drawn that while the technical characteristics of the Sémont maneuver make it suitable only for use as rehabilitation in unilateral benign paroxysmal positional vertigo, this experience indicates that the Brandt-Daroff technique is better suited for the bilateral forms of this disorder.
BibTeX: @article{Petrone1997, author = {Petrone, D and De Candia, N and Cassano, P}, title = {[Bilateral semicircular canal pathology].}, journal = {Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale}, year = {1997}, volume = {17}, issue = {3}, pages = {215--218}, keywords = {Adolescent; Adult; Calculi, complications; Female; Humans; Labyrinth Diseases, complications; Male; Semicircular Canals; Vertigo, etiology, rehabilitation}, pmid = {9489147} }
Valenzuela, V., Neira, P. and Viada, J.	[Canalith reposition procedure for the treatment of benign paroxysmal postural vertigo]. [Abstract] [BibTeX]	2000	Revista medica de Chile Vol. 128(6), pp. 619-626	article
Abstract: Paroxysmal positional vertigo is a frequent and handicapping disease. To assess the effectiveness of physical therapies using particle reposition procedures in the treatment of paroxysmal positional vertigo. Fifty nine patients (13 male) with paroxysmal positional vertigo were studied. Clinical data was gathered, the affected channel was identified. In the same session, the corresponding canalith reposition procedure was performed (Epley maneuver for posterior channel and Lempert maneuver for lateral channel) and the immediate response was recorded. Twenty seven percent of patients had recurring episodes of vertigo and 60% had more than two weeks of evolution. In 49% of patients, vertigo was considered idiopathic and in 92%, the posterior channel was affected. One patient had a combined lesion of posterior and lateral channels and two patients had isolated lateral channel lesions. Seventy percent of patients recovered after two sessions of canalith reposition procedure. Canalith reposition maneuvers were highly effective for the treatment of paroxysmal positional vertigo.
BibTeX: @article{Valenzuela2000, author = {Valenzuela, V and Neira, P and Viada, J}, title = {[Canalith reposition procedure for the treatment of benign paroxysmal postural vertigo].}, journal = {Revista medica de Chile}, year = {2000}, volume = {128}, issue = {6}, pages = {619--626}, keywords = {Adolescent; Adult; Age Distribution; Clinical Protocols; Confidence Intervals; Female; Humans; Male; Middle Aged; Posture; Recurrence; Semicircular Canals, physiopathology; Treatment Outcome; Vertigo, epidemiology, rehabilitation}, pmid = {11016061} }
D'Onofrio, F., Costa, G., Mazzone, A. and Barillari, U.	[Canalith repositioning maneuver: proposal of a new therapy for benign paroxysmal positional vertigo of the posterior semicircular canal]. [Abstract] [BibTeX]	1998	Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale Vol. 18(5), pp. 300-306	article
Abstract: A new therapy is proposed for the treatment of Benign Paroxysmal Positional Vertigo (B.P.P.V.) of the Posterior Semicircular Canal (P.S.C.): the Canalith Repositioning Maneuver (C.R.M.). The need for a new maneuver to treat B.P.P.V. of the P.S.C. arises from the difficulties encountered in daily practice, under particular conditions (i.e. elderly, obese, traumatized patients and in the presence of rachis pain, etc.), to perform the most common rehabilitative techniques such as the Semont Maneuver and Epley's Canalith Repositioning Procedure (C.R.P.). The results achieved using this new technique on a group of 47 consecutive out-patients are presented and compared to those achieved using the Semont Maneuver in an analogous group of 23 patients. C.R.M. and the Semont Maneuver were performed once per treatment session and all patients were checked every 3 days until the symptoms of B.P.P.V. disappeared. Thereafter they were invited to return for check-up if signs of vertigo returned (follow-up 6-25 months). The two techniques proved equally effective: 87.5% of the cases were resolved with C.R.M., 82.6% with the Semont Maneuver. However, the C.R.M. provided other advantages as it resolved the problem immediately (i.e. in a single session) in 81% of the cases vs. 68.4% for the Semont Maneuver. In view of the Canalith theory, the action mechanism envisaged for all three maneuvers--C.R.M., the Semont Maneuver and the Epley C.R.P.--can be explained assuming that the canalith passes from the ampullar to the non ampullar branch of the (P.S.C.) passing finally through the Common Duct and into the Utricle. C.R.M. is a specific treatment for the B.P.P.V. of the P.S.C. and is simple to perform, well tolerated and quite effective. It is indicated in all cases of B.P.P.V. of the P.S.C. both as initial treatment and as alternative to other treatment methods which have proved ineffective or difficult to perform. Indeed, in therapy it is best to be quite skilled in more than one technique, availing oneself of a full range possibilities; in this way the cure can be tailored to the patient in each individual case and not vice versa.
BibTeX: @article{DOnofrio1998, author = {D'Onofrio, F and Costa, G and Mazzone, A and Barillari, U}, title = {[Canalith repositioning maneuver: proposal of a new therapy for benign paroxysmal positional vertigo of the posterior semicircular canal].}, journal = {Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale}, year = {1998}, volume = {18}, issue = {5}, pages = {300--306}, keywords = {Adolescent; Adult; Aged; Female; Follow-Up Studies; Humans; Male; Middle Aged; Posture; Retrospective Studies; Semicircular Canals, surgery; Treatment Outcome; Vertigo, rehabilitation, surgery}, pmid = {10361743} }
Califano, L., Montanaro, S.C., Capparuccia, P.G.G., Di Maria, D. and Villari, G.	[Case report: ipsilateral association of posterior and anterior canalolithiasis]. [Abstract] [BibTeX]	2002	Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale Vol. 22(6), pp. 376-379	article
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most frequently occurring dizzy syndrome. The literature provides ample descriptions of the forms determined by canalo/cupulolithiasis of the posterior canal, the most common, as well as canalo/cupulolithiasis of the horizontal canal. Descriptions of the forms of canalo/cupulolithiasis of the anterior canal are, instead, very rare and, sometimes questioned: this is fundamentally due to its superior position, which makes it a much less likely site for the accumulation of debris, both from a conceptual and practical point of view. For these reasons, the Authors feel that the presentation of this case of PPV is of particular interest. After analyzing and excluding other interpretations as less probable, they considered the syndrome as determined by the association of right posterior and anterior canalolithiasis. This form, as in the case of posterior canalolithiasis, responded to treatment with Semont's liberatory procedure.
BibTeX: @article{Califano2002, author = {Califano, L and Montanaro, S C and Capparuccia, P G G and Di Maria, D and Villari, G}, title = {[Case report: ipsilateral association of posterior and anterior canalolithiasis].}, journal = {Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale}, year = {2002}, volume = {22}, issue = {6}, pages = {376--379}, keywords = {Adult; Calculi, complications; Female; Humans; Labyrinth Diseases, complications; Vertigo, etiology}, pmid = {12647587} }
Qiao, W., Liu, J., Zeng, H., Liu, Y., Jia, W., Wang, H., Liu, B., Tan, J. and Li, C.	[Causes of emergency dizziness stratified by etiology]. [Abstract] [BibTeX]	2014	Zhonghua yi xue za zhi Vol. 94(21), pp. 1618-1622	article
Abstract: To explore the causes of emergency dizziness stratified to improve the diagnostic efficiency. A total of 1 857 cases of dizziness at our emergency department were collected and their etiologies stratified by age and gender. The top three diagnoses were benign paroxysmal positional vertigo (BPPV, 31.7%), hypertension (24.0%) and posterior circulation ischemia (PCI, 20.5%). Stratified by age, the main causes of dizziness included BPPV (n = 6), migraine-associated vertigo (n = 2), unknown cause (n = 1) for the group of <18 years; BPPV (51.5%), migraine-associated vertigo (14.5%) and neurosis (7.3%) for 18-44 years; BPPV (36.8%), hypertension (22.4%) and migraine-associated vertigo (11.2%) for 45-59 years; hypertension (30.8%), PCI (29.8%) and BPPV (22.9%) for 60-74 years; PCI (30.7%), hypertension (28.6%) and BPPV (25.5%) for 75-92 years. BPPV, migraine and neurosis were more common in females while hypertension and PCI predominated in males (all P < 0.05). As the main causes of emergency dizziness, BPPV, PCI, hypertension, neurosis and migraine showed the following significant demographic features: BPPV, PCI, hypertension, neurosis and migraine may be the main causes of dizziness. BPPV should be considered initially when vertigo was triggered repeatedly by positional change, especially for young and middle-aged women. And the other common causes of dizziness were migraine-associated vertigo, neurosis and Meniere's disease.Hypertension should be screened firstly in middle-aged and elderly patients presenting mainly with head heaviness and stretching. In elders with dizziness, BPPV is second in constituent ratio to PCI and hypertension.In middle-aged and elderly patients with dizziness, psychological factors should be considered and diagnosis and treatment should be offered timely.
BibTeX: @article{Qiao2014, author = {Qiao, Wenying and Liu, Jianguo and Zeng, Hong and Liu, Yugeng and Jia, Weihua and Wang, Honghong and Liu, Bo and Tan, Jing and Li, Changqing}, title = {[Causes of emergency dizziness stratified by etiology].}, journal = {Zhonghua yi xue za zhi}, year = {2014}, volume = {94}, issue = {21}, pages = {1618--1622}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Dizziness, etiology; Female; Humans; Hypertension; Male; Meniere Disease; Middle Aged; Physical Examination; Vertigo; Young Adult}, pmid = {25152282} }
Wang, H. and Yu, D.Z.	[Challenge in the management of benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2016	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 30(14), pp. 1161-1163	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder,which is defined as a disorder of the inner ear characterized by repeated episodes of positional vertigo as changes in head position.The effective positioning maneuvers has made BPPV the most successfully treated type of vertigo.However,some patients experience a serious disturbance with residual vertigo,light cupula and persistent or repeated attacks of BPPV even after several trials of canalith repositioning procedures.In this article,the challenge as light cupula,management of residual vertigo and repeated attacks of BPPV after canalith repositioning procedures were reviewed.
BibTeX: @article{Wang2016a, author = {Wang, H and Yu, D Z}, title = {[Challenge in the management of benign paroxysmal positional vertigo].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2016}, volume = {30}, issue = {14}, pages = {1161--1163}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2016.14.020}, keywords = {Benign Paroxysmal Positional Vertigo, therapy; Humans; Patient Positioning; Semicircular Canals; Vestibular Diseases; benign paroxysmal positional vertigo; challenge; light cupula; residual vertigo}, pmid = {29798448} }
Ou, Y., Chen, L., Xu, Y., Liang, X., Yang, H. and Zheng, Y.	[Characteristic of nystagmus and treatment of horizontal semicircular canal benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2008	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 22(16), pp. 721-724	article
Abstract: To investigate the characteristic of nystagmus and treatment of horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV). The positioning nystagmic features in 43 patients with HSC-BPPV treated between April 2004 and October 2006 were recorded and analyzed with video nystagmography. After the subtype and the effect side were determined, the appropriate repositioning maneuvers were chosen. (1) Geotropic nystagmus was recorded in 27 cases, of whom 19 cases were treated with barbecue maneuver and/or combined forced prolonged position maneuver, while the others were treated with Asprella's maneuver. (2) Apogeotropic nystagmus was recorded in 16 cases with two types, one of which could turn into geotropic nystagmus with Gufoni's maneuver or spontaneously (in 12 cases), the other type could not (in 4 cases) transform accepted barbecue maneuver and/or combined forced prolonged position maneuver. The total improvement rate was 72.1% after 1 week and 81.4% 3 months later respectively. The otolith position and the pathogenesis could be distinguished according to the nystagmic characteristics and type of HSC-BPPV. It was necessary to apply the appropriate repositioning maneuvers to treat HSC-BPPV.
BibTeX: @article{Ou2008, author = {Ou, Yongkang and Chen, Ling and Xu, Yaodong and Liang, Xiangfeng and Yang, Haidi and Zheng, Yiqing}, title = {[Characteristic of nystagmus and treatment of horizontal semicircular canal benign paroxysmal positional vertigo].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2008}, volume = {22}, issue = {16}, pages = {721--724}, keywords = {Adult; Aged; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, therapy; Semicircular Canals; Treatment Outcome; Vertigo, diagnosis, therapy}, pmid = {18975771} }
Zhang, M.J., Zhang, X.L., Zhong, L.Z., Wang, J.F., Liu, D.L. and Zhang, Q.F.	[Characteristics analysis of patients with benign paroxysmal positional vertigo-spontaneously cured]. [Abstract] [BibTeX]	2018	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 32(18), pp. 1426-1428	article	DOI
Abstract: To analyze the characteristics of patients with benign paroxysmal positional vertigo which were spontaneously cured. A total of 1 257 patients with chief complaint of positional vertigo were included and analyzed retrospectively, in which 921 cases were diagnosed as BPPV with the diagnosis standard of Guiyang meeting, and the other 336 cases were negative in the positional test diagnosed as BPPV-spontaneously cured. The age，gender and history course of the two groups were analyzed respectively. ①Among the 1 257 cases of BPPV, 336 (111 male and 225 female) were diagnosed as BPPV-spontaneously cured, with total self remission rate of 26.7%. And the female self remission rate is lower than men slightly（25.9% vs 28.5%）.②The ratio of male to female was 1∶2 in patients with BPPV-spontaneously cured and 1∶2.3 in patients with BPPV. Patients of the two groups were mostly female, and there was no significant difference in gender distribution. ③There was no significant difference in age distribution between patients of BPPV-spontaneously cured and BPPV, and patients of ＞50-70 years old were common in both groups.④The history course of patients in BPPV-spontaneously cured and BPPV both were mostly within 2 weeks at their first visit to hospital,each accounting for 75.3% and 69.3%.But the ratio of patients with BPPV-spontaneously cured for 1-2 weeks was higher than that of the BPPV (20.5% vs 15.1%), and the difference was statistically significant. Whether patients with BPPV can cure spontaneously is not related to age or gender, while women may have a tendency of lower self remission rate. The natural course of patients with BPPV-spontaneously cured is mostly within 2-4 weeks. The duration of natural course may be related to the type of semicircular canal involved.
BibTeX: @article{Zhang2018, author = {Zhang, M J and Zhang, X L and Zhong, L Z and Wang, J F and Liu, D L and Zhang, Q F}, title = {[Characteristics analysis of patients with benign paroxysmal positional vertigo-spontaneously cured].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2018}, volume = {32}, issue = {18}, pages = {1426--1428}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2018.18.015}, keywords = {benign paroxysmal positional vertigo; nature course; spontaneously-cured}, pmid = {30550177} }
Wang, X. and Xu, Y.S.	[Clincal analysis of missed diagnosis and misdiagnosis of benign paroxysmal positional vertigo]. [BibTeX]	2018	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 32(24), pp. 1904-1905	article	DOI
BibTeX: @article{Wang2018, author = {Wang, X and Xu, Y S}, title = {[Clincal analysis of missed diagnosis and misdiagnosis of benign paroxysmal positional vertigo].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2018}, volume = {32}, issue = {24}, pages = {1904--1905}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2018.24.014}, keywords = {diagnostic errors; missed diagnosis; vertigo}, pmid = {30550137} }
Hou, T., Yin, S.H., Zhu, Z.A. and Long, J.	[Clinical analysis of 384 cases of benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2017	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 31(8), pp. 601-606	article	DOI
Abstract: To study the disease characteristics in cases with benign paroxysmal positional vertigo(BPPV). The characteristics and clinical features of 384 cases with BPPV were retrospectively analyzed,and all cases were treated with repositioning maneuver.The treatment outcomes were observed and analyzed during the follow-up period. ①Of the 384 cases,331(86.20%) cases were PC-BPPV, 47(12.24%) cases were HC-BPPV and 3(0.78%) cases were AC-BPPV, 3(0.78%) cases were combined semicircular canal BPPV. ②All cases underwent repositioning maneuver, PC-BBPV cases first efficiency was 93.66%, long-term (six months) efficiency was 96.68%; HC-BBPV cases first efficiency was 91.49%, long-term (six months) efficiency was 95.74%;AC-BPPV cases first efficiency and long-term efficiency were 66.67%;combined semicircular canal BPPV cases first efficiency and long-term efficiency were 66.67%.③Among 331 cases with PC-BBPV, cases diagnosed duct stones accounted for 96.37%,cases diagnosed crest stones accounted for 3.63%. Among 47 cases with HC-BBPV, cases diagnosed duct stones accounted for 78.72%，cases diagnosed crest stones accounted for 21.28%.④During the follow-up of six months,the recurrence rate was 12.76%(49/384). ①In BPPV cases of Guangxi,the ratio of male and female,age of onset and the incidence of BPPV in each semicircular canal are consistent with other literatures.Geographical and ethnic factors do not affect the above results.②Repositioning maneuver is an simple and effective treatment for cases with BPPV.③There is higher recurrence rate in cases with BPPV after repositioning maneuver.
BibTeX: @article{Hou2017, author = {Hou, T and Yin, S H and Zhu, Z A and Long, J}, title = {[Clinical analysis of 384 cases of benign paroxysmal positional vertigo].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2017}, volume = {31}, issue = {8}, pages = {601--606}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2017.08.007}, keywords = {Benign Paroxysmal Positional Vertigo; China; Female; Follow-Up Studies; Humans; Male; Patient Positioning; Retrospective Studies; Semicircular Canals, physiopathology; Treatment Outcome; repositioning maneuver; treatment outcome; vertigo}, pmid = {29871323} }
Zhu, M.C., Zhou, F., Tan, G.J., Wang, M., Yu, F., Wang, H.T., Huang, L.F. and Liang, Z.J.	[Clinical analysis of benign paroxysmal positional vertigo associated with Meniere's disease]. [Abstract] [BibTeX]	2016	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 30(20), pp. 1615-1619	article	DOI
Abstract: To explore treatment and therapeutic effectiveness of patients with Meniere' s disease and benign paroxysmal positional vertigo. A series of BPPV 60 cases was retrospective analyzed. The patients were divided into three groups: Meniere' s disease with multiple semicircular canal BPPV(n=6), with single semicircular canal BPPV (n=11) and BPPV without Meniere' s disease group(Control,n=43). All patients were diagnosed by the Dix-Hallpike test or roll test and treated with the canalith repositioning procedure. The outcomes were compared among the three groups. Unilateral semicircular canal BPPV was more than bilateral BPPV, the posterior semicircular canal was the most common canal involved, and multiple semicircular canal BPPV with Meniere' s disease patients needed repeated canalith repositioning procedure and had a higher recurrence rate. A lower success rate of treatment and a higher recurrence rate was found in BPPV patients with Meniere' s disease compared with those without Meniere' s disease . The recurrence rate is highest in multiple semicircular canal BPPV with Meniere' s disease.
BibTeX: @article{Zhu2016, author = {Zhu, M C and Zhou, F and Tan, G J and Wang, M and Yu, F and Wang, H T and Huang, L F and Liang, Z J}, title = {[Clinical analysis of benign paroxysmal positional vertigo associated with Meniere's disease].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2016}, volume = {30}, issue = {20}, pages = {1615--1619}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2016.20.009}, keywords = {Meniere's disease; benign paroxysmal positional vertigo; canalith repositioning procedure }, pmid = {29871157} }
Guo, X.D., Wang, Q.L., Mei, X.S., Li, Y. and Zhang, Z.C.	[Clinical analysis of benign paroxysmal positional vertigowith multiple canal involvement]. [Abstract] [BibTeX]	2016	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 30(13), pp. 1013-1015	article	DOI
Abstract: To compare the clinical features and outcomes between patients with multi-canal benign paroxysmal positional vertigo(BPPV) and single-canal BPPV. Five-hundred and seventy-eight patients with BPPV were retrospectively analyzed and divided into three groups: single-canal BPPV(526 cases),multi-canal BPPV in unilateral ear(11 cases) and multi-canal BPPV in both ears(41 cases).All patients were diagnosed by using the Dix-Hallpike test or roll test and treated with the canalith repositioning procedure.The following factors,including aetiology,age,sex,response to treatment and recurrence,were compared among the three groups. ①Greater percentage of idiopathic cases were identified in single-canal(66.2%:48.2%, <0.01).Traumatic origin and prior history of BPPV were more common in bilateral multi-canal(41.6%:9.2%, <0.05)and unilateral multi-canal (36.2%:0, <0.01)respectively.②The recurrence rate was higher in multi-canal BPPV(40.4%:14.3%, <0.01). Idiopathic BPPV is more common in single-canal BPPV.Potential causes may be identified in multi-canal BPPV.However,over 90% of the patients with single-canal and multi-canal BPPV are cured.
BibTeX: @article{Guo2016, author = {Guo, X D and Wang, Q L and Mei, X S and Li, Y and Zhang, Z C}, title = {[Clinical analysis of benign paroxysmal positional vertigowith multiple canal involvement].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2016}, volume = {30}, issue = {13}, pages = {1013--1015}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2016.13.002}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis, etiology; Humans; Patient Positioning; Recurrence; Retrospective Studies; Semicircular Canals; benign paroxysmal positional vertigo; prognosis; recurrence; semicircular canal}, pmid = {29798027} }
Zhang, G., Tang, Y., Chen, Y., Zeng, Y., Xu, Y. and Wang, L.	[Clinical analysis of different canalith repositioning maneuver in treatment of apogeotropic nystagmus of horizontal semicircular canal benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2015	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 29(18), pp. 1602-1604	article
Abstract: To analyze the clinical effect of different canalith repositioning maneuver in the treatment of the apogeotropic nystagmus of horizontal semicircular canal benign paroxysmal positional vertigo (apogeotropic HSC-BPPV). Forty patients of apogeotropic HSC-BPPV colleted from March 2014 to May 2015 were divided into two groups, each group had 20 cases. The control group was repositioned with the Gufoni maneuver before the Barbecue maneuver, the research group with the improved Nuti maneuver. The success rate of the research group was not lower than that of the control group, which hadn't statistical (P > 0.05). And after the Barbecue maneuver, all patients have been recovered. Comparing with the Gufoni maneuver, the improved Nuti maneuver designed by us, had the same success rate to treat apogeotropic HSC-BPPV, and is easier to learn,with more compliance,more comfort and more repeatability.
BibTeX: @article{Zhang2015a, author = {Zhang, Guoqing and Tang, Yueying and Chen, Yu and Zeng, Yisheng and Xu, Yahua and Wang, Liyun}, title = {[Clinical analysis of different canalith repositioning maneuver in treatment of apogeotropic nystagmus of horizontal semicircular canal benign paroxysmal positional vertigo].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2015}, volume = {29}, issue = {18}, pages = {1602--1604}, keywords = {Benign Paroxysmal Positional Vertigo, therapy; Humans; Nystagmus, Pathologic, therapy; Patient Positioning, methods; Semicircular Canals, physiopathology}, pmid = {26790257} }
Zhou, F., Zhu, M.C., Wang, M., Wang, H.T., Jiao, Y.L., Huang, L.F. and Liang, Z.J.	[Clinical analysis of idiopathic sudden sensorineural hearing loss with vertigo and without vertigo]. [Abstract] [BibTeX]	2018	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 32(12), pp. 920-923	article	DOI
Abstract: To explore the clinical characteristics and treatments of patients with idiopathic sudden sensorineural hearing loss（ISSHL） with or without vertigo. One hundred and twenty ISSHL cases were divided into vertigo group ( =36) , without vertigo group ( =84) , and with benign paroxysmal positional vertigo group ( =15). All patients were in regular treatment. Besides, according to the types of BPPV, patients do the Epley maneuver or Barbecue roll maneuver. We summarized the result and treatment of the patients. The audiometric curve of ISSHL with vertigo were mainly at flat type. After treatment of the ISSHL patients were better than the patients with vertigo in the degrees of hearing loss . Furthermore, the rate of the patients of marked efficiency, efficiency and total efficiency of ISSHL was lower than the ones without.The patients with BPPV, including 12 cases of posterior semicircular canal and the 3 cases of lateral semicircular canal, were all ipsilateral. ISSHL with vertigo group lost hearing is severer than ISSHL without vertigo. Thus the hearing and the treatment effect were worse.The symptoms without vertigo in ISSHL were better than the patients with vertigo.
BibTeX: @article{Zhou2018b, author = {Zhou, F and Zhu, M C and Wang, M and Wang, H T and Jiao, Y L and Huang, L F and Liang, Z J}, title = {[Clinical analysis of idiopathic sudden sensorineural hearing loss with vertigo and without vertigo].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2018}, volume = {32}, issue = {12}, pages = {920--923}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2018.12.009}, keywords = {Audiometry; Benign Paroxysmal Positional Vertigo, complications; Hearing Loss, Sensorineural, complications, diagnosis, therapy; Hearing Loss, Sudden, complications, diagnosis, therapy; Humans; Semicircular Canals; Barbecue roll maneuver; Epley maneuver; hearing loss,sudden; vertigo}, pmid = {29921074} }
Gong, N., Zhang, X., Ge, L. and Xu, D.	[Clinical analysis of idiopathic sudden sensorineural hearing loss with vertigo]. [Abstract] [BibTeX]	2015	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 29(22), pp. 1963-5, 1969	article
Abstract: To explore the clinical characteristics and prognosis of patients with idiopathic sudden sensorineural hearing loss (ISSHL) with vertigo. By analyzing the clinical data of 271 ISSHL patients, they were divided into without vertigo group (n = 169) and vertigo group (n = 102). In vertigo group, 34 cases were patients with benign paroxysmal positional vertigo (BPPV) secondary to the ISSHL. All patients received conventional treatment. According to the types of BPPV, patients with secondary BPPV received Epley maneuver or Barbecue roll maneuver. By analyzing the results of the pure tone audiometry test and treatment outcomes of the patients, we summarized the clinical characteristics of ISSHL patients with vertigo. The audiometric curves of ISSHL with vertigo group were mainly at high frequency. The degrees of hearing loss of these patients were severe and profound. After treatment, the improvement of hearing threshold for ISSHL with vertigo group was lower than that for ISSHL without vertigo group. What's more, the rate of recovery, success and total effective of audition for ISSHL with vertigo group was also obviously lower than that for ISSHL without vertigo group. Of all the patients with BPPV, 27 cases of posterior semicircular canal and 7 cases of lateral semicircular canal were identified. All patients with BPPV were diagnosed as the same ears as the ISSHL. ISSHL with vertigo group lost hearing more severely than ISSHL without vertigo group. Also, the improvement of hearing and the effective after treatment were really poor. The symptoms of ISSHL with BPPV group improved and eased significantly than that of ISSHL without BPPV group. The major of BPPV secondary to the ISSHL occurs in the posterior semicircular canal. The canalith repositioning is an effective therapy to the secondary BPPV.
BibTeX: @article{Gong2015, author = {Gong, Nan and Zhang, Xiaotong and Ge, Liqiao and Xu, Dadao}, title = {[Clinical analysis of idiopathic sudden sensorineural hearing loss with vertigo].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2015}, volume = {29}, issue = {22}, pages = {1963--5, 1969}, keywords = {Audiometry, Pure-Tone; Auditory Perception; Benign Paroxysmal Positional Vertigo, complications, therapy; Hearing Loss, Sensorineural, complications, therapy; Hearing Loss, Sudden, complications, therapy; Humans; Patient Positioning; Prognosis; Semicircular Canals, physiopathology; Treatment Outcome}, pmid = {26911059} }
Han, Z., Tian, L. and Chi, F.	[Clinical analysis of the diagnosis and treatment of benign paroxysmal positional vertigo by TRV-CRP]. [Abstract] [BibTeX]	2013	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 27(22), pp. 1243-1246	article
Abstract: To explore the effective of the new mechanical assistant canalith repositioning procedure (TRV-CRP) to the diagnosis and treatment of the benign paroxysmal positional vertigo (BPPV). The data of the cases with suspected diagnosis of BPPV from April to June of 2012 checked and treated by TRV-CRP in our vestibular function checking room were collected and analyzed. All of the cases were followed up to one to three months. Total 504 cases of suspected diagnosis of BPPV were collected. Three cases were rejected for un completed procedure. All of the 501 completed procedure cases included 162 male and 339 female with age ranging from 10 years old to 86 years old (52. 8 +/- 14 years old). 169 cases (33.73%) were positive diagnosis and 332 cases were negative diagnosis (66.27%). 135 cases enrolled only one semicircular canal (SC) account for 79.89% of all the positive diagnosis that included 17 cases of left horizontal SC, 4 cases of left superior SC, 29 cases of left posterior SC, 23 cases of right horizontal SC, 4 cases of superior SC and 58 cases of right posterior SC. 25 cases enrolled more than two SC (14.80%). 9 cases of objective BPPV (5.33%) included 5 cases of right posterior SC, 3 cases of left posterior SC and one cases of right horizontal SC. Exception of 163 cases without classic BPPV history in the 332 negative diagnosis cases, 169 cases had classic BPPV history including 14 cases treated by manual canalith repositioning procedure and 33 cases which had released from the vertigo. The rate of treatment effective by TRV-CRP was 100%. There were 20 cases returned for retreatment because their unsatisfied about the release of their symptom but proved to be negative diagnosis again in 10 cases and positive diagnosis in 10 cases, however, only 4 cases proved to be the same SC disease were considered as relapse (2.37%) and others enrolled different SC. After retreated, all cases got release without relapse. TRV-CRP could diagnosis 34% of the primary diagnosis cases of BPPV. TRV-CRP had high rate of effective and lower relapse which especially fitted to patients suffered from complex BPPV or difficult to finish the manual repositioning procedure. However, due to the expensive of TRV-CRP, it is reasonable to combine TRV-CRP and manual repositioning procedure in clinical.
BibTeX: @article{Han2013, author = {Han, Zhao and Tian, Liang and Chi, Fanglu}, title = {[Clinical analysis of the diagnosis and treatment of benign paroxysmal positional vertigo by TRV-CRP].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2013}, volume = {27}, issue = {22}, pages = {1243--1246}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Child; Female; Humans; Male; Middle Aged; Otolithic Membrane; Physical Therapy Modalities; Treatment Outcome; Vertigo, diagnosis, therapy; Young Adult}, pmid = {24616981} }
Ju, J., Li, J.R. and Zou, S.Z.	[Clinical characteristics and short term outcome of very old benign paroxysmal positional vertigo patients]. [Abstract] [BibTeX]	2017	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 31(24), pp. 1872-1874	article	DOI
Abstract: To provide evidence and strategy for treatment of very old patients with benign paroxysmal positional vertigo (v-BPPV) by retrospective analysis of v-BPPV patients. According to the criteria, 19 v-BPPV patients were collected, aging from 80 to 91 years old, including 10 horizontal semicircular canal BPPV (HC-BPPV), 4 posterior semicircular canal (PC-BPPV) and 5 mutiple semicircular canal BPPV patients. PC-BPPV patients were treated by Epley or Li maneuver, and HC-BPPV patients were treated by Barbecue or Li maneuver. Each patient was treated twice, with an interval of 5 to 10 minutes. Rates of 3-day cure and efficacy were 63.16% and 94.74%, respectively. Rates of 1-week cure and efficacy were 89.47% and 100.00%, respectively. v-BPPV can have good outcomes via proper treatment. Age should not influence BPPV outcomes, while we should pay more attention to v-BPPV patients' physiclal status and systematic diseases which may increase risk to diagnosis and treatment.
BibTeX: @article{Ju2017, author = {Ju, J and Li, J R and Zou, S Z}, title = {[Clinical characteristics and short term outcome of very old benign paroxysmal positional vertigo patients].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2017}, volume = {31}, issue = {24}, pages = {1872--1874}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2017.24.002}, keywords = {Aged, 80 and over; Benign Paroxysmal Positional Vertigo, diagnosis, therapy; Humans; Retrospective Studies; Semicircular Canals; aged, 80 and over; treatment effectiveness; vertigo}, pmid = {29798306} }
Chen, Z., Chen, Y., Xu, S., Yin, W., Qian, Y. and Liu, S.	[Clinical characteristics of benign paroxysmal positional vertigo secondary to sudden deafness]. [Abstract] [BibTeX]	2013	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 27(1), pp. 31-33	article
Abstract: To retrospectively analyze the clinical characteristics of the benign paroxysmal positional vertigo (BPPV) secondary to the sudden deafness (SD) and to explore pathogenetic mechanism. One hundred and seventy-eight cases of the SD in our department were retrospectively analyzed. They were all treated under the guidance of clinical guidelines. (1) In all these patient's with SD, there were 31 cases with BPPV secondary to the SD. There were 26 cases of BPPV of posterior semicircular canal and 5 cases of BPPV of lateral BPPV semicircular canal. All patients with BPPV were diagnosed as the same ears as the SD, including 16 cases on left sides and 15 on right sides. (2) The interval between the onset of SD and BPPV was less than one week in 27 cases, between one week and one month in 3 cases, and between one and three months in 1 case. (3) All patients with BPPV secondary to the SD were cured with Epley maneuver or Barbecue roll maneuver. The occurrence of BPPV may follow SD, and the major of BPPV secondary to the SD occurs in the posterior semicircular canal. The canalith repositioning is an effective therapy to the secondary BPPV.
BibTeX: @article{Chen2013a, author = {Chen, Zhiling and Chen, Yanchun and Xu, Shiying and Yin, Wenhua and Qian, Yasheng and Liu, Suqin}, title = {[Clinical characteristics of benign paroxysmal positional vertigo secondary to sudden deafness].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2013}, volume = {27}, issue = {1}, pages = {31--33}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo; Female; Hearing Loss, Sudden, complications, diagnosis; Humans; Male; Middle Aged; Retrospective Studies; Vertigo, diagnosis, etiology; Young Adult}, pmid = {23646430} }
Zhao, P.Y.	[Clinical effect of ligustrazine in patients with benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	1991	Zhong xi yi jie he za zhi = Chinese journal of modern developments in traditional medicine Vol. 11(12), pp. 719-20, 708	article
Abstract: The therapeutic effect of Ligustrazine was studied in patients with benign paroxysmal positional vertigo (BPPV). 11 cases were given Ligustrazine 100 mg daily (iv. or im.), another 11 cases were given Valium and Diphenidol as the control group. The results were as follows: In Ligustrazine group, the average curative time was 37 days. In the control group, the average curative time was 72 days. This result suggests that Ligustrazine is a useful drug in the treatment of BPPV. It is believed that the cause of BPPV is due to the occlusion of the anterior vestibular artery. Ligustrazine has the effect of improving microcirculation of the cochlea.
BibTeX: @article{Zhao1991, author = {Zhao, P Y}, title = {[Clinical effect of ligustrazine in patients with benign paroxysmal positional vertigo].}, journal = {Zhong xi yi jie he za zhi = Chinese journal of modern developments in traditional medicine}, year = {1991}, volume = {11}, issue = {12}, pages = {719--20, 708}, keywords = {Adult; Aged; Cochlea, blood supply; Female; Humans; Male; Microcirculation; Middle Aged; Posture; Pyrazines, therapeutic use; Vasodilator Agents, therapeutic use; Vertigo, drug therapy, physiopathology}, pmid = {1821336} }
Qi, H., Wang, B., Yu, W., Zheng, Z. and Yang, J.	[Clinical efficacy and quality of life evaluation of BPPV by different reduction methods]. [Abstract] [BibTeX]	2016	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 30(5), pp. 392-395	article
Abstract: Comparative analysis of the clinical curative effect of manipulative reduction and TRV- CRP treatment of BPPV, comfort degree during reset and quality of life improvement. One hundred and thirty-two patients with BPPV were randomly divided into two groups ,one group underwent the traditional manip- ulative reduction, the other group with TRV-CRP. DRI and VAS was evaluated in the pre and after treatment and evaluation of the efficacy was conducted. The results of two groups were compared. The effective rate of manipulative reduction after a week treatment was 89. 23% and TRV-CRP.was 98. 51%, which was higher in TRV-CRP group than that of the manipulation reduction group(P<0. 05). The comfort degree of the manipulation reduction group was 4. 54±2. 48,higher than the TRV-CRP group which was 5. 48±1. 44 (P<0. 05). The score of DHI showed no significant difference before treatment between manipulation reduction group and TRV-CRP group(P>0. 05), the score of the two groups were decreased after a week of reduction, but the improvement of TRV-CRP group was higher than that of manipulation reduction group(P<0. 05). The success rate of TRV-CRP was higher than that of manipulative reduction,but manipulative reduction comfort degree was higher than TRV-CRP, the two methods can both improve the quality of life of patients with BPPV. TRV-CRP has many advantages over manipulative reduction, but manipulative reduction is simple with low cost, and the effect is still a great advantage. In clinical work, we should reasonable combine the two methods,so as to improve the cure rate of RPPV.
BibTeX: @article{Qi2016, author = {Qi, Hui and Wang, Binquan and Yu, Wenyong and Zheng, Zhiying and Yang, Jie}, title = {[Clinical efficacy and quality of life evaluation of BPPV by different reduction methods].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2016}, volume = {30}, issue = {5}, pages = {392--395}, keywords = {Benign Paroxysmal Positional Vertigo, therapy; Humans; Patient Positioning; Quality of Life; Treatment Outcome}, pmid = {27382685} }
Owada, S., Yamamoto, M., Suzuki, M., Yoshida, T. and Nomura, T.	[Clinical evaluation of vertigo in menopausal women]. [Abstract] [BibTeX]	2012	Nihon Jibiinkoka Gakkai kaiho Vol. 115(5), pp. 534-539	article
Abstract: Vertigo is one of the usual menopausal symptoms. We have often examined some women under the complaint of vertigo related with the menopause. We diagnosed each disease based on neuro-otological examinations and investigated the characteristics of menopausal-associated vertigo. We studied 413 women aged 40-59 years old who complained of vertigo. There were 73 women with menopause symptoms (14 women introduced from the gynecologist in our medical center, 18 women had undergone treatment at another female clinic, and 41 women visited an otorhinolaryngologist first) compared with 340 women without menopause symptoms. In the menopause group, 41 (56.2%) cases were diagnosed as having benign paroxysmal positional vertigo (BPPV), 13 (17.8%) cases had Meniere's disease, sudden deafness with vertigo accounted 2 cases, one was an acoustic tumor, and so on. The percentage of patients with BPPV was almost same ratio between the menopause group (56.2%) and the non-menopause group (52.9%). The percentage of patients with Meniere's disease was higher markedly in the menopausal group (17.8%). than the non-menopause group (9.7%). Menopausal symptoms are caused not only by hot flashes related to a lack of estrogen but also by psychological factors. The onset of Meniere's disease can also be influenced by psychological factors. As for the diagnosis of Meniere's disease, we supposed the reason for the higher percentage in the menopausal group was its relationship with psychological factors. We could diagnose and treat some menopausal women with vertigo. We believe that joint consultation with a gynecologist and otorhinolaryngologist would be necessary to ensure an optimum quality of life for such patients.
BibTeX: @article{Owada2012, author = {Owada, Satoko and Yamamoto, Masahiko and Suzuki, Mitsuya and Yoshida, Tomoe and Nomura, Toshiyuki}, title = {[Clinical evaluation of vertigo in menopausal women].}, journal = {Nihon Jibiinkoka Gakkai kaiho}, year = {2012}, volume = {115}, issue = {5}, pages = {534--539}, keywords = {Female; Humans; Menopause; Middle Aged; Vertigo, diagnosis, therapy}, pmid = {22686064} }
Feng, X.Z., Zhu, J.S., Lu, J.N. and Zhang, L.P.	[Clinical features and advanced progress of secondary BPPV]. [Abstract] [BibTeX]	2017	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 31(20), pp. 1621-1624	article	DOI
Abstract: BPPV is a disease provoked by abrupt head movements, results in short paroxysmal vertigo or nystagmus. These patients often can accurately describe the dizziness happened when they head move suddenly, especially when looking upward, turning over in bed, lying down, or bending over. BPPV is divided into idiopathic BPPV and secondary BPPV, in most cases. The underlying cause cannot be determined, which is called idiopathic; however, in 30% patients, BPPV may be attributed to a specific cause and is termed secondary BPPV. We reviewed the pathogenesis, mechanisms, clinical features, treatment and the latest progress of secondary BPPV.
BibTeX: @article{Feng2017, author = {Feng, X Z and Zhu, J S and Lu, J N and Zhang, L P}, title = {[Clinical features and advanced progress of secondary BPPV].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2017}, volume = {31}, issue = {20}, pages = {1621--1624}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2017.20.020}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis, etiology, therapy; Dizziness; Head Movements; Humans; Nystagmus, Pathologic; Semicircular Canals; Vertigo; clinical features; latest progress; vertigo}, pmid = {29797965} }
Zhang, J.-H., Huang, J., Zhao, Z.-X., Zhao, Y., Zhou, H., Wang, W.-Z. and Tian, G.-H.	[Clinical features and therapy of subjective benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2007	Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery Vol. 42(3), pp. 177-180	article
Abstract: To evaluate the clinical features and therapy of subjective benign paroxysmal positional vertigo (S-BPPV). By retrospectively analyzing the results of clinical features and therapy in 12 patients with S-BPPV from January 2003 to September 2006, the results were compared with 24 patients with objective benign paroxysmal positional vertigo (O-BPPV) of posterior semicircular canal. S-BPPV patients suffered from attack of transient vertigo with sudden onset triggered by head motion but no concomitant nystagmus in Dix-Hallpike test. The latency and duration of vertigo attack were (4.42 +/- 2.02) s and (8.67 +/- 4.31) s in S-BPPV, (3.2 +/- 1.18) s and (14.75 +/- 4.97) s in O-BPPV of posterior semicircular canal. The differences between the two groups were all significant (t = 2.30, P < 0.05 and t = 3.61, P < 0.01). The symptoms disappeared in 11 patients after a single therapy of particular repositioning maneuver and 1 patient after 2 times therapy in S-BPPV. The one-stage success rate was 91.7% in S-BPPV and 79.2% in O-BPPV of posterior semicircular canal, but the difference between these two groups was not significant. The number of circulation therapy in first management was (1.75 +/- 1.08) times in S-BPPV and (3.38 +/- 1.06) times in O-BPPV of posterior semicircular canal, while the difference was significant (t = 4.32, P < 0.01). There were 2 patients recurred during follow-up in S-BPPV and 7 patients in O-BPPV of posterior semicircular canal, but the difference wasn't significant. Longer latency, shorter duration and need less circulation therapy are achieved in S-BPPV compared with O-BPPV of posterior semicircular canal, which indicate that the effectiveness of S-BPPV seems to be more favorable than that of O-BPPV of posterior semicircular canal.
BibTeX: @article{Zhang2007, author = {Zhang, Jian-Hua and Huang, Jian and Zhao, Zhong-Xin and Zhao, Ying and Zhou, Hui and Wang, Wen-Zhao and Tian, Guo-Hong}, title = {[Clinical features and therapy of subjective benign paroxysmal positional vertigo].}, journal = {Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery}, year = {2007}, volume = {42}, issue = {3}, pages = {177--180}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Retrospective Studies; Semicircular Canals, physiopathology; Treatment Outcome; Vertigo, diagnosis, etiology, therapy; Young Adult}, pmid = {17633273} }
Takeda, N., Nishiike, S., Kitahara, T., Kubo, T., Ogino, H. and Koizuka, I.	[Clinical features and utricular dysfunction in patients with benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	1997	Nihon Jibiinkoka Gakkai kaiho Vol. 100(4), pp. 449-456	article
Abstract: We report the clinical features in patients with benign paroxysmal positional vertigo (BPPV), who met the following criteria; (1) a history of brief episodes of positional vertigo, and (2) a characteristic torsional paroxysmal positional nystagmus that was observed visually. The mean age of onset was 55 years. There was no sex predominance. In most patients, positional vertigo disappeared within 2 months. We then used the eccentric rotatory test to examine the patients otolithic function. In the eccentric rotatory test, a patient is rotated around an axis located behind his head (eccentric rotation, ECR). We have demonstrated that the enhancement of vestibulo-ocular reflex (VOR) gain in ECR can be used as an index of the utricular function. Enhancement of VOR gain was observed in ECR to the lower ear in positional vertigo, but not to the uppermost ear. The findings suggest an imbalance in utricular function in patients with BPPV. Otoconia dislodged from the deranged utricle may be a source of canalolithiasis/cupulolithiasis.
BibTeX: @article{Takeda1997, author = {Takeda, N and Nishiike, S and Kitahara, T and Kubo, T and Ogino, H and Koizuka, I}, title = {[Clinical features and utricular dysfunction in patients with benign paroxysmal positional vertigo].}, journal = {Nihon Jibiinkoka Gakkai kaiho}, year = {1997}, volume = {100}, issue = {4}, pages = {449--456}, keywords = {Adult; Aged; Female; Humans; Male; Middle Aged; Posture; Reflex, Vestibulo-Ocular; Rotation; Saccule and Utricle, physiopathology; Vertigo, physiopathology}, pmid = {9146018} }
Zhao, Z., Mu, Z., Fu, Z., Liang, J., Lin, J., Ou, Y. and Kong, W.	[Clinical features of 168 patients with vertigo]. [Abstract] [BibTeX]	2010	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 24(19), pp. 880-882	article
Abstract: To investigate the clinical characteristics and common etiology of vertigo. The clinical data of 168 patients with vertigo in the department of otolaryngolology and neurology from December 2007 to March 2009 were retrospectively analyzed The patients were inquired and examined by pure tone average thresholds, videonystagmography, Dix-Hallpike test, cervical spine X-ray, skull CT and (or) MRI and transcranial Doppler. One hundred and thirty-four patients with vertigo were of peripheral origin, with 66 cases benign paroxysmal positional vertigo, 30 cases Meniere's disease, 24 cases sudden deafness, 5 cases vestibular neuritis, 5 cases otitis media ,2 cases ear herpes zosters and 2 cases ototoxicity. Among 26 patients with vertigo of central, 20 patients were vertebrobasilar TIA. The most common etiology of the vestibular peripheral vertigo is the benign paroxysmal positional vertigo. Detailed history and the features of vertigo, particular about the duration of vertigo and hearing change, may provide the important evidences for the accurate diagnosis and differential diagnosis of vertigo.
BibTeX: @article{Zhao2010, author = {Zhao, Zhibin and Mu, Zhonglin and Fu, Zheng and Liang, Juntao and Lin, Jie and Ou, Yangfeng and Kong, Weijia}, title = {[Clinical features of 168 patients with vertigo].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2010}, volume = {24}, issue = {19}, pages = {880--882}, keywords = {Adolescent; Adult; Aged; Electronystagmography; Female; Humans; Male; Middle Aged; Retrospective Studies; Vertigo, diagnosis, etiology, physiopathology; Young Adult}, pmid = {21174748} }
Uno, A., Moriwaki, K., Kato, T., Nagai, M. and Sakata, Y.	[Clinical features of benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2001	Nihon Jibiinkoka Gakkai kaiho Vol. 104(1), pp. 9-16	article
Abstract: Our understanding of the pathomechanism of benign paroxysmal positional vertigo (BPPV) has improved dramatically. A type of BPPV featuring mixed torsional and vertical nystagmus induced by the Dix-Hallpike maneuver involves the posterior semicircular canal (P-BPPV). The other type of BPPV featuring horizontal nystagmus induced by spine-to-lateral head positioning involves the horizontal canal BPPV (H-BPPV). In complaints of vertigo or dizziness, 619 patients visited our department last year. Of these, 142 (23%) was had positional nystagmus consistent with a diagnosis of BPPV, 118 (19%) had no nystagmus but were suspected of BPPV due to vertigo episodes. BPPV was the most frequent diagnosis. H-BPPV was not rare, but accounted for 30% of BPPV. Of H-BPPV, 73% featured direction changing geotropic nystagmus, and 27% direction changing apogeotropic nystagmus. H-BPPV resolved faster than P-BPPV. Most cases caused by head trauma were P-BPPV. Transition between P- and H-BPPV was found in 6 cases. Women outnumbered men by about 3 to 2 in both P- and H-BPPV. Peak incidence was found in the those in their 60s and 70s, suggesting that the etiologies of both types of BPPV are essentially the same.
BibTeX: @article{Uno2001a, author = {Uno, A and Moriwaki, K and Kato, T and Nagai, M and Sakata, Y}, title = {[Clinical features of benign paroxysmal positional vertigo].}, journal = {Nihon Jibiinkoka Gakkai kaiho}, year = {2001}, volume = {104}, issue = {1}, pages = {9--16}, keywords = {Adult; Age Factors; Aged; Female; Head, physiology; Humans; Male; Middle Aged; Nystagmus, Pathologic, physiopathology; Posture, physiology; Semicircular Canals, physiopathology; Sex Factors; Vertigo, classification, diagnosis, epidemiology}, pmid = {11218739} }
Chen, Y., Zhuang, J.-h., Zhao, Z.-x., Li, Y.-c. and Jin, Z.	[Clinical features of horizontal semicircular canal benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2012	Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery Vol. 47(12), pp. 987-990	article
Abstract: To explore the clinical features of horizontal semicircular canal benign paroxysmal positional vertigo. The clinical manifestations of 239 patients with horizontal semicircular canal benign paroxysmal positional vertigo from August 2003 to December 2010 were retrospectively analyzed. 25.7% (239/931) of all the benign paroxysmal positional vertigo patients were the horizontal semicircular canal benign paroxysmal positional vertigo was involved. One hundred and ninety-seven patients showed geotropic nystagmus in head rolling test with a mean latency period of (0.88 ± 0.72) s and a mean duration period of (26.36 ± 19.71) s. Forty-two patients showed apogeotropic nystagmus in head rolling test with a mean latency period of (2.69 ± 1.83) s and a mean duration period of (53.48 ± 43.12) s. Among all the horizontal semicircular canal benign paroxysmal positional vertigo patients, 39 (16.3%) presented horizontal nystagmus with slight upbeating component. The nystagmus latency in apogeotropic nystagmus group was longer than that in geotropic nystagmus group (t = -6.33, P < 0.001), and nystagmus duration period was also longer (t = -3.99, P < 0.001). Applied Barbecue maneuver to the patients with geotropic nystagmus, 192 patients were cured after (1.6 ± 0.8) rotations; After applied head shaking maneuver to the patients with apogeotropic nystagmus, 40 patients changed to geotropic nystagmus and cured after (1.9 ± 0.8) rotations. Incidence rate of horizontal semicircular canal benign paroxysmal positional vertigo was higher than expectation. Barbecue maneuver was applied to patients with geotropic nystagmus. While to the patients with apogeotropic nystagmus, head shaking maneuver should be performed firstly and then followed by Barbecue maneuver.
BibTeX: @article{Chen2012, author = {Chen, Ying and Zhuang, Jian-hua and Zhao, Zhong-xin and Li, Yan-cheng and Jin, Zhe}, title = {[Clinical features of horizontal semicircular canal benign paroxysmal positional vertigo].}, journal = {Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery}, year = {2012}, volume = {47}, issue = {12}, pages = {987--990}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic; Retrospective Studies; Semicircular Canals; Vertigo, diagnosis, therapy; Young Adult}, pmid = {23328037} }
Gao, B., Huang, W.-n., Song, H.-t., Wang, L.-y. and Zhou, J.-m.	[Clinical features of multiple canal involvement in benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2009	Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery Vol. 44(8), pp. 627-630	article
Abstract: To describe a series of patients with multiple canal involvement in benign paroxysmal positional vertigo (BPPV), with respect to diagnosis and management. Ninety-five individuals with symptoms of BPPV and positional nystagmus were included in this study. The diagnosis was based on a history of brief episodes of vertigo and the presence of multiple positional nystagmus as confirmed by video-oculographic examination. Patients were treated by means of different particle repositioning manoeuvres according to the affected canal. Ninety-five patients showed multiple positional nystagmus during the examination corresponding to simultaneous multi-canal BPPV. Fourteen patients (14.7%) had bilateral canal BPPV. Six patients had bilateral posterior canal. Six patients had bilateral horizontal canal, and two patients had bilateral anterior canal. Fifty-three patients (55.8%) had torsional, up-beating nystagmus with down-beating nystagmus, which suggested possible affected both of posterior and anterior canals. Twenty patients (21.1%) had torsional up-beating nystagmus and horizontal direction nystagmus, which suggested possible affected both of posterior and horizontal canals. Five patients had down-beating nystagmus with horizontal nystagmus, which suggested affected both of anterior and horizontal canals. Three patients had torsional up-beating with down-beating and horizontal nystagmus, which suggested possible affected multiple canals. Treatment given to the patients varied according to the canal affected, started with the canal that elicited a strong positional nystagmus and vertigo, and 93.7% (89/95) of patients were symptom free or improved. It has been found that multi-canal BPPV is not a rate observation in clinic, and most of them affected posterior and anterior canals. Treatment of multi-canal BPPV can be effective using repositioning maneuver.
BibTeX: @article{Gao2009, author = {Gao, Bo and Huang, Wei-ning and Song, Hai-tao and Wang, Li-yi and Zhou, Jin-mei}, title = {[Clinical features of multiple canal involvement in benign paroxysmal positional vertigo].}, journal = {Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery}, year = {2009}, volume = {44}, issue = {8}, pages = {627--630}, keywords = {Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Nystagmus, Physiologic; Otolithic Membrane; Semicircular Canals; Vertigo, diagnosis, pathology, therapy; Young Adult}, pmid = {19961768} }
Li, X.X., Ou, Y.K., Tang, X.W., Chen, L., Liu, P., Huang, Q.H. and Zheng, Y.Q.	[Clinical features of recurrences in benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2018	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 32(11), pp. 823-826	article	DOI
Abstract: To study the clinical features of patients with recurrent benign paroxysmal positional vertigo (BPPV) and to analyze potential related factors of recurrences. Eighty patients who suffered recurrent BPPV were enrolled in this study. Patients were divided into three groups: young group (21 cases), middle-aged group (25 cases) and old-aged group (34 cases). Theclinical data including age, gender, pathological pattern and canal type of BPPV were collected. We further analyzed the efficacy of repositioning treatment for recurrent BPPV. In this study, there are 62 cases of primary BPPV(77.50%) and 18 cases of secondary BPPV(22.50%). In patients with recurrent BPPV, the laterior semicircular canal BPPV and posterior semicircular canals BPPV were the most common, and there was no differences on the aspects of age and gender in the two groups of patients with recurrent HSC BPPV and PSC BPPV ( >0.05).Compared with the primary diagnosis, we found that 48.75% cases relapsed in the same semicircular canals, 21.25% cases relapsed in other canals of the same ear, and 30.00% cases relapsed in a different ear. In this study, 96.25% patients with recurrent BPPV were cured in a month and one-time reset success rate was 56.25%. The age, gender, pathological pattern and canal type show certain clinical features of recurrent BPPV. The evidence of long term of recurrence course and high variability of problematic location support the approval opinion based on new otolith.
BibTeX: @article{Li2018b, author = {Li, X X and Ou, Y K and Tang, X W and Chen, L and Liu, P and Huang, Q H and Zheng, Y Q}, title = {[Clinical features of recurrences in benign paroxysmal positional vertigo].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2018}, volume = {32}, issue = {11}, pages = {823--826}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2018.11.006}, keywords = {Aged; Benign Paroxysmal Positional Vertigo, diagnosis, pathology, therapy; Humans; Middle Aged; Otolithic Membrane; Patient Positioning; Recurrence; Semicircular Canals, pathology; benign paroxysmal positional vertigo; clinical features; recurrence}, pmid = {29921050} }
Tian, Y.S., Wang, S.Z., Liu, Y., Wang, D. and Guo, L.R.	[Clinical features of the recurrence of idiopathic benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2018	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 32(2), pp. 118-121	article	DOI
Abstract: To investigate the clinical features of the recurrence of idiopathic benign paroxysmal positional vertigo(IBPPV)patients. Patients with IBPPV were enrolled and were followed-up for 36 months after being well controlled.The data of the patients including age,gender,and co-morbidities(hypertension,diabetes,hyperlipidemia)were analyzed.Characteristics of the patients with recurrent BPPV were compared with those without recurrence. Two hundred and one patients were enrolled and twenty-two(10.9%)patients presented recurrent IBPPV within 36 months.Among them,about 16% showed changes in the involved semicircular canals.50% recurrence occurred within 6 months after the first treatment.The recurrence rate of BPPV in 50-60 years old patients(50%)is higher than other patients(P=0.04).No significant difference in terms of gender or co-morbidities(hypertension,diabetes,hyperlipidemia)was observed between the two groups. The incidence of recurrence in idiopathic BPPV patients was 10.9%in the present study.The mean period of 50% recurrence after a symptom-free interval was about 6 months.Furthermore,different semicircular canals were involved in about 50% of patients during recurrence.BPPV recurrence was not correlated with age,gender or co-morbiditie.
BibTeX: @article{Tian2018a, author = {Tian, Yong Sheng and Wang, Shu Zhen and Liu, Ying and Wang, Dan and Guo, Liang Rong}, title = {[Clinical features of the recurrence of idiopathic benign paroxysmal positional vertigo].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2018}, volume = {32}, issue = {2}, pages = {118--121}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2018.02.010}, keywords = {Benign Paroxysmal Positional Vertigo, complications, diagnosis; Comorbidity; Diabetes Complications; Diabetes Mellitus; Humans; Hyperlipidemias, complications; Hypertension, complications; Recurrence; Retrospective Studies; Semicircular Canals; recurrence; vertigo}, pmid = {29757558} }
Wang, Y., Qin, X., Liu, J. and Zhang, K.	[Clinical observation of post semicircular canal benign paroxysmal positional vertigo treated with acupuncture at dizzy auditory region plus modified Epley]. [Abstract] [BibTeX]	2016	Zhongguo zhen jiu = Chinese acupuncture & moxibustion Vol. 36(9), pp. 911-914	article	DOI
Abstract: To compare the effects between acupuncture mainly at dizzy auditory region combined with modified Epley and simple modified Epley for post semicircular canal benign paroxysmal positional vertigo (PC-BPPV). Sixty-seven patients were randomly assigned into an observation group (37 cases) and a control group (30 cases). Modified Epley was used in the two groups, and acupuncture was mainly applied at dizzy auditory region, Baihui (GV 20), emotion region and Taiyang (EX-HN 5) for 2 courses (6 days as a course), once a day. Syndrome scores before and after treatment as well as the effects of the two groups were observed. The total effective rate of the observation group was 91.9% (34/37),which was higher than 83.3% (25/30) of the control group, but there was no statistical significance between the two groups ( >0.05). The syndrome scores were improved apparently after treatment in the two groups (both <0.001), with the better results after 1-course and 2-course treatments in the observation group compared with the corresponding ones in the control group (both <0.01). Acupuncture mainly at dizzy auditory region combined with modified Epley for PC-BPPV are better than simple modified Epley.
BibTeX: @article{Wang2016c, author = {Wang, Yulin and Qin, Xuxu and Liu, Jia and Zhang, Kaiyu}, title = {[Clinical observation of post semicircular canal benign paroxysmal positional vertigo treated with acupuncture at dizzy auditory region plus modified Epley].}, journal = {Zhongguo zhen jiu = Chinese acupuncture & moxibustion}, year = {2016}, volume = {36}, issue = {9}, pages = {911--914}, doi = {https://doi.org/10.13703/j.0255-2930.2016.09.004}, keywords = {acupuncture therapy; dizzy auditory region; modified Epley manipulative reduction; post semicircular canal benign paroxysmal positional vertigo (PC-BPPV)}, pmid = {29231382} }
Yuan, H., Song, Y. and Zhang, D.	[Clinical observation of the γ-globulin levels when Benign paroxysmal positional vertigo is attacking]. [Abstract] [BibTeX]	2015	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 29(10), pp. 931-933	article
Abstract: To observe the characteristics of serum protein in patients with benign paroxysmal positional vertigo (BPPV) during the symptomatic period. Fifty-five patients with BPPV and 58 control subjects were enrolled in the study. All the patients underwent the Dixe-Hallpike and Roll maneuver to confirm the type of BPPV. The average time of onset was (1.0 ± 0.8)days in the group of BPPV. The clinical features and the laboratory tests of serum protein electrophoresis, blood counts, and liver and kidney function were performed in both groups. The levels of serum albumin (Alb), α1 globulin, α2 globulin and β globulin of BPPV group did not differ statistically in the two groups (P > 0.05); The γ-globulin levels were significantly higher in patients with BPPV than in controls (P < 0.05). The γ-globulin levels are increased when BPPV is attacking.
BibTeX: @article{Yuan2015, author = {Yuan, Huiping and Song, Yongbin and Zhang, Dongchun}, title = {[Clinical observation of the γ-globulin levels when Benign paroxysmal positional vertigo is attacking].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2015}, volume = {29}, issue = {10}, pages = {931--933}, keywords = {Alpha-Globulins, analysis; Benign Paroxysmal Positional Vertigo, blood, diagnosis; Beta-Globulins, analysis; Case-Control Studies; Humans; Serum Albumin, analysis; gamma-Globulins, analysis}, pmid = {26596012} }
Ou, Y., Zheng, Y., Zhu, H., Chen, L., Zhong, J., Tang, X., Huang, Q. and Xu, Y.	[Clinical research of the otolith abnormal migration during canalith repositioning procedures for posterior semicircular canal benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2015	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 29(1), pp. 9-12	article
Abstract: To investigate the risk factor,type and characteristic nystagmus of the otolith abnormal migration during diagnosis and treatment for posterior semicircular canal benign paroxysmal positional vertigo (PSC-BPPV). The therapy and prevention is also discussed. Four hundred and seventy-nine patients with PSC-BPPV were treated by Epley's canalith repositioning procedures(CRP) from March 2009 to March 2012. We observed otolith abnormal migration complicating during diagnosis and treatment. According the type of otolith abnormal migration, the additional repositioning maneuver was performed. The rate of complication was 8. 1%(39/479), with canal conversion in 5.4%(26/479) and primarily canal reentry in 2.7%(13/479). The rate of incidence of conversion to horizontal canal conversion and anterior canal were 4. 8%(23/479)and 0. 6%(3/479) respectively. All the patient was cured in follow up. The risk factors were unappropriated head movement during or after CRP, including another Dix-Hallpike were performed immediately. To prevent the complications,the pathognostic positioning sequence and angle of head rotation are commenced during CRP. Appropriate short time postural restrictions post-treatment is necessary. Careful observation of nystagrnus variation is crucial to determine the otolith abnormal migration.
BibTeX: @article{Ou2015, author = {Ou, Yongkang and Zheng, Yiging and Zhu, Honglei and Chen, Ling and Zhong, Junwei and Tang, Xiaowu and Huang, Qiuhong and Xu, Yaodong}, title = {[Clinical research of the otolith abnormal migration during canalith repositioning procedures for posterior semicircular canal benign paroxysmal positional vertigo].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2015}, volume = {29}, issue = {1}, pages = {9--12}, keywords = {Benign Paroxysmal Positional Vertigo, therapy; Head; Humans; Incidence; Nystagmus, Pathologic, etiology; Otolithic Membrane; Patient Positioning, adverse effects; Semicircular Canals; Vertigo}, pmid = {25966545} }
Noguchi, Y., Ohgaki, T., Tsunoda, A., Komatsuzaki, A. and Muraoka, H.	[Clinical study in vertiginuous patients suspected of having neurovascular compression syndrome of the eighth cranial nerve]. [Abstract] [BibTeX]	1997	Nihon Jibiinkoka Gakkai kaiho Vol. 100(5), pp. 492-498	article
Abstract: Neurovascular compression syndrome of the 5th and 7th cranial nerves has been recognized as the cause of trigeminal neuralgia and hemifacial spasm. On the other hand, it is still difficult to diagnose vertigo as neurovascular compression syndrome of the 8th cranial nerve. To detect some specific finding in this syndrome of the 8th cranial nerve, 5 patients with vertigo with hemifacial spasm were examined for the clinical course and neuro-otological features. In all patients MRI and/or angiography suggested vascular compression against the 8th cranial nerve. The clinical courses of these patients revealed various symptoms resembling benign paroxysmal positional vertigo, vestibular neuronitis and Meniere's disease. Audiograms showed two normal hearing patterns, bilateral high frequency hearing loss probably due to aging in one case, bilateral C5-dip in one and fluctuating unilateral hearing loss like Meniere's disease in one. The prolongation of IPL I-III on auditory brainstem response proposed as a criterion by Møller was detected in one case. No response in the caloric test was found in two cases. These abnormalities in the auditory brainstem response and caloric test appeared to be useful for diagnosis but were uncommon findings in all cases. Electronystagmographic examinations including the eye tracking test, optokinetic nystagmus and optokinetic pattern were all normal. We could not find any specific clinical findings valuable for diagnosis of neurovascular compression syndrome of the 8th cranial nerve. It is proposed that the indication of microvascular decompression should be decided carefully.
BibTeX: @article{Noguchi1997, author = {Noguchi, Y and Ohgaki, T and Tsunoda, A and Komatsuzaki, A and Muraoka, H}, title = {[Clinical study in vertiginuous patients suspected of having neurovascular compression syndrome of the eighth cranial nerve].}, journal = {Nihon Jibiinkoka Gakkai kaiho}, year = {1997}, volume = {100}, issue = {5}, pages = {492--498}, keywords = {Cerebral Angiography; Electronystagmography; Evoked Potentials, Auditory, Brain Stem; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Nerve Compression Syndromes, complications, diagnosis; Vertigo, etiology; Vestibulocochlear Nerve}, pmid = {9184027} }
Zhu, Z.J., Wei, L.P., Xu, Z.X., Xu, H.J., Liu, Q. and Luo, N.	[Clinical study of aged patients with secondary benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2017	Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery Vol. 52(9), pp. 670-675	article	DOI
Abstract: To investigate the clinical features and evaluate the efficacy of manual reduction in treatment of age patients with secondary benign paroxysmal positional vertigo (s-BPPV). Thirty-two cases of aged patients ( the s-BPPV group: including 19 cases of female and 13 males, age from 60 to 86 years old)with secondary benign paroxysmal positional vertigo from Jul. 2013 to Sep. 2015 in our hospital were retrospectively analyzed. The results were compared with 121 patients( the primary group: including 82 cases of female and 39males, aged from 60 to 86 years old)with aged primary benign paroxysmal positional vertigo(p -BPPV). All the patients were followed up for 12 months. Statistical data analysis was carried out with SPSS 19.0. 20.92%(32/153)of all the observed elderly patients with BPPV was the aged s-BPPV. The sex ratio and onset age had no significant difference between the two groups(χ(2)=0.79, >0.05; =0.37, >0.05). The rate of two or more semicircular canal involvement in the secondary group(21.88%) was higher than that in primary group(6.61%)(χ(2)=6.67, <0.05). Bilateral semicircular canals were involved in 5 of the 32 cases in secondary group(15.63%) and 4 of the 121 cases in aged primary group(3.31%), The difference was significant(χ(2)=6.94, <0.05). The effective rate after first manual reduction was 57.50%(23/40)in secondary group and 82.31%(107/130)in primary group, the difference was significant(χ(2)=10.46, <0.05). The total effective rate were 87.50%(35/40) after more than once manual reduction in secondary group and 91.54%(119/130) in primary group, the difference was not significant(χ(2)= 0.59, >0.05). The numbers of circulation of the first successful manual reduction management were (3.9±1.3)times in secondary group and (2.1±1.1)times in primary group, the difference was significant( =3.15, <0.05). The recurrence rate was 37.50%(15/40) in the secondary group and 16.15%(21/130)in primary group after during follow-up for 12 months, the difference was statistically significant(χ(2)=8.35, <0.05). It's shown that the aged patients with secondary BPPV is not rare in clinical practice, sudden deafness and head trauma are frequent more than other reasons. The aged patients with secondary BPPV are prone to injury in multi-semicircular and bilateral canal compared with the primary BPPV. The effective rate after first manual reduction of secondary BPPV is lower than primary BPPV, it's needed more circulation of first success in manual reduction management. The total effective rates are not significant in two groups and recurrence rate is relatively high in secondary group.
BibTeX: @article{Zhu2017, author = {Zhu, Z J and Wei, L P and Xu, Z X and Xu, H J and Liu, Q and Luo, N}, title = {[Clinical study of aged patients with secondary benign paroxysmal positional vertigo].}, journal = {Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery}, year = {2017}, volume = {52}, issue = {9}, pages = {670--675}, doi = {https://doi.org/10.3760/cma.j.issn.1673-0860.2017.09.007}, keywords = {Aged; Benign paroxysmal positional vertigo}, pmid = {28910891} }
Liu, X. and Li, G.	[Clinical study of benign paroxysmal positional vertigo recurrence]. [Abstract] [BibTeX]	2009	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 23(7), pp. 304-306	article
Abstract: To investigate the cause of recurrence and clinical significance in benign paroxysmal positional vertigo (BPPV). By retrospectively analyzing the clinical data and results of TCD, CT or MRI of head of 65 patients with non-recurred BPPV and 44 patients with recurred BPPV in 2 years after successful canalith repositioning maneuver. The prognosis of BPPV shows significant correlated with age, family history, migraine history, intracranial arterial and carotid stenosis and stroke history. Many causes play part in the recurrence of BPPV, but most of them correlate with blood disturbance of labyrinth. We can know the causes of recurred BPPV from the clinical data and results of TCD, CT or MRI of head and predict its recurrence, and do corresponding intervention eventually.
BibTeX: @article{Liu2009, author = {Liu, Xianghong and Li, Guangsheng}, title = {[Clinical study of benign paroxysmal positional vertigo recurrence].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2009}, volume = {23}, issue = {7}, pages = {304--306}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Prognosis; Recurrence; Retrospective Studies; Treatment Outcome; Vertigo, etiology; Young Adult}, pmid = {19670608} }
Li, H., Zhuang, J. and Zhao, Z.	[Clinical study on canalith repositioning procedure for benign paroxysmal positional vertigo of semicircular canal]. [Abstract] [BibTeX]	2005	Lin chuang er bi yan hou ke za zhi = Journal of clinical otorhinolaryngology Vol. 19(22), pp. 1029-1031	article
Abstract: To determine the effectiveness of canalith repositioning procedure for the treatment of benign paroxysmal positional vertigo (BPPV). Medical records from two hundred and thirty cases with benign paroxysmal positional vertigo treated between January 2002 to June 2004 were analyzed retrospectively. Patients were divided into two groups,treatment group (122 cases) and control group (108 cases). Treatment group received a single treatment of canalith repositioning procedure based on the hypothesis that the vertigo and nystagmus of BPPV were due to debris floating in the long arm of the semicircular canal. Treatment outcome was analyzed after two weeks classified as cure, improvement or no change. After a single treatment of canalith repositioning procedure, the vertigo and nystagmus in 88 cases of treatment group immediately or gradually disappeared in 1-2 weeks, 18 cases improved, 16 cases got no effect. Complete remission of vertigo and nystagmus was found in 72.1%, the total improvement rate was 86.9%. The vertigo and nystagmus in 51 cases of control group immediately disappeared in 1-2 weeks, 23 cases improved, 34 cases got no effect. Complete remission of vertigo and nystagmus was found in 47.2%, the total improvement rate was 68.5%, and the difference between groups was very significant (P < 0.001, P < 0.01). The canalith repositioning procedure was effective for most patients with benign paroxysmal positional vertigo and can be recommended as the first-line treatment modality.
BibTeX: @article{Li2005, author = {Li, Hua and Zhuang, Jianghua and Zhao, Zhongxin}, title = {[Clinical study on canalith repositioning procedure for benign paroxysmal positional vertigo of semicircular canal].}, journal = {Lin chuang er bi yan hou ke za zhi = Journal of clinical otorhinolaryngology}, year = {2005}, volume = {19}, issue = {22}, pages = {1029--1031}, keywords = {Adult; Aged; Aged, 80 and over; Case-Control Studies; Female; Humans; Male; Middle Aged; Retrospective Studies; Semicircular Canals; Treatment Outcome; Vertigo, etiology, therapy; Vestibular Diseases, therapy; Young Adult}, pmid = {16463766} }
Zhang, D.-g., Fan, Z.-m., Han, Y.-c., Yu, G. and Wang, H.-b.	[Clinical value of dynamic posturography in the evaluation and rehabilitation of vestibular function of patients with benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2010	Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery Vol. 45(9), pp. 732-736	article
Abstract: To explore the clinical value of dynamic posturography in the evaluation and rehabilitation of vestibular function of patients with benign paroxysmal positional vertigo (BPPV). A total of 48 patients with BPPV of posterior semicircular canal in vertigo clinic of our hospital from May 2007 to December 2008 were retrospectively analyzed in this study. All patients underwent the inspection of caloric test, static posturography, and dynamic posturography. The vestibular tests were performed at two different time points: at onset when patients had typical nystagmus provoked by the Dix-Hallpike maneuver before treatment with the Epley maneuver (canalith repositioning maneuver, CRM), and at one week after treatment with CRM as their nystagmus disappeared. And results at theses two time points were compared. Eight patients whose dynamic balances were still abnormal after CRM accepted vestibular rehabilitation exercise using dynamic posturography, and re-examined 3 weeks later with dynamic posturography. Among 48 cases of BPPV, the abnormal rates of caloric test, static posturography, and dynamic posturography before CRM were 25.0%, 33.3% and 70.8%, respectively. The abnormal rate of dynamic posturography was much higher than that of caloric test or static posturography, and the differences were statistically significant (χ² = 4.84, 7.88; P < 0.05). After CRM, the abnormal rates of caloric test, static posturography, and dynamic posturography were 14.6%, 8.3% and 16.7%, respectively. After CRM, the abnormal rate of static and dynamic posturography showed significant reduction (χ² = 24.04, 10.08; P < 0.05), however, the results of caloric test showed no significant change (χ² = 3.20, P > 0.05). Eight patients whose dynamic balances were still abnormal after CRM, accepted vestibular rehabilitation exercise lasting 3 weeks using dynamic posturography. The dynamic balances were all improved to normal after vestibular rehabilitation. Dynamic posturography can quantitatively analyze postural balance, and is helpful in comprehensive evaluation of the vestibular function of BPPV patients. Impaired balance often presents in patients with BPPV. Treatment of BPPV using the canalith repositioning maneuver results in improved postural stability in static and dynamic posturography. However, not all patients have normal dynamic stability after successful CRM. The vestibular rehabilitation exercise using dynamic posturography is a helpful adjunct to the treatment for these patients.
BibTeX: @article{Zhang2010, author = {Zhang, Dao-gong and Fan, Zhao-min and Han, Yue-chen and Yu, Gang and Wang, Hai-bo}, title = {[Clinical value of dynamic posturography in the evaluation and rehabilitation of vestibular function of patients with benign paroxysmal positional vertigo].}, journal = {Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery}, year = {2010}, volume = {45}, issue = {9}, pages = {732--736}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo; Female; Humans; Male; Middle Aged; Retrospective Studies; Vertigo, physiopathology, rehabilitation; Vestibular Function Tests, methods; Young Adult}, pmid = {21092670} }
Wang, L., Zhou, H.F., Wang, M.X., Zhang, J., Su, J. and Guo, Y.	[Comparison of anxiety and depression state among patients with different type of benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2016	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 30(21), pp. 1710-1713	article	DOI
Abstract: To investigate and analyze the state of anxiety and depression among patients with different type of benign paroxysmal positional vertigo(BPPV). Patients with four types of BPPV were enrolled in our study,which named as posterior semicircular canals BPPV(PC-BPPV),anterior semicircular canals BPPV(AC-BPPV), horizontal semicircular canals BPPV(HC-BPPV), multiple canals BPPV(MC-BPPV).Thorough otological and neuro-otological examinations were performed on all cases,and their states of anxiety and depression were assessed by hospital anxiety and depression scale(HADS). The incidence of anxiety and depression of all cases divided into four types BPPV (PC-BPP, AC-BPPV, HC-BPPV, MC-BPPV) were 36.45%, 22.78%, 28.57%, 63.16% respectively in our study .The differences among the four groups were statistically significant( < 0.05).That were higher in these cases with PC-BPPV or MC-BPPV than those with AC-BPPV or HC-BPPV.The HADS aggregate scores of the pre-repositioning were statistically significant( < 0.05). And the patients with PC-BPPV or MC-BPPV were higher than the other two groups.The HADS aggregate scores of the post-repositioning were statistically significant( <0.05). And the cases with PC-BPPV or MC-BPPV were higher than the other two groups. The post-repositioning scores were compared with the pre-repositioning scores, and the difference was significant( < 0.05). Among all cases with the four different types of BPPV,anxiety and depression psychological mood is more common in patients with PC-BPPV or MC-BPPV.Mood disorders affect the reset recovery after treatment,and reduce the therapeutic effect.We should pay more attention to psychological state of the patients with BPPV during treatment.And early psychological intervention can improve treatment effect.
BibTeX: @article{Wang2016, author = {Wang, L and Zhou, H F and Wang, M X and Zhang, J and Su, J and Guo, Y}, title = {[Comparison of anxiety and depression state among patients with different type of benign paroxysmal positional vertigo].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2016}, volume = {30}, issue = {21}, pages = {1710--1713}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2016.21.011}, keywords = {anterior semicircular canals; anxiety;depression; benign paroxysmal positional vertigo; horizontal semicircular canals; posterior semicircular canals}, pmid = {29871180} }
Yuan, Q., Shi, D., Yu, L., Ke, X. and Zhang, H.	[Comparison of anxiety and depression state among patients with different type of vestibular peripheral vertigo]. [Abstract] [BibTeX]	2014	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 29(8), pp. 729-732	article
Abstract: To investigate and analyze the status of anxiety and depression among patients with four types of peripheral vertigo. The clinical data of patients with one of the four types of peripheral vertigo, namely benign paroxysmal positional vertigo (BPPV), vestibular migraine (VM), Menière's disease (MD), and vestibular neuritis (VN), were collected. Thorough otological and neuro-otological examinations were performed on these patients, and their status of anxiety and depression were assessed using self-rating anxiety scale (SAS) and self-rating depression scale (SDS). A total of 129 patients with one of the four types of peripheral vertigo(49 cases of BPPV, 37 cases of VM, 28 cases of MD and 15 cases of VN) were included in the study. The scores of SAS and SDS were higher in the patients with VM or MD than those with BPPV or VN (P < 0.05), and the incidence of anxiety (VM = 45.9% MD = 50.0%) and depression (VM = 27.0% MD = 28.6%) were higher in the patients with VM or MD than those with BPPV or VN (P < 0.05). Paired comparisons showed the differences between the incidences of BPPV and MV groups, BPPV and MD groups, and MD and VN groups were statistically significant (P < 0.05). Among patients with different types of peripheral vertigo, anxiety/depression is more common in patients with VM or MD. This may be due to the different mechanisms involved in different types of vertigo, as well as differences in the prevention and self-control of the patients against the vertigo.
BibTeX: @article{Yuan2014, author = {Yuan, Qing and Shi, Dongmei and Yu, Lisheng and Ke, Xingxing and Zhang, Hua}, title = {[Comparison of anxiety and depression state among patients with different type of vestibular peripheral vertigo].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2014}, volume = {29}, issue = {8}, pages = {729--732}, keywords = {Anxiety, complications; Benign Paroxysmal Positional Vertigo; Depression, complications; Ear, Inner; Humans; Incidence; Meniere Disease; Migraine Disorders; Psychiatric Status Rating Scales; Vertigo, classification, complications; Vestibular Neuronitis; Vestibule, Labyrinth}, pmid = {26248448} }
He, P., Xu, X.R., Jin, Z.G., Liu, Y.H. and Zhai, L.H.	[Comparison of simple canalith repositioning treatment and medication therapeutic alliance in the management of canalithiasis associated with benign paroxysmal positional vertigo of the horizontal semicircular canal]. [Abstract] [BibTeX]	2016	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 30(8), pp. 598-601	article	DOI
Abstract: To compare the therapeutic efficacy and the recurrence rate between the simple repositioning method and the reposition manoeuvre plus medication in the treatment of horizontal semicircular canal otolith benign paroxysmal positional vertigo (HSC-BPPV). Sixty-two patients diagnosed with otolith HSC-BPPV by roll maneuver test were randomly divided into canalith repositioning group (32 patients) and reposition plus drug treatment group (30 patients). Patients in the canalith repositioning group were treated only with Barbecue reposition maneuver; patients in the reposition plus drug treatment group were treated firstly with Barbecue reposition maneuver and then were given Alprostadil, Cinepazide and Betahistine drug treatment. Both groups were evaluated after 7 days and 28 days treatment, and the recurrence rate was analyzed after 3 months. After 7 days of the treatment , the recovery rate of the two groups was 62.5% and 73.3%, respectively. There's no significant difference between the two groups. However, the total effective power of the reposition plus drug treatment group was 96.7%, which was significantly higher than that of the canalith repositioning group (75.0%) (χ²=5.858, <0.05). There were 8 patients in the canalith repositioning group showed changes of BBPV types after treatment, while only 1 patient in the reposition plus drug treatment group showed lesion changes. The difference was statistically significant (χ²=4.061, <0.05). After 28 days of the treatment, the recovery rate and the total effective power of the two groups was 100%, respectively. There is no statistical difference in the total effective rate between the two groups. After 3 months follow-up, 2 patients in the canalith repositioning group (6.25%) and in the reposition plus drug treatment group (6.67%) showed BBPV recurrence, and no significant difference in the recurrence rate was found between the two groups ( >0.05). The repositioning maneuver is the preferred method for treating HSC BPPV. Canalith reposition maneuver plus medication has no obvious effect on the recovery rate and the recurrence rate, it only increases the effective rate and reduces the changes of the BBPV types.
BibTeX: @article{He2016, author = {He, P and Xu, X R and Jin, Z G and Liu, Y H and Zhai, L H}, title = {[Comparison of simple canalith repositioning treatment and medication therapeutic alliance in the management of canalithiasis associated with benign paroxysmal positional vertigo of the horizontal semicircular canal].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2016}, volume = {30}, issue = {8}, pages = {598--601}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2016.08.003}, keywords = {Benign Paroxysmal Positional Vertigo, therapy; Humans; Otolithic Membrane; Patient Positioning; Recurrence; Semicircular Canals; benign paroxysmal positional vertigo; medication treatment; pharmacotherapy}, pmid = {29871085} }
Zhang, Y.-x., Wu, C.-l., Xiao, G.-r. and Zhong, F.-f.	[Comparison of three types of self-treatments for posterior canal benign paroxysmal positional vertigo: modified Epley maneuver, modified Semont maneuver and Brandt-Daroff maneuver]. [Abstract] [BibTeX]	2012	Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery Vol. 47(10), pp. 799-803	article
Abstract: To compare the efficacy and recurrence rates of modified Epley maneuver, modified Semont maneuver and Brandt-Daroff maneuver in patients with posterior canal benign paroxysmal positional vertigo (PC-BPPV). One hundred and sixty-eight patients with unilateral PC-BPPV were included in the study, which were divided into four groups randomly, 45 with modified Epley maneuver (group 1), 43 with modified Semont maneuver (group 2), and 40 with Brandt-Daroff maneuver (group 3). There were 40 controls without physical therapy technique (group 4) included. The efficacy after one week and one month, the time to recovery, the frequency of side effects and recurrence rates among the four groups were evaluated. The efficacy of modified Epley maneuver was superior to the other three groups after one week (χ(2)(1, 2) = 8.55, P < 0.05; χ(2)(1, 3) = 23.23, P < 0.01;χ(2)(1, 4) = 44.00, P < 0.01) and to the Brandt-Daroff maneuver at follow-up evaluation after one month (χ(2) = 8.42, P < 0.05). The efficacy of modified Semont maneuver was superior to the control groups after one week (χ(2) = 14.49, P < 0.01), but there was no difference between the two groups after one month (χ(2) = 0.01, P > 0.05). The efficacy of Brandt-Daroff maneuver was not different with the control group at one week and one month follow-up evaluation (χ(2) = 3.35, P > 0.05;χ(2) = 0.18, P > 0.05). Kaplan-Meier testing showed that the time to recovery was significantly shorter in the modified Epley group. The frequency of side effects was not significantly different among the three physical therapy groups. There was no difference in the frequency of recurrence among the four groups (χ(2) = 4.076, P = 0.253). Duration of illness before self-treatment and age were the independent predictors of recurrence. The modified Epley maneuver is more effective for self treatment of PC-BPPV than modified Semont maneuver and Brandt-Daroff maneuver. Daily routine of self-treatment does not prevent the recurrence of PC-BPPV.
BibTeX: @article{Zhang2012, author = {Zhang, Yan-xing and Wu, Cheng-long and Xiao, Gui-rong and Zhong, Fang-fang}, title = {[Comparison of three types of self-treatments for posterior canal benign paroxysmal positional vertigo: modified Epley maneuver, modified Semont maneuver and Brandt-Daroff maneuver].}, journal = {Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery}, year = {2012}, volume = {47}, issue = {10}, pages = {799--803}, keywords = {Aged; Benign Paroxysmal Positional Vertigo; Female; Humans; Male; Middle Aged; Physical Therapy Modalities; Semicircular Canals; Treatment Outcome; Vertigo, etiology, therapy}, pmid = {23302158} }
Eysink Smeets, M.M., van Leeuwen, R.B. and van de Berg, R.	[Complaints of imbalance in elderly people]. [Abstract] [BibTeX]	2016	Tijdschrift voor gerontologie en geriatrie Vol. 47(1), pp. 9-15	article	DOI
Abstract: Balance disorders in the elderly often have several contributing causes. The search for these causes focuses on vision, proprioception, coordination and medication. The peripheral vestibular system is often overlooked. This is probably due to the fact that most clinicians overlook the vestibular system, when complaints of vertigo are missing. However, dysfunction of the vestibular system may cause imbalance without vertigo. Three cases are presented. One case illustrates several contributing causes leading to imbalance. Two other cases illustrate causes of vestibular dysfunction resulting in imbalance without vertigo: a bilateral vestibulopathy and benign paroxysmal positional vertigo. Symptoms, examination and treatment are discussed. All patients with imbalance should undergo a Head Impulse Test and Dix-Hallpike maneuver.
BibTeX: @article{EysinkSmeets2016, author = {Eysink Smeets, Marjolein M and van Leeuwen, Roeland B and van de Berg, Raymond}, title = {[Complaints of imbalance in elderly people].}, journal = {Tijdschrift voor gerontologie en geriatrie}, year = {2016}, volume = {47}, issue = {1}, pages = {9--15}, doi = {https://doi.org/10.1007/s12439-015-0158-9}, keywords = {Aged; Aged, 80 and over; Aging, physiology; Audiometry; Benign Paroxysmal Positional Vertigo, diagnosis, therapy; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Physical Examination; Physical Therapy Modalities; Postural Balance, physiology; Vestibular Diseases, diagnosis, physiopathology, therapy; Vestibule, Labyrinth, physiopathology; Labyrinthine dysfunction; Vestibular dysfunction}, pmid = {26518204} }
You, J., Yu, D., Yin, S., Feng, Y., Tan, J., Song, Q. and Chen, B.	[Complementary self-treatment for posterior canal benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2014	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 28(10), pp. 693-696	article
Abstract: To examine the value of self-treatment for Posterior canal benign paroxysmal positional vertigo (PC-BPPV). The treatment effect was compared between patients treated with modified Epley in outpatient clinic combined with self treatment at home and patients treated by modified Epley alone. A randomized controlled trial were carried out in the Department of Otolaryngology Head and Neck Surgery, the Affiliated Sixth People's Hospital of Shanghai Jiao Tong University from December 2012 to May 2013. 147 out of 150 patients with unilateral idiopathic BPPV-PSC were enrolled in follow-up. Among which, 73 patients were allocated in modified Epley-alone group and 74 were allocated in slef-treatment group. The success rate was 53.4% in modified Epley-alone group vs 83.8% in self-treatment group (P < 0.01) after 1 week treatment. In the modified Epley-alone group,the success rate of hand repositioning group and chair-assisted repositioning group was 45.9% vs 61.1% (P > 0.05), the risk rate was 0.752, 95% CI (0.486 - 1.163). In the self-treatment group, the success rate of hand repositioning group and chair-assisted repositioning group was 87.5% vs 81.0% (P > 0.05), the risk rate was 1.081, 95% CI (0.888-1.316). Incidence rate of serious complications was 0% in the modified Epley-alone group and 1.3% in the self-treatment group (P > 0.05). Complementary self-treatment with modified Epley maneuver treated PC-BPPV sooner and more effectively, Compared with modified Epley maneuver alone. And its incidence rate of serious complications didn't increase. Chair-assisted repositioning showed better result than hand repositioning alone, and self-treatment at home can reduce the effect of the gap. We found that complementary self-treatment with modified Epley maneuver had more benefits for patients with PC-BPPV.
BibTeX: @article{You2014, author = {You, Jin and Yu, Dongzhen and Yin, Shankai and Feng, Yanmei and Tan, Jun and Song, Qiang and Chen, Bin}, title = {[Complementary self-treatment for posterior canal benign paroxysmal positional vertigo].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2014}, volume = {28}, issue = {10}, pages = {693--696}, keywords = {Aged; Benign Paroxysmal Positional Vertigo, therapy; Female; Follow-Up Studies; Humans; Male; Middle Aged; Patient Positioning, methods; Self Care; Treatment Outcome}, pmid = {25129967} }
Wu, Z.-m., Zhang, S.-z., Liu, X.-j., Ji, F., Chen, A.-t., Yang, W.-y. and Han, D.-y.	[Complications of canalith repositioning procedure for benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2009	Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery Vol. 44(8), pp. 623-626	article
Abstract: To investigate the incidence of complications of canalith repositioning procedure (CRP) for benign paroxysmal positional vertigo (BPPV) in order to recognize and intervene the complication. Totally 430 cases of BPPV were treated by CRP between Jan., 2005 and Nov., 2007. The patients with complication were retreated with CRP according to the new canals otolith falling into. There were 313 patients with posterior canal BPPV, among which 5 had complications during CRP for posterior canal BPPV and 3 for horizontal canal BPPV. And 1 patient transformed from cupulolithiasis to canalithiasis during Semont CRP, which made CRP possible. Three patients had horizontal BPPV during CRP for posterior canal BPPV. Horizontal BPPV emerged during CRP for anterior canal BPPV in 1 patient. CRP for the posterior BPPV had more patients with complication than that of CRP for the anterior BPPV, but the percentage was on the contrary, and they were 1.9% (8/313) and 28.6% (2/7) respectively. The rate of complication during CRP was 3.3% (14/430) and all of them recovered well with CRP. There are possibility for canal otolith transferred from one canal to another. Careful observation of nystagmus and reevaluation of the patients with BPPV in case of unsuccessful treatments are crucial to determine the complications.
BibTeX: @article{Wu2009, author = {Wu, Zi-ming and Zhang, Su-zhen and Liu, Xing-jian and Ji, Fei and Chen, Ai-ting and Yang, Wei-yan and Han, Dong-yi}, title = {[Complications of canalith repositioning procedure for benign paroxysmal positional vertigo].}, journal = {Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery}, year = {2009}, volume = {44}, issue = {8}, pages = {623--626}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Otolithic Membrane; Semicircular Canals; Vertigo, diagnosis, therapy; Young Adult}, pmid = {19961767} }
Maslovara, S., Butković-Soldo, S., Drvis, P., Roje-Bedeković, M., Trotić, R., Branica, S., Habek, M., Cvjetko, T., Vesligaj, T., Adamec, I., Gabelić, T., Jurić, S., Vceva, A., Vranjes, Z., Sarić, I., Cejić, O. and Zivić, T.	[CROATIAN GUIDELINES FOR DIAGNOSIS AND MANAGEMENT OF BENIGN PAROXYSMAL POSITIONAL VERTIGO (BPPV)]. [Abstract] [BibTeX]	2015	Lijecnicki vjesnik Vol. 137(11-12), pp. 335-342	article
Abstract: BPPV is generally the most common cause of vertigo, caused by a pinch-off of tiny calcium carbonate crystals (called the otoconia or the otoliths) from the macula utriculi, most frequently due to the degenerative processes or a trauma, whereby the crystals, under the action of gravity in certain head positions coinciding with its direction, arrive to some of the semicircular canals, usually the posterior one, due to the existent anatomical circumstances and relationships, thus creating an inadequate stimulus of the cupular senses while floating through the endolymph and provoking symptoms of a strong and short-term dizziness. Two main clinical forms can be distinguished: canalolythiasis, with an accommodation of otolithic debris in the semicircular canal, and cupulolythiasis, with their location immediately next to the cupular sense. The diagnosis is established by a positive positioning test, Dix-Hallpike for the posterior and the supine roll for the lateral canal. Although one can expect a spontaneous recovery subsequent to few weeks or months, various methods of otolith repositioning to a less sensitive place lead to a prompt improvement while reducing or withdrawing the symptoms completely. These guidelines are intended for all who treat the BPPV in their work, with an intention to assist in the diagnosis and application of an appropriate therapeutic method.
BibTeX: @article{Maslovara2015, author = {Maslovara, Sinisa and Butković-Soldo, Silva and Drvis, Petar and Roje-Bedeković, Marina and Trotić, Robert and Branica, Srećko and Habek, Mario and Cvjetko, Tereza and Vesligaj, Tihana and Adamec, Ivan and Gabelić, Tereza and Jurić, Stjepan and Vceva, Andrijana and Vranjes, Zeljko and Sarić, Ingrid and Cejić, Olivera and Zivić, Tihomir}, title = {[CROATIAN GUIDELINES FOR DIAGNOSIS AND MANAGEMENT OF BENIGN PAROXYSMAL POSITIONAL VERTIGO (BPPV)].}, journal = {Lijecnicki vjesnik}, year = {2015}, volume = {137}, issue = {11-12}, pages = {335--342}, keywords = {Benign Paroxysmal Positional Vertigo, classification, diagnosis, therapy; Croatia; Humans; Otolithic Membrane, pathology; Patient Positioning; Practice Guidelines as Topic}, pmid = {26975061} }
Sun, L.B., Zheng, Z.Y., Wang, B.Q., Yu, W.Y., Yang, J., Guo, W.J. and Ren, H.J.	[Curative effect analysis of the vestibular rehabilitation training on residual dizziness after successful canalith repositioning maneuvers in patients with benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2017	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 31(12), pp. 897-900	article	DOI
Abstract: To explore the curative effect and quality life of the vestibular rehabilitation training on residual dizziness after successful canalith repositioning maneuvers in patients with benign paroxysmal positional vertigo (BPPV). Residual dizziness after successful canalith repositioning maneuvers in patients with BPPV were enrolled in our study. They were randomized into three groups, the control group A were no disposition which include 32 patients, the intervention group B were guided to self rehabilitation training which include 33 patients, the control group C were guided to Brandt Daroff training which include 33 patients. Dizziness handicap inventory (DHI) and residual dizziness duration were used to evaluation the patients. After one week vestibular rehabilitation training, the scores of DHI in group B and C decreased, and there was no significant difference ( >0.05), there were significant differences between group B and group C in group A, respectively ( <0.01). After four weeks of vestibular rehabilitation training, the scores of DHI in group B and group C were lower than those in group A, the decrease of group B was significantly higher than that of group C ( <0.01). The residual dizziness duration indicated that no statistical differences in the B, C groups ( >0.05) and scores of group B,C were significantly lower than group A ( <0.05). The appropriate vestibular rehabilitation training on residual dizziness after successful canalith repositioning maneuvers in patients with BPPV can help promote the central vestibular compensation, reduce the residual symptoms, improve the quality life of patients, and which can be used as the adjuvant treatment on BPPV patient who has residual dizziness symptoms.
BibTeX: @article{Sun2017, author = {Sun, L B and Zheng, Z Y and Wang, B Q and Yu, W Y and Yang, J and Guo, W J and Ren, H J}, title = {[Curative effect analysis of the vestibular rehabilitation training on residual dizziness after successful canalith repositioning maneuvers in patients with benign paroxysmal positional vertigo].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2017}, volume = {31}, issue = {12}, pages = {897--900}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2017.12.001}, keywords = {Benign Paroxysmal Positional Vertigo, therapy; Dizziness, therapy; Humans; Patient Positioning; Vestibule, Labyrinth; residual dizziness; vertigo; vestibular rehabilitation therapy}, pmid = {29798407} }
de Campora, L., Romano, L., Barbieri, M. and Nuti, D.	[Delayed diagnosis of benign paroxysmal vertigo: economic impact]. [Abstract] [BibTeX]	2001	Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale Vol. 21(5), pp. 277-280	article
Abstract: Some time has passed since the early 1980's when a group of vestibologists with the same singular passion introduced in Italy the concept of Paroxysmal Positional Vertigo (PPV). Since then great advances have been made, but, despite the energy focused on improving and expanding the knowledge on this common disorder, PPV still frequently goes unrecognized. The direct consequence of delayed diagnosis is prolonged patient discomfort and the execution of useless, costly clinical examinations. Today, in most cases, delayed diagnosis is unjustified. Within the modern concept of health care economics, such delay is costly to the health care provider and has obvious psycho-physical repercussions for the patient who has to undergo a fruitless series of examinations and treatments of all types without reaping any benefits. In this light the Authors have performed a study to identify and quantify the relative costs of the most common errors made in the diagnosis of PPV. For a sample population of 100 patients, the clinical-instrumental tests performed before the disorder was correctly diagnosed were gathered and analyzed. Then the costs for the management of PPV patients diagnosed late were compared with those for patients whose diagnosis was reached early on. The results indicate that for each delay in PPV diagnosis the average cost was Euro 317.66 vs. Euro 64.04 for early diagnosis: a difference of Euro 253.06. The Authors underline how in this brief period of time (March-September 2000) the prescription of excessive testing led to a significant waste of money (Euro 10137.01).
BibTeX: @article{Campora2001, author = {de Campora, L and Romano, L and Barbieri, M and Nuti, D}, title = {[Delayed diagnosis of benign paroxysmal vertigo: economic impact].}, journal = {Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale}, year = {2001}, volume = {21}, issue = {5}, pages = {277--280}, keywords = {Adult; Aged; Female; Humans; Male; Middle Aged; Severity of Illness Index; Time Factors; Vertigo, diagnosis, economics}, pmid = {11865784} }
Zhou, S.Z., Li, J.R., Tian, S.Y., Ju, J. and Jia, M.Y.	[Demographic characteristics and canalith repositioning efficacy in 907 patients with typical benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2018	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 32(15), pp. 1153-1157	article	DOI
Abstract: Abstract To review the demographic characteristics and canalith repositioning efficacy in 907 patients with typical benign paroxysmal positional vertigo(BPPV). The demographic characteristics of 907 patients with typical BPPV were statistically analyzed. According to the type of BPPV, patients were treated with the appropriate repositioning maneuver, and the clinical efficacy of repositioning maneuver was analyzed and summarized. Nine hundred and seven patients of BPPV with typical nystagmus were elected in this study. 585 out of 907 were female and 322 out of were male, and the mean age was 53.10±14.25(13 to 89) years. The lesion located to the posterior semiCIrcular canal was 489 patients(53.9%), horizontal semiCIrcular canal was 312 patients(34.4%), anterior semiCIrcular was 63 patients(6.9%), and multiple semiCIrcular was 43 patients(4.8%). According to Kaplan-Meier survival analysis curve, the median cure time for the modified Semont and Epley repositioning maneuver in PC-BPPV groups was 3 days, and there was no significant difference in survival curves between the two repositioning maneuver. Meanwhile, the median cure time for Barbecue and Li horizontal canal quick repositioning maneuver groups was 3 days, and 1 day for Gufoni repositioning maneuver group in HC-BPPV groups. And there was no significant difference in survival curves among the three repositioning maneuver. In the AC-BPPV, 7 cases, 31 cases, 57 cases, 58 cases were cured with the Li anterior canal quick repositioning maneuver in the 1st day, the 3rd day, 1 week later, and 1 month later, and 5 cases lost to be follow-up. According to Kaplan-Meier survival analysis curve, the median cure time for the Li anterior canal quick repositioning maneuver in AC-BPPV groups was 3 days. Repositioning maneuver represents a simple, safe, rapid and effective approach to the treatment of BPPV. Therefore, repositioning maneuver should be choice for the BPPV treatment.
BibTeX: @article{Zhou2018, author = {Zhou, S Z and Li, J R and Tian, S Y and Ju, J and Jia, M Y}, title = {[Demographic characteristics and canalith repositioning efficacy in 907 patients with typical benign paroxysmal positional vertigo].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2018}, volume = {32}, issue = {15}, pages = {1153--1157}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2018.15.007}, keywords = {repositioning maneuver; therapy; vertigo; vestibular disease}, pmid = {30282147} }
Schmal, F. and Stoll, W.	[Diagnosis and management of benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2002	Laryngo- rhino- otologie Vol. 81(5), pp. 368-380	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is a common disorder of the vestibular labyrinth which should be suspected in all patients with a history of vertigo during changes of head position. The BPPV appears to be caused by free-floating debris in the posterior semicircular canal. The diagnosis is confirmed by eliciting characteristic symptoms during the Dix-Hallpike test. Although the BPPV usually is a self-limited disorder treatment with a specific bedside maneuver is effective and can shorten the duration of symptoms.
BibTeX: @article{Schmal2002, author = {Schmal, F and Stoll, W}, title = {[Diagnosis and management of benign paroxysmal positional vertigo].}, journal = {Laryngo- rhino- otologie}, year = {2002}, volume = {81}, issue = {5}, pages = {368--380}, doi = {https://doi.org/10.1055/s-2002-34527}, keywords = {Female; Humans; Labyrinth Diseases, diagnosis, physiopathology, therapy; Lithiasis, diagnosis, physiopathology, therapy; Male; Physical Therapy Modalities, methods; Posture, physiology; Semicircular Canals, physiopathology, surgery; Terminology as Topic; Vertigo, diagnosis, physiopathology, therapy}, pmid = {12389590} }
Suzuki, A.R., Herdman, S.J. and Tusa, R.J.	[Diagnosis and therapeutic options in benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	1999	Acta otorrinolaringologica espanola Vol. 50(2), pp. 106-117	article
Abstract: Benign paroxysmal positional vertigo (BPPV) is one of the most common and treatable causes of vertigo. We examined BPPV types and the effectiveness of physical therapy in each type. BPPV is caused by a utricular statoconium that blocks the semicircular canal. Statoconia can block any of the semicircular canals, but they generally affects the posterior canal. Diagnosis is based on a typical history and characteristic eye movements elicited by the Dix-Hallpike test. Treatment involves a physical maneuver designed to mobilize the free calcium particles from the semicircular canal to the utricle. Canalith repositioning is the mainstay of treatment. The maneuver is illustrated in detail and other forms of treatment and their indications are discussed.
BibTeX: @article{Suzuki1999a, author = {Suzuki, A R and Herdman, S J and Tusa, R J}, title = {[Diagnosis and therapeutic options in benign paroxysmal positional vertigo].}, journal = {Acta otorrinolaringologica espanola}, year = {1999}, volume = {50}, issue = {2}, pages = {106--117}, keywords = {Diagnosis, Differential; Humans; Posture; Vertigo, diagnosis, etiology, therapy}, pmid = {10217683} }
Gao, B., Song, H.-t., Zhou, J.-m., Gong, X. and Huang, W.-n.	[Diagnosis and therapy for benign paroxysmal positional vertigo of the anterior semicircular canal]. [Abstract] [BibTeX]	2007	Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery Vol. 42(6), pp. 428-431	article
Abstract: To analyse the video-oculographic findings of positional tests and evaluate the efficacy of canalith repositioning procedure (CRP) in patients with paroxysmal positional vertigo ( BPPV) of the anterior semicircular canal (ASC). A retrospective study of 31 patients with ASC BPPV. Then the CRP was performed. Twenty-two individuals (70.97%) presented a unilateral positional nystagmus during the Dix-Hallpike test, in 17 individuals had torsional nystagmus component, 5 individuals only had pure positional down beat nystagmus. Nine patients presented bilateral positional nystagmus, 7 individuals had torsional component positional nystagmus, in 2 patients the direction of the torsional component were the same during right and left Dix-Hallpike test, in 4 patients the torsional component were concurrent with positional down beat nystagmus but the direction could not be ascertained clinically, in 2 patients had pure positional down beat nystagmus. Nineteen patients (61.29%) had unilateral lesion, 11 patients had the left ASC BPPV, 8 patients had right ASC BPPV. Eleven patients had with both ASC and PSC BPPV in the ipsilateral. Twenty-one patients (67.74%) were cured, 29 patients (93.55%) were improved, 2 (6.45%) patients were inefficacy. CRP effectively resolved the nystagmus and vertigo in 14 patients (45.16%) when applied only once, The average number of CRP was 1.7 times, there were 5 patients recurrence during the follow-up. ASC BPPV was not a common condition. The torsional nystagmus component of ASC BPPV might be weak during the Dix-Hallpike test. The positional nystagmus of ASC BPPV was triggered bilaterally. Based on these findings, CRP could be one of the most effective treatment methods for ASC BPPV.
BibTeX: @article{Gao2007, author = {Gao, Bo and Song, Hai-tao and Zhou, Jin-mei and Gong, Xia and Huang, Wei-ning}, title = {[Diagnosis and therapy for benign paroxysmal positional vertigo of the anterior semicircular canal].}, journal = {Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery}, year = {2007}, volume = {42}, issue = {6}, pages = {428--431}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo; Female; Humans; Male; Middle Aged; Retrospective Studies; Semicircular Canals; Vertigo, diagnosis, therapy}, pmid = {17702417} }
Sun, S., Wang, H., Wang, W., Man, R. and Zheng, X.	[Diagnosis and therapy for horizontal semicircular canal cupulolithiasis]. [Abstract] [BibTeX]	2015	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 29(1), pp. 23-26	article
Abstract: By analysing the video-nystagmography findings of positional tests,to evaluate the therapeutic effect of the patients with horikontal semicircular canal cupulolithiasis (HSC-Cup). A retrospective study of 36 patients with HSC-Cup. The induced nystagmus in roll tests was recorded by videonystagmography, whose direction, latency, intensity and time characteristics were analysed. All of the 36 patients were treated with lying position avoiding normal side and oral-taken betahistine mesilate tablets. A week later return visits and curative effects evaluation were made. Horizontal apogeotropic nystagmus was induced by turning left or right in HSC-Cup roll tests. The time of latency and duration turning to normal and lesion side were(0. 93 ± 0. 65)s and(1. 01 ± 0. 78)s, (100.58 ± 36. 56)s and (118. 65 ± 143. 71)s, which showed no statistically significant difference (P>0. 05). The duration of nystagmus was more than 60 seconds. The intensity of nystagmus turning to normal and lesion side were(45.58 ± 28.71)°/s and (20.42 ± 16. 64)°/s. The intensity turning to normal side was greater than lesion side obviously. The difference was statistically significant (P<0. 05). Twenty-three patients withright HSC-Cup, and 13 patients with left HSC-Cup were taken in count. They were treated with above methods and return visit a week later. Twenty-eight patients (77. 77%) were cured, 36 patients (100. 00%) were improved. There were 4 patients recurrence during the follow-up. The direction and duration time of induced nystagmus are available to diagnose the HSC-Cup. The lesion side may determined according to the intensity of induced nystagmus. Lying position avoiding normal side and oral-taken betahistine mesilate tablets is an effective treatment methods for HSC-Cup.
BibTeX: @article{Sun2015, author = {Sun, Shiping and Wang, Huizhong and Wang, Weiguo and Man, Rongjun and Zheng, Xia}, title = {[Diagnosis and therapy for horizontal semicircular canal cupulolithiasis].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2015}, volume = {29}, issue = {1}, pages = {23--26}, keywords = {Benign Paroxysmal Positional Vertigo, complications, diagnosis; Face; Humans; Nystagmus, Physiologic; Retrospective Studies; Semicircular Canals; Treatment Outcome; Vertigo}, pmid = {25966549} }
Hess, M.M., Kühn, A. and Lamprecht, J.	[Diagnosis and therapy of benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	1990	HNO Vol. 38(7), pp. 262-265	article
Abstract: The clinical features and therapeutical aspects of 31 patients with benign paroxysmal positional vertigo (BPPV) were studied. Attention is drawn to diagnostic criteria such as the "Hallpike manoeuvre" and guidelines are given for the differentiation of BPPV and cervical nystagmus. The results of this study are discussed with special regard to habituation training.
BibTeX: @article{Hess1990, author = {Hess, M M and Kühn, A and Lamprecht, J}, title = {[Diagnosis and therapy of benign paroxysmal positional vertigo].}, journal = {HNO}, year = {1990}, volume = {38}, issue = {7}, pages = {262--265}, keywords = {Female; Habituation, Psychophysiologic; Humans; Male; Meniere Disease, etiology, therapy; Middle Aged; Posture; Vestibular Function Tests}, pmid = {2394604} }
Tian, Y., Zhang, T. and Jiang, X.	[Diagnosis and treatment of 318 benign paroxysmal positional vertigo cases]. [Abstract] [BibTeX]	2012	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 26(1), pp. 13-15	article
Abstract: To investigate the diagnosis, treatment and therapeutic effect of various types of BPPV. Three hundred and eighteen BPPV patients were retrospectively analyzed. After the types of BPPV were determined by nystagmus characteristics provoked by positioning test, the appropriate repositioning maneuvers were performed. For patients unresponsive to initial treatment, a repetitive treatment was given after seven days. If patients failed after three continuous treatments, other therapeutic methods were chosen and performed. Overall effectiveness in the next three months after treatment was observed. Of 318 patients, 221 (69.5%) with posterior semicircular canal involvement, Epley repositioning maneuver was performed; 62 (19.5%) with horizontal semicircular canal involvement, Barbecue maneuver combined forced prolonged position maneuver were applied; 23 (7.2%) with anterior canal involvement were treated with Epley maneuver; 12 (3.8%) had the mixed type and were treated with corresponding repositioning maneuvers. After one week the total improvement rate was 82.1% (261/318) and 91.8% three months later (292/318). The different BPPV variants can be diagnosed according to the nystagmus characteristics during the appropriate provoking maneuvers, and appropriate repositioning maneuvers is a very effective method which can shorten disease period and relieve the symptoms. The method is easy to apply and could be widely performed clinically.
BibTeX: @article{Tian2012, author = {Tian, Ying and Zhang, Tao and Jiang, Xuejun}, title = {[Diagnosis and treatment of 318 benign paroxysmal positional vertigo cases].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2012}, volume = {26}, issue = {1}, pages = {13--15}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic; Retrospective Studies; Vertigo, diagnosis, therapy; Young Adult}, pmid = {22509688} }
Amor Dorado, J.C., Rubio Rodríguez, J.P., Costa Ribas, C. and Rossi Vargas, J.	[Diagnosis and treatment of a case of benign paroxysmal posture vertigo of the horizontal canal]. [Abstract] [BibTeX]	2003	Acta otorrinolaringologica espanola Vol. 54(7), pp. 527-530	article
Abstract: Ahorizontal canal positional vertigo with apogeotropic and persistent directional changing nystagmus is reported. A new procedure consisting in cervical hiperflexion was used to determine the affected side in order to perform a particle repositioning manoeuvre.
BibTeX: @article{AmorDorado2003, author = {Amor Dorado, J C and Rubio Rodríguez, J P and Costa Ribas, C and Rossi Vargas, J}, title = {[Diagnosis and treatment of a case of benign paroxysmal posture vertigo of the horizontal canal].}, journal = {Acta otorrinolaringologica espanola}, year = {2003}, volume = {54}, issue = {7}, pages = {527--530}, keywords = {Female; Humans; Middle Aged; Otolaryngology, methods; Vertigo, diagnosis, therapy}, pmid = {14671926} }
Lebedeva, N.V., Zamergrad, M.V., Parfenov, V.A. and Antonenko, L.M.	[Diagnosis and treatment of benign paroxysmal positional vertigo in common clinical practice]. [Abstract] [BibTeX]	2017	Terapevticheskii arkhiv Vol. 89(1), pp. 57-61	article	DOI
Abstract: To analyze typical medical practice in managing patients with benign paroxysmal positional vertigo (BPPV). 33 patients (5 men and 28 women; mean age, 58 years) with BPPV who had been referred for consultation to the Medical Diagnostic Department, Clinic of Nervous Diseases, I.M. Sechenov First Moscow State Medical University, regarding for vertigo, were examined. Information about the disease before visiting the clinic, such as the duration of vertigo, its pattern, and triggers, previously established diagnoses, prescribed treatment and its efficacy, concomitant diseases, was analyzed. BPPV was not timely diagnosed in 93.9% of cases. The cause of vertigo was most commonly mistakenly assumed to be cerebrovascular disease (66.6%) and cervical spine pathology (15.1%). During a primary examination, none of the patients underwent positional tests (otoneurological examination) that formed the basis for the diagnosis of BPPV. Alternatively, 90.3% of cases underwent instrumental examination: magnetic resonance imaging of the brain, X-ray of the cervical spine, and ultrasonic duplex scanning of the brachiocephalic arteries. Ineffective diagnosis led to the choice of nonoptimal treatment tactics: instead of therapeutic repositioning maneuvers (RM), the patients received therapy with drugs, such as various vasoactive agents (84.8%), nootropic and chondroprotective drugs (12%), or muscle relaxants (9.1%). After BPPV was detected, all patients underwent curative RM, which resulted in regression of the disease. One-year follow-up of the patients showed that the therapeutic effect of RM persisted. Lack of effective and timely diagnosis of BPPV reflects physicians' poor awareness that this condition is the most common cause of vestibular vertigo. The role of vascular and cervicogenic factors in the development of vertigo is overestimated. Most patients with BPPV undergo unreasonable examinations and receive ineffective treatment. It is necessary to raise awareness of BPPV among of physicians and to set up specialized centers for the management of patients with dizziness.
BibTeX: @article{Lebedeva2017, author = {Lebedeva, N V and Zamergrad, M V and Parfenov, V A and Antonenko, L M}, title = {[Diagnosis and treatment of benign paroxysmal positional vertigo in common clinical practice].}, journal = {Terapevticheskii arkhiv}, year = {2017}, volume = {89}, issue = {1}, pages = {57--61}, doi = {https://doi.org/10.17116/terarkh201789157-61}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis, therapy; Female; Health Services, standards, statistics & numerical data; Humans; Male; Middle Aged}, pmid = {28252629} }
Pal'chun, V.T., Kunel'skaia, N.L. and Rotermel', E.V.	[Diagnosis and treatment of benign paroxysmal postural vertigo]. [Abstract] [BibTeX]	2007	Vestnik otorinolaringologii(1), pp. 4-7	article
Abstract: The article describes pathogenetic aspects, clinical picture, principal diagnostic methods and treatment of patients with benign paroxysmal postural vertigo (BPPV). The evidence obtained at examination of 148 patients with complaints for vertigo episodes is provided. The group of 29 patients with a positive Dix-Holpike test was analysed. BPPV onset correlated with age, gender, prevalence of the pathological process location on the right, presence of labyrinthine hydropse.
BibTeX: @article{Palchun2007, author = {Pal'chun, V T and Kunel'skaia, N L and Rotermel', E V}, title = {[Diagnosis and treatment of benign paroxysmal postural vertigo].}, journal = {Vestnik otorinolaringologii}, year = {2007}, issue = {1}, pages = {4--7}, keywords = {Adolescent; Adult; Aged; Diagnosis, Differential; Drug Combinations; Female; Ginkgo biloba; Humans; Male; Middle Aged; Plant Extracts, therapeutic use; Posture; Vertigo, diagnosis, drug therapy, therapy}, pmid = {17495794} }
Huang, H.M., Huang, Y., Cui, Y., Ge, R.M. and Fu, M.	[Diagnosis and treatment of canal conversion during canalith repositioning procedure for benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2018	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 32(11), pp. 816-818	article	DOI
Abstract: To investigate the diagnosis and treatment of canal conversion during canalith repositioning procedure for benign paroxysmal positional vertigo. The clinic features, nystagmus characteristics, diagnosis and treatment of the patients with benign paroxysmal positional vertigo who suffered from canal conversion during canalith repositioning procedure were analyzed retrospectively.All patients'positioning test and canalith repositioning procedure were done with the aid of videonystagmography. A total of 186 patients with benign paroxysmal positional vertigo were diagnosed and performed canalith repositioning procedure.Eight patients (4.3%) developed canal conversion after canalith repositioning procedure.Of these 8 patients,5 cases with posterior canal canalolithiasis converted to lateral canal canalolithiasis,2 cases with lateral canal canalolithiasis converted to posterior canal canalolithiasis,and 1 case with posterior canal canalolithiasis converted to anterior canal canalolithiasis. All cases recovered well under the corresponding repositioning procedure. The change of the characteristics of positioning nystagmus is the major diagnostic feature of canal conversion. Accurate diagnosis and targeted repositioning procedure are the key to the success of canal conversion treatment.
BibTeX: @article{Huang2018, author = {Huang, H M and Huang, Y and Cui, Y and Ge, R M and Fu, M}, title = {[Diagnosis and treatment of canal conversion during canalith repositioning procedure for benign paroxysmal positional vertigo].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2018}, volume = {32}, issue = {11}, pages = {816--818}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2018.11.004}, keywords = {Benign Paroxysmal Positional Vertigo, therapy; Humans; Nystagmus, Pathologic; Patient Positioning; Posture; Retrospective Studies; Semicircular Canals; benign paroxysmal positional vertigo; canal conversion; canalith}, pmid = {29921048} }
Xing, G., Chen, Z. and Bu, X.	[Diagnosis and treatment of horizontal canal benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2001	Zhonghua er bi yan hou ke za zhi Vol. 36(1), pp. 28-30	article
Abstract: To explore effective methods for the diagnosis and treatment of horizontal-canal benign paroxysmal positional vertigo (HC-BPPV). Medical records from nine patients with HC-BPPV, treated between July 1996 and March 2000, were retrospectively analyzed. Data of complete history, audiograms, positional tests and neuro-otological examinations were collected. All patients were treated with a particle repositioning maneuver called the "barbecue rotation" which starts with the patient in the supine position and consists of three 90-degree head rotations towards the unaffected ear. HC-BPPV was characterized by brief attacks of intense vertigo that were induced mainly by rolling over in bed (9/9) and turning the head to either side while upright (5/9). In most cases, rotation to the pathological side from supine position caused a very intense horizontal nystagmus beating towards the undermost ear. Findings such as latency and fatigability, which are common features of posterior-canal BPPV (PC-BPPV), were not present. After the barbecue rotation, all patients had immediate and sustained relief of their attacks during the 4 to 15 months' follow up. HC-BPPV is different from PC-BPPV and other vertiginous diseases in typical presentations and positional testing results. The barbecue rotation is a successful method for curing the disorder.
BibTeX: @article{Xing2001, author = {Xing, G and Chen, Z and Bu, X}, title = {[Diagnosis and treatment of horizontal canal benign paroxysmal positional vertigo].}, journal = {Zhonghua er bi yan hou ke za zhi}, year = {2001}, volume = {36}, issue = {1}, pages = {28--30}, keywords = {Adult; Aged; Female; Follow-Up Studies; Humans; Male; Middle Aged; Otolithic Membrane; Posture; Retrospective Studies; Rotation; Semicircular Canals, physiopathology; Vertigo, diagnosis, etiology, therapy}, pmid = {12761903} }
of Chinese Journal of Otorhinolaryngology Head, E.B., Surgery, N. and of Chinese Medical Association, C.O.H.S.S.	[Diagnosis basis and curative effect appraisal of benign paroxysmal positional vertigo]. [BibTeX]	2007	Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery Vol. 42(3), pp. 163-164	article
BibTeX: @article{ChineseJournalofOtorhinolaryngologyHead2007, author = {Editorial Board of Chinese Journal of Otorhinolaryngology Head and Neck Surgery and Chinese Otorhinolaryngology Head Surgery Society of Chinese Medical Association}, title = {[Diagnosis basis and curative effect appraisal of benign paroxysmal positional vertigo].}, journal = {Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery}, year = {2007}, volume = {42}, issue = {3}, pages = {163--164}, keywords = {Humans; Treatment Outcome; Vertigo, diagnosis, etiology, therapy}, pmid = {17633403} }
López-Escámez, J.A., López-Nevot, A., Gámiz, M.J., Moreno, P.M., Bracero, F., Castillo, J.L. and Salinero, J.	[Diagnosis of common causes of vertigo using a structured clinical history]. [Abstract] [BibTeX]	2000	Acta otorrinolaringologica espanola Vol. 51(1), pp. 25-30	article
Abstract: The structured clinical history is the most sensitive test for diagnosing vertigo. Its diagnostic effectiveness on the first visit was analyzed and key signs and symptoms with high predictive value for common causes of vertigo were identified. One hundred outpatients who complained of dizziness or loss of balance were evaluated using a structured clinical interview. Each questionnaire was examined independently by three blinded investigators, who assigned a diagnosis and identified the elements of the history that figured most prominently in the diagnosis. The gold standard was defined as independent selection of the same diagnostic category by all three investigators. A first-visit diagnosis was obtained in 40% of patients (95% confidence interval 30-50%): 38% women and 42% men. Causes included benign positional paroxysmal vertigo (BPPV, 13 patients), headache-associated vertigo (9), Meniere disease (7), cervical vertigo (3), psychiatric dizziness (2), post-traumatic vertigo (2), vertebro-basilar transient ischemic attack (1), vestibular neuritis (1), convulsive seizure (1), and presyncope (1). The best predictors of BPPV were the precipitating mechanism (specificity [SP] 100%), positional nystagmus (sensitivity [SE] 90%, SP 63%), and the Dix-Hallpike test (SE 82%, SP 71%). Elements predictive of headache-associated vertigo were duration of the attack (minutes) and a personal history of headache (both, SP 100%). Other predictors were facial hypoesthesia (SE 92%, SP 47%) and associated neurological disease (SE 82%, SP 58%).
BibTeX: @article{Lopez-Escamez2000, author = {López-Escámez, J A and López-Nevot, A and Gámiz, M J and Moreno, P M and Bracero, F and Castillo, J L and Salinero, J}, title = {[Diagnosis of common causes of vertigo using a structured clinical history].}, journal = {Acta otorrinolaringologica espanola}, year = {2000}, volume = {51}, issue = {1}, pages = {25--30}, keywords = {Adult; Female; Humans; Male; Predictive Value of Tests; Prospective Studies; Surveys and Questionnaires; Vertigo, diagnosis, etiology}, pmid = {10799928} }
Ma, X., Jing, Y.-y., Xia, R.-m. and Yu, L.-s.	[Different pathogenesis of benign paroxysmal positional vertigo from the nystagmus during particle repositioning maneuver]. [Abstract] [BibTeX]	2009	Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery Vol. 44(5), pp. 377-380	article
Abstract: To analyze the nystagmus during particle repositioning maneuver for posterior semicircular canal benign paroxysmal positional vertigo (PC-BPPV), and verify different pathogenesis of benign paroxysmal positional vertigo (BPPV). The chief complains, nystagmus during positioning test and particle repositioning maneuver (PRM) were recorded in detail from 66 PC-BPPV cases during Dec.2007 and Apr.2008, and verifying possible pathogenesis of BPPV was based on nystagmus. Of all 66 PC-BPPV cases, the four positions of PRM were found in 24 cases presented upward torsional nystagmus at the second or third position, 21 cases presented negative nystagmus except the first position, 7 cases presented intensity horizontal nystagmus during PRM and 14 cases presented downward nystagmus at the second or third position during PRM. Of all 66 cases, 78.8% of them were accord with canalithiasis and cupulolithiasis while the other may be related with otolith organ or nerve disease. Besides canalithiasis and cupulolithiasis, part of BPPV may be related with otolith organ or nerve disease.
BibTeX: @article{Ma2009a, author = {Ma, Xin and Jing, Yuan-yuan and Xia, Rui-ming and Yu, Li-sheng}, title = {[Different pathogenesis of benign paroxysmal positional vertigo from the nystagmus during particle repositioning maneuver].}, journal = {Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery}, year = {2009}, volume = {44}, issue = {5}, pages = {377--380}, keywords = {Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, etiology; Semicircular Canals; Vertigo, etiology, pathology, therapy; Young Adult}, pmid = {19567045} }
Blessing, R., Mann, W. and Beck, C.	[Differential diagnosis of benign paroxysmal positional vertigo in Menière's disease]. [Abstract] [BibTeX]	1986	HNO Vol. 34(9), pp. 372-375	article
Abstract: 135 patients with BPPV and 56 patients with Meniere's disease were evaluated critically. The reliability of the diagnostic criteria (history and physical examination, audiograms and vestibular function tests) were compared. History, physical examination and patients' complaints were inconclusive. Moderate or severe medio- or pancochlear inner ear damage was more reliable, but not pathognomonic of Meniere's disease. Patients with BPPV had normal hearing or a high-frequency loss. Electronystagmographically recorded vestibular function tests were unreliable in establishing the diagnosis. The most valid test to distinguish BPPV and Meniere's disease was Hallpike's positional test, using Frenzel's spectacles for better observation of the provoked nystagmus.
BibTeX: @article{Blessing1986, author = {Blessing, R and Mann, W and Beck, C}, title = {[Differential diagnosis of benign paroxysmal positional vertigo in Menière's disease].}, journal = {HNO}, year = {1986}, volume = {34}, issue = {9}, pages = {372--375}, keywords = {Adult; Audiometry; Diagnosis, Differential; Female; Hearing Loss, Sensorineural, diagnosis; Humans; Labyrinth Diseases, diagnosis; Male; Meniere Disease, diagnosis; Posture; Vertigo, diagnosis; Vestibular Function Tests}, pmid = {3771295} }
Blankenburg, S. and Westhofen, M.	[Differentiation of benign paroxysmal positional vertigo subtypes]. [BibTeX]	2007	Laryngo- rhino- otologie Vol. 86(6), pp. 410-414	article	DOI
BibTeX: @article{Blankenburg2007, author = {Blankenburg, Sandra and Westhofen, Martin}, title = {[Differentiation of benign paroxysmal positional vertigo subtypes].}, journal = {Laryngo- rhino- otologie}, year = {2007}, volume = {86}, issue = {6}, pages = {410--414}, doi = {https://doi.org/10.1055/s-2007-982584}, keywords = {Electronystagmography; Head Movements, physiology; Humans; Physical Therapy Modalities; Posture; Vertigo, classification, diagnosis, rehabilitation}, pmid = {17541897} }
González del Pino, B. and Pérez Fernández, N.	[Disability in patients with benign paroxysmal positional vertigo with posterior semicircular canal involvement]. [Abstract] [BibTeX]	2003	Acta otorrinolaringologica espanola Vol. 54(6), pp. 401-408	article
Abstract: The aim of this work is to analyze the vestibular function and level of disability in two populations of patients with positional vertigo but with different results in the Dix-Hallpike test. 114 patients were assessed. In 65 the Dix-Hallpike test was positive (DH+) and in 49 negative (DH). The caloric test was performed as well as the assessment of disability with the pertinent questionnaires for vestibular disability. Patients in the DH+ group showed a higher level of disability in the physical subscale of the DHI and a higher perception of a deteriorated quality of life. Patients in the DH- group showed a more severe disability in the emotional subscale of the DHI. Once the phenomenon of nystagmus fatigability is ruled out, patients with positional vertigo and DH- must not be considered a minor form of positional vertigo.
BibTeX: @article{GonzalezdelPino2003, author = {González del Pino, B and Pérez Fernández, N}, title = {[Disability in patients with benign paroxysmal positional vertigo with posterior semicircular canal involvement].}, journal = {Acta otorrinolaringologica espanola}, year = {2003}, volume = {54}, issue = {6}, pages = {401--408}, keywords = {Adult; Aged; Caloric Tests; Disabled Persons; Female; Humans; Male; Middle Aged; Semicircular Canals, physiopathology; Surveys and Questionnaires; Vertigo, diagnosis, physiopathology}, pmid = {14567074} }
Pabst, F., Machetanz, J., Gerk, U., Simonis, G. and Schellong, S.	[Diseases of the peripheral vestibular system: contribution of ENT medical diagnostics and therapy]. [Abstract] [BibTeX]	2015	Der Internist Vol. 56(1), pp. 36-40	article	DOI
Abstract: The most common types of vertigo caused by diseases of the peripheral vestibular system are benign paroxysmal positional vertigo (BPPV), Meniere's disease and vestibular neuritis. A thorough examination of the medical history and clinical examination are usually sufficient for the differential diagnostics. Treatment includes differentiated repositioning maneuvers, medicinal treatment and physiotherapy.
BibTeX: @article{Pabst2015, author = {Pabst, F and Machetanz, J and Gerk, U and Simonis, G and Schellong, S}, title = {[Diseases of the peripheral vestibular system: contribution of ENT medical diagnostics and therapy].}, journal = {Der Internist}, year = {2015}, volume = {56}, issue = {1}, pages = {36--40}, doi = {https://doi.org/10.1007/s00108-014-3550-6}, keywords = {Diagnosis, Differential; Diagnostic Techniques, Neurological; Humans; Otolaryngology, methods; Vertigo, diagnosis, etiology, therapy; Vestibular Diseases, complications, diagnosis, therapy}, pmid = {25502656} }
Probst, R.	[Dizziness from a neuro-otological viewpoint]. [Abstract] [BibTeX]	1995	Therapeutische Umschau. Revue therapeutique Vol. 52(11), pp. 724-731	article
Abstract: The symptom of vertigo can be due to many different causes. Differential diagnosis will be discussed primarily from a neuro-otologic point of view. Vertigo can be thought of as a subjective disturbance of the integration of different sensory inputs. The history and subjective characterisation of vertigo often provide enough information for initial differential diagnosis and recommendation for a specific evaluation. The evaluation includes simple tests of posture and gait, tests of ocular motility, and examination of nystagmus. Instability and nystagmus towards a specific direction point to a vestibular disorder, especially if the nystagmus is suppressed by optical fixation. The most common causes of a vestibular disorder are benign paroxysmal positional vertigo (BPPV), a sudden vestibular loss (or vestibular neuritis), and Ménière's disease. These three diseases are discussed briefly.
BibTeX: @article{Probst1995, author = {Probst, R}, title = {[Dizziness from a neuro-otological viewpoint].}, journal = {Therapeutische Umschau. Revue therapeutique}, year = {1995}, volume = {52}, issue = {11}, pages = {724--731}, keywords = {Diagnosis, Differential; Eye Movements; Gait; Humans; Meniere Disease, complications, diagnosis; Neurologic Examination; Posture; Vertigo, diagnosis, etiology, physiopathology; Vestibular Diseases, complications, diagnosis; Vestibular Function Tests}, pmid = {7502247} }
Mochalina, N., Khoshnood, A., Karlberg, M. and Dryver, E.	[Dizziness in the emergency room]. [Abstract] [BibTeX]	2015	Lakartidningen Vol. 112	article
Abstract: The majority of patients who present to the Emergency Department with vertigo suffer from benign conditions. However, a few percent of these patients have life-threatening conditions, such as a cerebellar stroke. The HINTS clinical decision rule (Head-Impulse test, Nystagmus, Test-of-Skew) allows the physician to identify patients with an acute vestibular syndrome of central origin. HINTS is more sensitive than early magnetic resonance imaging. There is no role for computed tomography in the evaluation of patients with isolated acute vestibular syndrome in the Emergency Department. For patients with benign paroxysmal positional vertigo, simple reposition maneuvers are effective for symptom relief.
BibTeX: @article{Mochalina2015, author = {Mochalina, Natalia and Khoshnood, Ardavan and Karlberg, Mikael and Dryver, Eric}, title = {[Dizziness in the emergency room].}, journal = {Lakartidningen}, year = {2015}, volume = {112}, keywords = {Critical Pathways; Dizziness, diagnosis, etiology; Emergency Service, Hospital; Humans; Neurologic Examination; Vertigo, diagnosis, etiology; Vestibular Function Tests}, pmid = {25710226} }
Johkura, K.	[Dizziness/vertigo caused by small cerebellar/brainstem strokes]. [Abstract] [BibTeX]	2011	Rinsho shinkeigaku = Clinical neurology Vol. 51(11), pp. 1092-1095	article
Abstract: Unlike brainstem strokes, small cerebellar strokes can cause isolated dizziness/vertigo with horizontal nystagmus mimicking vestibular neuritis or direction-changing apogeotropic positional nystagmus mimicking benign paroxysmal positional vertigo. Horizontal nystagmus caused by cerebellar strokes were directed toward the side of the lesion, and enhanced when the patient lie on the non-affected side; the enhanced nystagmus were apogeotropic at this position. Direction-changing apogeotropic positional nystagmus, caused by similar cerebellar lesions, were also enhanced when the patient lie on the non-affected side. A possible mechanism of this enhancement of the two nystagmus may be a disinhibition of the otolich-ocular responses.
BibTeX: @article{Johkura2011, author = {Johkura, Ken}, title = {[Dizziness/vertigo caused by small cerebellar/brainstem strokes].}, journal = {Rinsho shinkeigaku = Clinical neurology}, year = {2011}, volume = {51}, issue = {11}, pages = {1092--1095}, keywords = {Brain Stem Infarctions, complications; Cerebellar Diseases, complications; Dizziness, etiology; Humans; Stroke, complications; Vertigo, etiology}, pmid = {22277491} }
Rascol, O. and Montastruc, J.L.	[Drug therapy of vertigo]. [Abstract] [BibTeX]	1994	La Revue du praticien Vol. 44(3), pp. 354-360	article
Abstract: Drug treatment of vertigo is symptomatic. Highly varied classes of drugs are used, and their mechanisms of action are poorly known. The use of these drugs is empiric as they have been insufficiently evaluated. "Emergency" treatment of acute rotatory paroxysmal vertigo includes acetyl-dl-leucine (of unknown mechanism of action), vestibuloplegic drugs (anticholinergic drugs, H1 antihistamines and calcium antagonists), and dopaminergic antagonists (for their antiemetic properties). The length of such treatment should be short so as not to compromise spontaneous vestibular compensation. In case of recurrent or chronic vertigo, in order to avoid unnecessary prescription of antivertigo drugs, the physician must first eliminate non-vestibular vertigo (such as lipothymia, hypoglycemia or phobic manifestations), benign paroxysmal positional vertigo (which requires physical therapy) and tumours (such as acoustic neurinome, requiring surgery). To treat Ménière's disease, histaminergics and calcium antagonists are used, as well as drugs that are considered to diminish the pressure of the endolymphatic liquid (diuretics, acetazolamide, hyperosmotic substances). Their superiority to placebo has not been convincingly demonstrated. Vertigo of unknown origin is no longer attributed to vascular causes and cannot justify the prescription of vasodilators of questionable efficacy. H1 antihistamines, histaminergics and calcium antagonists are still prescribed despite the general lack of proper evaluation of their efficacy. The placebo effect probably explains a good part of their therapeutic success. Because of their potential side effects, none of these drugs should be routinely prescribed on a long-term basis.
BibTeX: @article{Rascol1994, author = {Rascol, O and Montastruc, J L}, title = {[Drug therapy of vertigo].}, journal = {La Revue du praticien}, year = {1994}, volume = {44}, issue = {3}, pages = {354--360}, keywords = {Acute Disease; Chronic Disease; Humans; Recurrence; Vertigo, drug therapy, etiology, physiopathology}, pmid = {8178102} }
Yang, Q., Yin, S. and Liu, Y.	[Effect observation of the three steps self-modified canalith repositioning in the treament of posterior semicicular canal BPPV]. [BibTeX]	2014	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 28(22), pp. 1796-1798	article
BibTeX: @article{Yang2014, author = {Yang, Qiangwei and Yin, Shihua and Liu, Yuan}, title = {[Effect observation of the three steps self-modified canalith repositioning in the treament of posterior semicicular canal BPPV].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2014}, volume = {28}, issue = {22}, pages = {1796--1798}, keywords = {Humans; Vertigo, therapy}, pmid = {25752119} }
Song, Y., Bai, W. and Ma, X.	[Effects of canalith repositioning procedures with anti-vertigo drugs on benign paroxysmal positional vertigo]. [BibTeX]	2013	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 27(21), pp. 1217-1218	article
BibTeX: @article{Song2013, author = {Song, Yan and Bai, Weiliang and Ma, Xiulan}, title = {[Effects of canalith repositioning procedures with anti-vertigo drugs on benign paroxysmal positional vertigo].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2013}, volume = {27}, issue = {21}, pages = {1217--1218}, keywords = {Benign Paroxysmal Positional Vertigo, therapy; Combined Modality Therapy, methods; Humans; Otolaryngology, methods; Semicircular Canals}, pmid = {24617006} }
Xu, Y., Fu, M. and Zhang, N.	[Efficacy of different treatment on residual symptoms aftercanalith repositioning procedure in patients withbenign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2016	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 30(14), pp. 1146-1149	article	DOI
Abstract: To assess which methods are effective for residual symptoms after canalith repositioning procedure in patients with benign paroxysmal positional vertigo(BPPV) then guide the clinical treatment. A total of 93 cases who were diagnosed with BPPV,then after the canalith repositioning procedure,which still have residual symptoms were enrolled in our study.They were randomized into three groups,The control group(A),The drug group(Ginkgo Leaves Soft-gel Capsule and Qiangli Dingxuan tablets)(B),The vestibular rehabilitation gymnastics group(C).Then compare the efficacy of different treatment. In the follow-up of 30 days,the number of DHI scores decline of group A is significantly lower than that of group B( <0.05) and C( <0.05),making statistical significance.The residual symptom duration of group A is significantly longer than that of group B( <0.05) and C( <0.05),making statistical significance.There is no significant statistical difference in comparing the number of DHI scores decline in the follow-up of 30 days,and the residual symptom duration of B and C( >0.05). The drugs for improve the microcirculation and vestibular rehabilitation gymnastics can reduce the duration of residual symptoms.
BibTeX: @article{Xu2016, author = {Xu, Y and Fu, M and Zhang, N}, title = {[Efficacy of different treatment on residual symptoms aftercanalith repositioning procedure in patients withbenign paroxysmal positional vertigo].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2016}, volume = {30}, issue = {14}, pages = {1146--1149}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2016.14.015}, keywords = {Benign Paroxysmal Positional Vertigo, therapy; Humans; Patient Positioning; benign paroxysmal positional vertigo; residual symptoms; treatment}, pmid = {29798443} }
Babac, S. and Arsović, N.	[Efficacy of Epley maneuver in treatment of benign paroxysmal positional vertigo of the posterior semicircular canal]. [Abstract] [BibTeX]	2012	Vojnosanitetski pregled Vol. 69(8), pp. 669-674	article
Abstract: Benign paroxysmal positional vertigo is one of the most frequent peripheral vestibular system disorders. The aim of this study was to examine the efficacy of the Epley maneuver in treating benign paroxysmal positional vertigo of the posterior semicircular canal (p-BPPV) and to discover possible causes of failure. This prospective study included 75 patients. In all the cases medical history showed and the positioning Dix-Hallpike test confirmed the diagnosis of p-BPPV. We also performed clinical ENT examination, searching for spontaneous nystagmus, vestibulospinal tests, caloric test, and audiometry. All the patients were treated by the modified Epley canalith repositioning maneuver. The patients were followed up at the intervals of seven and, fourteen days, and one, tree, and six months and one year. The maneuver was repeated if vertigo and nystagmus on control positioning test persisted. The transition from positive into negative Dix Hallpike test after one or two Epley maneuver was considered as success in treatment. After the initial Epley maneuver the recovery rate was 90.7%, and after the second 96%. In three (4%) patients with secondary p-BPPV, symptoms did not cease even after the second repositioning maneuver. The etiology of p-BPPV had a significant effect on the maneuver's success rate (p < 0.01), whereas duration of symptoms, age and gender had no effect (p > 0.05). After a successful treatment 11 (14.66%) patients had recurrent attack of BPPV during the first year. The Epley maneuver is very successful repositioning procedure in treating p-BPPV. The patients with idiopathic form p-BPPV showed higher success rate with Epley maneuver than those with secondary p-BPPV.
BibTeX: @article{Babac2012, author = {Babac, Snezana and Arsović, Nenad}, title = {[Efficacy of Epley maneuver in treatment of benign paroxysmal positional vertigo of the posterior semicircular canal].}, journal = {Vojnosanitetski pregled}, year = {2012}, volume = {69}, issue = {8}, pages = {669--674}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Female; Humans; Male; Middle Aged; Physical Therapy Modalities; Vertigo, diagnosis, therapy}, pmid = {22924262} }
Zhang, H., Li, J., Guo, P., Tian, S. and Li, K.	[Efficacy of quick repositioning maneuver for posterior semicircular canal benign paroxysmal positional vertigo in different age groups]. [Abstract] [BibTeX]	2015	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 29(23), pp. 2053-2056	article
Abstract: To observe the short and long-term efficacy of quick repositioning maneuver for posterior semicircular canal benign paroxysmal positional vertigo (PC-BPPV) in different age groups. The clinical data of 113 adult patients with single PC-BPPV who underwent quick repositioning maneuver from July 2009 to February 2015 were retrospectively analyzed. The quick repositioning maneuver was to roll the patient from involved side to healthy side in the coronal plane for 180° as quickly as possible. The patients were divided into 3 groups according to different ages: young group (< 45 years), middle-age group (45 ≤ age < 60 years) and old group (≥ 60 years). The short and long term outcomes of the three groups were observed. The left ear was involved in 58 cases (51.3%) and the right ear in 55 cases (48.7%). The short term improvement rates of the young, middle-age and the old groups were 92.5%, 93.6% and 92.3% respectively, and the long term improvement rate was 90.0%, 85.1% and 73.1% respectively. There was no significant difference among the three groups in short and long term outcomes (P > 0.05). The recurrence rate of the three groups was 5.0%, 6.4% and 15.4% respectively, also no significant difference (P > 0.05). The quick repositioning maneuver along the coronal plane for PC-BPPV has a definite effect for every age groups. The method is simple, rapid and easy to master, and the patients are tolerated the maneuver well without evident side effect.
BibTeX: @article{Zhang2015, author = {Zhang, Hao and Li, Jinrang and Guo, Pengfei and Tian, Shiyu and Li, Keliang}, title = {[Efficacy of quick repositioning maneuver for posterior semicircular canal benign paroxysmal positional vertigo in different age groups].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2015}, volume = {29}, issue = {23}, pages = {2053--2056}, keywords = {Adult; Benign Paroxysmal Positional Vertigo, therapy; Humans; Middle Aged; Patient Positioning; Retrospective Studies; Semicircular Canals, physiopathology}, pmid = {27101677} }
Wang, X.-y., Ji, B., Yong, J. and Liu, L.-z.	[Efficacy of the modified Epley maneuver versus modified Semont maneuver for posterior canal benign paroxysmal positional vertigo: a meta-analysis]. [Abstract] [BibTeX]	2013	Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery Vol. 48(8), pp. 634-639	article
Abstract: To evaluate the efficacy of the modified Epley maneuver Versus modified Semont maneuver for posterior canal benign paroxysmal positional vertigo. The randomized controlled trials (RCT) about modified Epley maneuver Versus modified Semont maneuver for posterior canal benign paroxysmal positional vertigo from January 1985 to July 2013 were searched in CNKI,OVID, PubMed, CBM, EMBASE, WanFang Data, and Cochrane Library. Two reviewers independently screened the literatures, extracted the data, and evaluated the methodological quality. Then meta-analyses were conducted by using RevMan 5.1 software. A total of six RCTs were included. Among the 453 patients involved, 232 patients were in the modified Epley maneuver group, while the other 221 patients were in the modified Semont maneuver group. The results of meta-analyses showed that the efficacy of the modified Epley maneuve group was superior to that of the modified Semont maneuver group in one-week cure rate[OR = 3.25, 95%CI (2.08, 5.10) , P < 0.01], one-week efficient [OR = 4.72, 95%CI (1.16, 19.15) , P = 0.03], with significant differences. There was no significant difference between the two groups in three-months cure rate [OR = 2.10, 95%CI (0.57, 7.75) , P = 0.27], incidence of adverse reactions [OR = 0.82, 95%CI(0.44, 1.52), P = 0.53] and relapse rate [OR = 0.56, 95%CI (0.20, 1.57) , P = 0.27]. Based on the current studies, modified Epley maneuver is superior to modified Semont maneuver in quicking relief posterior canal benign paroxysmal positional vertigo symptoms, but the long-term efficacy, recurrence rate and incidence of adverse reactions had no significant difference. For the quality restrictions and possible publication bias of the included studies, more double blind RCTs with high quality are required to further assess the effects.
BibTeX: @article{Wang2013, author = {Wang, Xiao-yan and Ji, Bin and Yong, Jun and Liu, Li-zhong}, title = {[Efficacy of the modified Epley maneuver versus modified Semont maneuver for posterior canal benign paroxysmal positional vertigo: a meta-analysis].}, journal = {Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery}, year = {2013}, volume = {48}, issue = {8}, pages = {634--639}, keywords = {Benign Paroxysmal Positional Vertigo, therapy; Double-Blind Method; Exercise Movement Techniques, methods; Humans; Recurrence; Vertigo}, pmid = {24195818} }
Blessing, R., Strutz, J. and Beck, C.	[Epidemiology of benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	1986	Laryngologie, Rhinologie, Otologie Vol. 65(8), pp. 455-458	article
Abstract: Every ninth patient with a previous history of vertigo at the ENT Hospital of the University of Freiburg suffers from BPPV. The incidence, some important pathogenetic factors and the clinical picture of BPPV are discussed. In young men posttraumatic aetiology dominates, whereas idiopathic BPPV prevails in perimenopausal women. The affected ear tends to be hard of hearing in the high frequencies and is sometimes hypoexcitable by caloric stimulation. The diagnosis is best made by personal examination with Frenzel's glasses in darkness. Electronystagmography, brainstem evoked response audiometry, and CT scanning are of no particular value in confirming the diagnosis of BPPV.
BibTeX: @article{Blessing1986a, author = {Blessing, R and Strutz, J and Beck, C}, title = {[Epidemiology of benign paroxysmal positional vertigo].}, journal = {Laryngologie, Rhinologie, Otologie}, year = {1986}, volume = {65}, issue = {8}, pages = {455--458}, keywords = {Adult; Aged; Audiometry, Pure-Tone; Craniocerebral Trauma, complications; Cross-Sectional Studies; Electronystagmography; Female; Germany, West; Hearing Loss, Sudden, epidemiology; Humans; Male; Meniere Disease, epidemiology, etiology; Middle Aged; Nystagmus, Pathologic, epidemiology; Posture; Vestibular Function Tests}, pmid = {3489871} }
Neuhauser, H.K.	[Epidemiology of dizziness and vertigo]. [Abstract] [BibTeX]	2009	Der Nervenarzt Vol. 80(8), pp. 887-894	article	DOI
Abstract: Dizziness and vertigo rank among the most common symptoms in medical practice and belong to the 10 most common reasons for a neurological examination. Epidemiological data on dizziness, vertigo and underlying specific disorders of vestibular origin are useful for clinical decision making, may contribute to a better understanding of disease mechanisms and help evaluate the state of patient care. This article gives an overview on the epidemiology of dizziness/vertigo and of four specific vestibular disorders: benign paroxysmal positional vertigo, vestibular migraine, vestibular neuritis and Menière's disease.
BibTeX: @article{Neuhauser2009a, author = {Neuhauser, H K}, title = {[Epidemiology of dizziness and vertigo].}, journal = {Der Nervenarzt}, year = {2009}, volume = {80}, issue = {8}, pages = {887--894}, doi = {https://doi.org/10.1007/s00115-009-2738-9}, keywords = {Causality; Comorbidity; Dizziness, epidemiology; Germany, epidemiology; Humans; Incidence; Risk Assessment; Risk Factors; Vertigo, epidemiology}, pmid = {19626307} }
Trijolet, J.-P., Pondaven-Letourmy, S., Robier, A. and Morinière, S.	[Epidermoid cysts of the fourth ventricle mimicking benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2008	Annales d'oto-laryngologie et de chirurgie cervico faciale : bulletin de la Societe d'oto-laryngologie des hopitaux de Paris Vol. 125(3), pp. 146-150	article	DOI
Abstract: To report a case of atypical positional vertigo revealing a fourth ventricle epidermoid cyst. We report a case of a thirty-year-old woman suffering from positional vertigo with downbeat nystagmus. Except for these symptoms, the physical examination was normal, apart from intermittent headaches. On videonystagmography, a decrease in the average speed of beats and lowered benefits obtained by slow motion were noted. MRI revealed a fourth ventricle epidermoid cyst. Physical examination may provide several signs that are likely to enable the examiner to distinguish between central nervous system or peripheral vertigos. Atypical symptoms such as a downbeat nystagmus, a lack of reversal in nystagmus beats when returning to the sitting position and a lack of a latency period in vertigo and nystagmus occurrence during the Dix-Hallpike maneuver suggest a central nervous system etiology. With atypical symptoms noted when questioning the patient or during physical examination, a central nervous system etiology should be mentioned and explored with cerebral MRI.
BibTeX: @article{Trijolet2008, author = {Trijolet, J-P and Pondaven-Letourmy, S and Robier, A and Morinière, S}, title = {[Epidermoid cysts of the fourth ventricle mimicking benign paroxysmal positional vertigo].}, journal = {Annales d'oto-laryngologie et de chirurgie cervico faciale : bulletin de la Societe d'oto-laryngologie des hopitaux de Paris}, year = {2008}, volume = {125}, issue = {3}, pages = {146--150}, doi = {https://doi.org/10.1016/j.aorl.2008.01.001}, keywords = {Adult; Diagnosis, Differential; Epidermal Cyst, diagnosis, pathology, surgery; Female; Fourth Ventricle, pathology, surgery; Humans; Magnetic Resonance Imaging; Severity of Illness Index; Vertigo, diagnosis}, pmid = {18472086} }
Aranda-Moreno, C. and Jáuregui-Renaud, K.	[Epley and Semont maneuvers in the treatment of bening paroxymal postural vertigo]. [Abstract] [BibTeX]	2000	Gaceta medica de Mexico Vol. 136(5), pp. 433-439	article
Abstract: To compare the effectiveness of the 'repositioning' Epley maneuver and the 'liberatory' Semont maneuver in the treatment of benign paroxysmal positional vertigo (BPPV) of the posterior semicircular canal, a prospective study was performed, with 3 months of followup. A consecutive sample of 100 patients was included in two groups (age-and-sex matched) with a similar number of patients with idiopathic BPPV in each group. Group I was treated using the 'repositioning' maneuver and group II, the 'liberatory' maneuver. At weeks 1, 4, and 12 during the study, the proportion of patients without positional nistagmus was identified, and patients gave an evaluation of their subjective improvement (as a percentage). When positional nystagmus was evident, the corresponding maneuver was used again. Sixty percent of the patients were without nystagmus after the single use of any of the maneuvers. At the end of the study, more than 90% of patients were without nystagmus, with a 90% median value of subjective improvement. Patients with idiopathic BPPV showed a similar response to treatment as patients with BPPV associated to other disorders. We conclude that both maneuvers are effective for the treatment of BPPV of the posterior semicircular canal.
BibTeX: @article{Aranda-Moreno2000, author = {Aranda-Moreno, C and Jáuregui-Renaud, K}, title = {[Epley and Semont maneuvers in the treatment of bening paroxymal postural vertigo].}, journal = {Gaceta medica de Mexico}, year = {2000}, volume = {136}, issue = {5}, pages = {433--439}, keywords = {Female; Follow-Up Studies; Humans; Male; Middle Aged; Physical Therapy Modalities, methods; Posture; Vertigo, etiology, rehabilitation}, pmid = {11080927} }
Zhang, H., Geng, M., Yan, B. and Lu, X.	[Epley's manoeuvre versus Epley's manoeuvre plus labyrinthine sedative in the management of benign paroxysmal positional vertigo: prospective, randomised study]. [Abstract] [BibTeX]	2012	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 26(16), pp. 750-752	article
Abstract: To compare the efficacy of Epley's manoeuvre and Epley's manoeuvre plus labyrinthine sedative in the treatment of benign paroxysmal positional vertigo. Eighty-four patients with benign paroxysmal positional vertigo were included in a randomized study. Forty-two cases in control group were treated with Epley's manoeuvre alone and the other 42 cases in treated group received Epley's manoeuvre together with Betahistine mesilate tablets, flunarizine hydrochloride, and extract of Ginkgo biloba leaves tablets. Both groups were analyzed after one week and four weeks, and recurrence was observed after half a year. After one week treatment, cure rate and total effective rate of treated group was higher than that of control group (78.57% vs. 50.00% and 92.86% vs. 80.95%, P < 0.05, respectively). After four weeks treatment, there was no significant difference in cure rate and total effective rate between two groups (80.95% vs. 71.43% and 95.24% vs. 90.48%, P > 0.05, respectively). After half year, recurrence was found in 3 patients in treated group compared with 7 patients in control group (7.14% vs. 16.67%), and the difference was statistically significant (P < 0.05). Epley's manoeuvre is the best treatment method of benign paroxysmal positional vertigo together with the medicine. It is easy, safe and effective, and the healing time can be shortened.
BibTeX: @article{Zhang2012a, author = {Zhang, Hui and Geng, Manying and Yan, Baoxing and Lu, Xing}, title = {[Epley's manoeuvre versus Epley's manoeuvre plus labyrinthine sedative in the management of benign paroxysmal positional vertigo: prospective, randomised study].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2012}, volume = {26}, issue = {16}, pages = {750--752}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo; Female; Humans; Hypnotics and Sedatives, therapeutic use; Male; Middle Aged; Musculoskeletal Manipulations; Treatment Outcome; Vertigo, drug therapy, therapy}, pmid = {23213757} }
Mompó Romero, L., Pons Rocher, F., Ferrer Ramírez, M.J. and López Martínez, R.	[Epley's reposition maneuver in the treatment of benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2001	Anales otorrinolaringologicos ibero-americanos Vol. 28(1), pp. 19-24	article
Abstract: We performed a prospective study over 19 patients to evaluate the efficacy of the Epley's particle repositioning maneuver for treatment of the benign paroxysmal positional vertigo (BPPV), 78.9% were cured through this procedure, so we find this method as very useful for improving the BPPV.
BibTeX: @article{MompoRomero2001, author = {Mompó Romero, L and Pons Rocher, F and Ferrer Ramírez, M J and López Martínez, R}, title = {[Epley's reposition maneuver in the treatment of benign paroxysmal positional vertigo].}, journal = {Anales otorrinolaringologicos ibero-americanos}, year = {2001}, volume = {28}, issue = {1}, pages = {19--24}, keywords = {Adult; Aged; Female; Humans; Male; Middle Aged; Posture; Prospective Studies; Vertigo, therapy}, pmid = {11265515} }
Li, F., Wang, X.G., Zhuang, J.H., Chen, Y., Zhou, X.W., Gao, B. and Gu, H.H.	[Etiological analysis on patients in department of vertigo and dizziness oriented outpatient]. [Abstract] [BibTeX]	2017	Zhonghua yi xue za zhi Vol. 97(14), pp. 1054-1056	article	DOI
Abstract: We aimed to explore the spectrum of causes for patients in department of vertigo and dizziness oriented outpatient, in order to provide a reference for diagnosis and treatment of patients with vertigo or dizziness. Retrospective analysis were carried out with clinical data of patients in our department of vertigo and dizziness oriented outpatient. The target group under study was diagnosed based on the uniform diagnostic criteria, and re-visiting patients were excluded. This clinical study was conducted on 5 348 cases, who visited our vertigo and dizziness oriented outpatient from December 2012 to July 2015. The ratio of male to female was 1∶1.48, the age range was between 16 and 93. The frequencies of different etiology were: benign paroxysmal positional vertigo 1 902(35.56%), Chronic subjective dizziness 1 329(24.85%), vestibular migraine 624(11.67%), Meniere's disease 378(7.07%), multi-sensory neuropathy 231(4.32%), vestibular paroxysmia 177(3.31%), benign recurrent vestibulopathy 171(3.20%), presyncope 66(1.23%), posterior circulation ischemia 57(1.07%), vestibular neuritis 54(1.01%), sudden deafness complicated vertigo 36(0.67%), other reasons 68(1.27%), unknown 255(4.77%). Our study indicates that the precedent three causes for vertigo or dizziness are benign paroxysmal positional vertigo, chronic subjective dizziness and vestibular migraine, followed by Meniere's disease、multi-sensory neuropathy, vestibular paroxysmia and benign recurrent vestibulopathy. Presyncope, posterior circulation ischemia, vestibular neuritis and sudden deafness complicated vertigo are relatively infrequent. There are still a certain proportion of patients undetermined.
BibTeX: @article{Li2017b, author = {Li, F and Wang, X G and Zhuang, J H and Chen, Y and Zhou, X W and Gao, B and Gu, H H}, title = {[Etiological analysis on patients in department of vertigo and dizziness oriented outpatient].}, journal = {Zhonghua yi xue za zhi}, year = {2017}, volume = {97}, issue = {14}, pages = {1054--1056}, doi = {https://doi.org/10.3760/cma.j.issn.0376-2491.2017.14.005}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Dizziness, etiology; Female; Humans; Male; Meniere Disease, complications, diagnosis; Middle Aged; Migraine Disorders, complications, diagnosis; Outpatients; Retrospective Studies; Young Adult; Dizziness; Epidemiology; Retrospective analysis; Vertigo}, pmid = {28395427} }
Xue, H., Chong, Y., Jiang, Z.D., Liu, Z.L., Ding, L., Yang, S.L., Wang, L. and Xiang, W.P.	[Etiological analysis on patients with vertigo or dizziness]. [Abstract] [BibTeX]	2018	Zhonghua yi xue za zhi Vol. 98(16), pp. 1227-1230	article	DOI
Abstract: To explore the spectrum of causes for patients with vertigo or dizziness in the Department of Neurology, and provide a reference for diagnosis and treatment of patients with vertigo or dizziness. Clinical data of patients in the Department of Neurology, Baotou Central Hospital between January 2016 and September 2017 was retrospectively analyzed. The target group under study was diagnosed based on the uniform diagnostic criteria. A total of 9 200 patients with a chief complaint of vertigo or dizziness were included. The ratio of male to female was 1∶1.8, with an age range of 19 to 85 years. The different etiology was as follows: benign paroxysmal positional vertigo (BPPV) (3 148 cases, 34.22%), persistent postural-perceptual dizziness (PPPD) (2 006 cases, 21.80%), vertigo caused by cerebrovascular diseases (1 463 cases, 15.90%), vestibular neuritis (741 cases, 8.05%), vestibular migraine (536 cases, 5.83%), vestibular paroxysmia (336 cases, 3.65%), Ménière disease (187 cases, 2.03%), drug-induced vertigo (96 cases, 1.04%), neurological degenerative diseases (74 cases, 0.80%), sudden sensorineural hearing loss (51 cases, 0.55%), multiple sclerosis and neuromyelitis optica (21 cases, 0.23%), other reasons (22 cases, 0.24%), unknown reasons (519 cases, 5.64%). Dizziness is resulted from various causes, and BPPV is the most common reason. Vertigo caused by cerebrovascular diseases appears to gradually increase along with age. PPPD is very common in clinical practice, so clinicians needs to be highly aware of BPPV and PPPD. Although those dizziness diseases have a low incidence, they should not be ignored. There are still certain proportion of vertigo patients whose diagnosis are undetermined.
BibTeX: @article{Xue2018, author = {Xue, H and Chong, Y and Jiang, Z D and Liu, Z L and Ding, L and Yang, S L and Wang, L and Xiang, W P}, title = {[Etiological analysis on patients with vertigo or dizziness].}, journal = {Zhonghua yi xue za zhi}, year = {2018}, volume = {98}, issue = {16}, pages = {1227--1230}, doi = {https://doi.org/10.3760/cma.j.issn.0376-2491.2018.16.008}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Dizziness; Female; Hearing Loss, Sudden; Humans; Male; Meniere Disease; Middle Aged; Retrospective Studies; Young Adult; Dizziness; Epidemiology; Vertigo; Vestibular diseases}, pmid = {29747309} }
Zhang, X.L., Zhang, M.J., Liu, D.L. and Zhang, Q.F.	[Etiological characteristics analysis of 3 137 outpatients with vertigo or dizziness in ENT department]. [Abstract] [BibTeX]	2018	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 32(10), pp. 758-761	article	DOI
Abstract: To analyze the etiological characteristics of patients in department of ENT with chief complaint of vertigo or dizziness in order to reduce the rate of misdiagnosis and wrong treatment. A total of 3 137 patients in department of ENT with chief complaint of vertigo or dizziness from Sep 2015 to Sep 2017 were included and the etiologies were clarified retrospectively. And in which with any of the 8 kinds of disease including benign paroxysmal positional vertigo(BPPV), vestibular neuritis, vestibular migraine (VM), Meiniére disease, recurrent vestibular disease, sudden deafness with vertigo, psychogenic vertigo, posterior circulation ischemia (PCI) together 2 138 patients were further stratified analyzed by gender and age. ①Etiological characteristics of patients with vertigo or dizziness：among the 3 137 patients with vertigo or dizziness in ENT department in our hosipital, the peripheral diseases of vestibular were the most common disease with a total of 1 607 cases, accounting for 51.23%. And there were 506 cases of the central diseases of vestibular accounting for 16.13%, 382 cases of other systemic diseases accounting for 12.18%, 85 cases（2.71%）of psychogenic vertigo, 557 cases （17.76%）of unknown etiology. ②Analysis of the frequent and serious causing of patients with vertigo or dizziness: among the 2 138(68.15%) patients with vertigo or dizziness, BPPV with a total of 827 cases (26.36%) was the most prevalent,while 215(25.99%) of them were diagnosed as self-cured BPPV,vestibular neuritis and VM were the second prevalent with 420 cases (13.39%) and 329 cases (10.49%) respectively, Meiniére disease, recurrent vestibular disease, sudden deafness with vertigo were the third prevalent with 209 cases (6.66%), 144 cases (4.59%), 102 cases (3.25%), respectively; well psychogenic vertigo and PCI were relatively rare, with respectively 85 cases (2.71%) and 22 cases (0.70%). Eotiology analysis stratified by age: The causes of vertigo or dizziness were ranged with age, and patients of 50-70 years old were most common with a total of 1 011 cases, accounting for 49.6%. Etiology analysis stratified by gender: There was gender difference in patients with vertigo or dizziness,such as BPPV, VM, recurrent vestibular disease, sudden deafness with vertigo and psychogenic vertigo were common in female, while PCI in male insteadly. ①Among the patients with vertigo or dizziness, the pheripheral diseases of vestibular are the most prevalent, in which BPPV takes the highest accidence. ②Patients ranging from 50 to 70 years old take the main parts in patients with vertigo or dizziness. And there is an obvious gender difference in patients with BPPV, VM, recurrent vestibular disease, sudden deafness with vertigo, psychogenic vertigo and PCI.
BibTeX: @article{Zhang2018b, author = {Zhang, X L and Zhang, M J and Liu, D L and Zhang, Q F}, title = {[Etiological characteristics analysis of 3 137 outpatients with vertigo or dizziness in ENT department].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2018}, volume = {32}, issue = {10}, pages = {758--761}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2018.10.008}, keywords = {Aged; Benign Paroxysmal Positional Vertigo, etiology; Dizziness, etiology; Female; Humans; Male; Middle Aged; Outpatients; Retrospective Studies; Vertigo, etiology; Vestibular Neuronitis, complications, diagnosis; clinical characteristic; etiological distribution; vertigo, dizziness}, pmid = {29873213} }
Pérez, P., Manrique, C., Alvarez, M.J., Aldama, P., Alvarez, J.C., Fernández, M.L. and Méndez, J.C.	[Evaluation of benign paroxysmal positional vertigo in primary health-care and first level specialist care]. [Abstract] [BibTeX]	2008	Acta otorrinolaringologica espanola Vol. 59(6), pp. 277-282	article
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most common cause of vestibular vertigo, but it is not well known in routine clinical practice. To determine the awareness of BPPV outside the ENT clinic. Retrospective study of sixty-nine patients treated for BPPV between June 2005 and December 2006 at the specialist clinic. We analyzed the routes and details for their referral and the time elapsed since the start of the symptoms. 42 patients (61 %) were referred through the conventional route (primary health-care or non-hospital ENT); 17 patients (25 %) came from the emergency room (one third of them were admitted); the remainder were patients hospitalized for some other problem (5 %) or informal consultations (9 %). Only one patient had been referred with a specific diagnosis of BPPV. The onset of vertigo symptoms before treatment was, on average, 20 weeks (SD, 32 weeks) and was significantly longer among patients coming from primary care (28 weeks) as compared with the other groups (P < .01, Kruskall-Wallis test). The mean time to referral was shorter among patients with idiopathic BPPV or with BPPV secondary to recurrent vestibulopathy whereas it was more prolonged among patients with a concomitant pathology capable of justifying the presence of positional symptoms, such as vestibular neuritis or post-traumatic BPPV (P < .01, Kruskall-Wallis test). The medical cost of treating BPPV prior to referral has been calculated at euro364 per individual (mostly for non-specific medical treatments) instead of the euro136 needed for effective positional treatment. BPPV continues to be a poorly understood pathology outside specialist neuro-otologic clinics, leading to delays in diagnosis and treatment, as well as the unnecessary consumption of resources.
BibTeX: @article{Perez2008, author = {Pérez, Paz and Manrique, Covadonga and Alvarez, María Jesús and Aldama, Patricia and Alvarez, Juan Carlos and Fernández, M Luisa and Méndez, Juan Carlos}, title = {[Evaluation of benign paroxysmal positional vertigo in primary health-care and first level specialist care].}, journal = {Acta otorrinolaringologica espanola}, year = {2008}, volume = {59}, issue = {6}, pages = {277--282}, keywords = {Adult; Aged; Aged, 80 and over; Clinical Competence; Female; Humans; Male; Medicine; Middle Aged; Primary Health Care; Referral and Consultation; Retrospective Studies; Specialization; Vertigo, diagnosis}, pmid = {18588787} }
López-Escámez, J.A., Gómez Fiñana, M., Fernández, A., Sánchez Canet, I., Palma, M.J. and Rodríguez, J.	[Evaluation of the treatment of benign paroxysmal positional vertigo with the DHI-S questionnaire]. [Abstract] [BibTeX]	2001	Acta otorrinolaringologica espanola Vol. 52(8), pp. 660-666	article
Abstract: Benign paroxysmal positional vertigo (BPPV) is a recurrent chronic disease and its handicap is usually underestimated. The aim of this study is to determine the impact of the treatment by Epley maneuver on short-term BPPV-related quality of life. Forty-two individuals with BPPV were included: 39 with posterior canal affected, 2 with the lateral canal and one with the anterior canal. Diagnosis was established if a consistent clinical history was found and Dix-Hallpike test (DHT) in cases with canal posterior involvement. Subjects with positive DHT were treated by a single Epley maneuver and were recommended to avoid supine for the next 48 hours. The BPPV relapses were investigated at 7th and 30th day post-treatment. BPPV-associated quality of life was evaluated by the Dizzness Handicap Inventory Short-form (DHI-S) at days 1st and 30th post-treatment. Total and partial scores for emotional, physical and functional subscales were compared by Wilcoxon test for paired samples. Dix-Hallpike test was found positive in el 59% individuals (23/39), and 41% cases did not required any treatment. Among 23 patients treated with Epley maneuver, DHT was found negative in 90% at 30th day follow-up. Mean and standard deviation of the total scores obtained in the DHI-S at the first day were 19.22 +/- 9.66 in the DHT positive-patients and 19.79 +/- 10.14 in the whole group (DHT positive or negative). These scores significantly decreased to 10.84 +/- 10.99 at 30 days post-treatment (p = 0.002 and p = 0.001, respectively). In conclusion, the DHI-S is a specific health questionnaire able to assess BPPV-related health and the effectiveness of treatment.
BibTeX: @article{Lopez-Escamez2001, author = {López-Escámez, J A and Gómez Fiñana, M and Fernández, A and Sánchez Canet, I and Palma, M J and Rodríguez, J}, title = {[Evaluation of the treatment of benign paroxysmal positional vertigo with the DHI-S questionnaire].}, journal = {Acta otorrinolaringologica espanola}, year = {2001}, volume = {52}, issue = {8}, pages = {660--666}, keywords = {Female; Humans; Male; Middle Aged; Prospective Studies; Surveys and Questionnaires; Vertigo, therapy}, pmid = {11771360} }
Roa Castro, F.M., Durán de Alba, L.M. and Roa Castro, V.H.	[Experience with Epley's manoeuvre and vestibular habituation training in benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2008	Acta otorrinolaringologica espanola Vol. 59(3), pp. 91-95	article
Abstract: The most frequent vestibular disorder is benign paroxysmal positional vertigo. In almost all patients it occurs spontaneously and mainly through involvement of the posterior semicircular canal. Treatment consists in vestibular habituation training and in canalith repositioning manoeuvres. A retrospective review of patient files between 1999 to 2001 evaluated those diagnosed as having BPPV due to the posterior semicircular canal in order to compare the response to treatment with vestibular habituation training and with Epley's manoeuvre. The cases are described and analyzed and their response to treatment is compared using Fisher's exact test. The percentage of success with Epleys manoeuvre was 100 %. Eighty-two per cent of patients responded in the first seven days after the first manoeuvre. Relapses occurred in 17.6 %. With vestibular habituation training, a success rate of 90 % was obtained in the first month, and this decreased to 80 % by the end of the second and third months. Significant differences between the two therapeutic modalities were only visible at the conclusion of the first seven days of treatment (P=.01). The evident advantage with Epley's manoeuvre is that it greatly reduces the time required to obtain a satisfactory result. In addition, it allows patients to return quickly to their daily activities and improves their quality of life.
BibTeX: @article{RoaCastro2008, author = {Roa Castro, Francisco Miguel and Durán de Alba, Luz María and Roa Castro, Víctor Hugo}, title = {[Experience with Epley's manoeuvre and vestibular habituation training in benign paroxysmal positional vertigo].}, journal = {Acta otorrinolaringologica espanola}, year = {2008}, volume = {59}, issue = {3}, pages = {91--95}, keywords = {Adult; Aged; Exercise Therapy; Female; Humans; Male; Middle Aged; Physical Therapy Modalities; Retrospective Studies; Vertigo, therapy; Vestibule, Labyrinth}, pmid = {18364199} }
Jin, Z.R., Lin, P., Yang, X.K. and Zhang, X.	[Experimental model study on Li's repositioning maneuver for horizontal semicircular canal benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2017	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 31(14), pp. 1116-1118	article	DOI
Abstract: Based on the standard spatial semicircular canal model, the scientificity and feasibility of Li's repositioning maneuver for horizontal semicircular canal benign paroxysmal positional vertigo were analyzed. The standard space semicircular canal model was established. The significance and shortcomings of each step were analyzed by simulating and observing the Li's repositioning maneuver for horizontal semicircular canal benign paroxysmal positional vertigo. According to the model of semicircular canal, the otoliths of horizontal semicircular canal are more likely to return to the ampulla instead of moving into the utriculus through the semicircular canal after using Li's repositioning maneuver. The experimental model suggests that Li's repositioning maneuver omits the necessary steps of repositioning method, and can not simulate the result of the reposition of otoliths.
BibTeX: @article{Jin2017, author = {Jin, Z R and Lin, P and Yang, X K and Zhang, X}, title = {[Experimental model study on Li's repositioning maneuver for horizontal semicircular canal benign paroxysmal positional vertigo].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2017}, volume = {31}, issue = {14}, pages = {1116--1118}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2017.14.016}, keywords = {Benign Paroxysmal Positional Vertigo, therapy; Humans; Models, Theoretical; Otolithic Membrane; Patient Positioning; Posture; Semicircular Canals; horizontal semicircular canal; model; repositioning maneuver; vertigo}, pmid = {29798254} }
Tian, Y.S., Zhang, Y., Ma, R. and Liu, P.	[Features of vestibular evoked myogenic potential in patients with residual dizziness after canalith repositioning procedures for benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2018	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 32(11), pp. 845-849	article	DOI
Abstract: To ananlyze the characteristics of the vestibular evoked myogenic action potential of patients with residual dizziness after successful canalith repositioning procedures(CRP)for idiopathic benign paroxysmal positional vertigo(IBPPV). Ninety-seven consecutive patients with IBPPV of the unilateral posterior semicircular canal and health controls were initially enrolled. The patients received 500 Hz tone burst evoked ocular vestibular evoked myogenic potentials(oVEMP) and cervical vestibular evoked myogenic potentials (cVEMP). After successfully CRP, the patients were divided into two groups: group with residual symptoms and group without residual symptoms. The abnormality of results of both oVEMP and cVEMP were compared between three groups. In the group with residual symptoms, the abnormal rate were 64.5% for oVEMP and 28.1% for cVEMP. In the group without residual symptoms, the abnormal rate were 17.9% for oVEMP and 12.5% for cVEMP. The abnormal rate of oVEMP in the group with residual symptoms was significantly higher than that in the group without residual symptoms(χ²=19.228, =0.000). However, there was no significant difference in the abnormal rate of cVEMP between these two groups(χ²=3.342, =0.068). In patients with IBPPV underwent successful CRP,the occurrence of residual symptoms is correlated to the abnormalities of oVEMP. It is indicated that the dysfunction of the utricle is related to the presence of residual symptoms after the CRP for IBPPV.
BibTeX: @article{Tian2018, author = {Tian, Y S and Zhang, Y and Ma, R and Liu, P}, title = {[Features of vestibular evoked myogenic potential in patients with residual dizziness after canalith repositioning procedures for benign paroxysmal positional vertigo].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2018}, volume = {32}, issue = {11}, pages = {845--849}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2018.11.011}, keywords = {Benign Paroxysmal Positional Vertigo, therapy; Dizziness; Humans; Patient Positioning; Saccule and Utricle; Semicircular Canals, pathology; Vestibular Evoked Myogenic Potentials; benign paroxysmal positional vertigo; residual symptoms; vestibular evoked myogenic potentials}, pmid = {29921055} }
Migueis, A.C., Sémont, A., Garcia, C.S. and Paço, J.	[Focus on the BPPV: Semont maneuver for the horizontal canal and anterior canal--differential diagnosis]. [BibTeX]	2005	Revue de laryngologie - otologie - rhinologie Vol. 126(3), pp. 193-199	article
BibTeX: @article{Migueis2005, author = {Migueis, Antonio Carlos and Sémont, Alain and Garcia, Carlos Stapleton and Paço, Joao}, title = {[Focus on the BPPV: Semont maneuver for the horizontal canal and anterior canal--differential diagnosis].}, journal = {Revue de laryngologie - otologie - rhinologie}, year = {2005}, volume = {126}, issue = {3}, pages = {193--199}, keywords = {Diagnosis, Differential; Eye Movements; Humans; Nystagmus, Pathologic, diagnosis; Physical Therapy Modalities; Posture; Semicircular Canals, physiopathology; Time Factors; Vertigo, classification, diagnosis, etiology, physiopathology, therapy}, pmid = {16366389} }
Rast, N. and Hess, K.	[Follow-up studies on benign paroxysmal posture vertigo]. [Abstract] [BibTeX]	1983	Schweizerische medizinische Wochenschrift Vol. 113(14), pp. 504-507	article
Abstract: In a prospective study, 47 out of 55 patients with benign paroxysmal positional nystagmus (BPN) were reexamined after 3-41/2 years. In a third of these patients head injury was found to be the cause of positional nystagmus. In a few patients BPN was found to be directly connected with non-traumatic labyrinth affection, intermittent vertebro-basilar insufficiency, or anaesthesia. In a quarter of the patients no causative factors were found. In 44% of the patients nystagmus disappeared in an average of 8.6 months. In the follow-up a quarter of the patients (28%) still suffered regularly from positional nystagmus. Finally, in another quarter of the patients (28%), episodic nystagmus occurred over years and averaged 3.6 episodes per patient. The course of BPN is therefore more resistant and less predictable than was previously believed. However, most patients learn to adjust to the symptom and are only mildly handicapped by BPN.
BibTeX: @article{Rast1983, author = {Rast, N and Hess, K}, title = {[Follow-up studies on benign paroxysmal posture vertigo].}, journal = {Schweizerische medizinische Wochenschrift}, year = {1983}, volume = {113}, issue = {14}, pages = {504--507}, keywords = {Adolescent; Adult; Aged; Anesthesia, General, adverse effects; Female; Functional Laterality; Humans; Male; Middle Aged; Nystagmus, Pathologic, etiology; Posture; Skull, injuries; Time Factors; Vertebrobasilar Insufficiency, complications; Vertigo, etiology}, pmid = {6545060} }
Li, L., Liu, J.G., Wang, Z.W. and Qi, X.K.	[Formulation and evaluation of diagnostic questionnaire for benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2017	Zhonghua yi xue za zhi Vol. 97(14), pp. 1061-1064	article	DOI
Abstract: To formulate and evaluate a rapid assessment questionnaire for benign paroxysmal positional vertigo(BPPV). The rapid assessment questionnaire for benign paroxysmal positional vertigo was developed based on the core clinical manifestations of BPPV.A total of 235 dizzy patients, with an average age of 56±16, were recruited from the Navy General Hospital during October 2015 to March 2016.The assessments were made by two specialists for BPPV, and the diagnoses were confirmed through follow-up.The reliability and validity of the scale questionnaire were analyzed with the SPSS 19.0 and the cutoff point was confirmed with the Receiver operating characteristic(ROC) curve analysis. Reliability test: Cronbach α value for the questionnaire was 0.644; Validity: KMO (Kasier-Meyer-Olkin) value for the questionnaire was 0.711.Two factors were used with a characteristic root of higher than 0.9.The total cumulative contribution rate was 53.816%.The load of each item was over 0.5.The range of the scale is 0 to 6 points, with the largest ROC curve area (0.894) at 3 points for the diagnosis of BPPV.The relative sensitivity and specialty were 92.45% and 71.60% , respectively. This rapid assessment questionnaire for benign paroxysmal positional vertigo posses good reliability and validity, and can be used as a tool for a quick diagnosis of BPPV for patients with dizziness. BPPV can be diagnosed with a score of 3 by using this questionnaire.
BibTeX: @article{Li2017a, author = {Li, L and Liu, J G and Wang, Z W and Qi, X K}, title = {[Formulation and evaluation of diagnostic questionnaire for benign paroxysmal positional vertigo].}, journal = {Zhonghua yi xue za zhi}, year = {2017}, volume = {97}, issue = {14}, pages = {1061--1064}, doi = {https://doi.org/10.3760/cma.j.issn.0376-2491.2017.14.007}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis; Dizziness; Humans; ROC Curve; Reproducibility of Results; Surveys and Questionnaires; Questionnaire; Reliability; Validity; Vertigo}, pmid = {28395429} }
Kruschinski, C., Kersting, M., Breull, A., Kochen, M.M., Koschack, J. and Hummers-Pradier, E.	[Frequency of dizziness-related diagnoses and prescriptions in a general practice database]. [Abstract] [BibTeX]	2008	Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen Vol. 102(5), pp. 313-319	article
Abstract: Dizziness can be due to multiple causes. However, the aetiology often remains unclear. At the same time, there is a lack of evidence-based treatment options. The aim of this study was to investigate the frequency of dizziness-related diagnoses, referrals and prescriptions in a general practice database. Data from computerized patient records of 138 general practices participating in the MedViP project were used for cross-sectional analysis of the time period April 2001 until December 2002. The identification of dizzy patients was performed via ICD-10 diagnoses, free text fields and medication issued for dizziness. Frequencies were counted and odds ratios calculated to describe associations between diagnoses and medication. For the period of investigation, 10,971 patients (from a total of 317,042 documented patients) were given at least one diagnosis of dizziness (prevalence 3.4%; mean age 59 years, 67.2% female). In 80.2% of the cases dizziness was coded as a symptom (R42) rather than a discrete disease. Prescriptions for dizziness were rather uncommon. An analysis of ATC codes showed that 6.6% of all affected patients were prescribed a specific drug for dizziness, most frequently betahistine. Antiemetics were prescribed in 7.1%, and the homeopathic preparation "Vertigoheel" in 2.8% of the dizzy patients. Betahistine was significantly more often prescribed for "unspecified" dizziness, vestibular neuritis, and benign paroxysmal positional vertigo; but not for Meniere's disease. It was given less often in "other peripheral" and in central vertigo as well as in cases where the symptom was coded (R42). 3.9% of the dizzy patients had been referred to the neurologist (55.4%), ENT-specialist (30.5%) or to both specialists (14.1%). The manner of coding and prescribing reflects both a symptom-orientated classification used by general practitioners and the limitation of treatment options.
BibTeX: @article{Kruschinski2008, author = {Kruschinski, Carsten and Kersting, Markus and Breull, Alf and Kochen, Michael M and Koschack, Janka and Hummers-Pradier, Eva}, title = {[Frequency of dizziness-related diagnoses and prescriptions in a general practice database].}, journal = {Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen}, year = {2008}, volume = {102}, issue = {5}, pages = {313--319}, keywords = {Cross-Sectional Studies; Databases, Factual; Diagnosis, Differential; Dizziness, drug therapy, epidemiology, etiology; Drug Prescriptions, statistics & numerical data; Family Practice; Female; Humans; Male; Middle Aged; Prevalence; Referral and Consultation, statistics & numerical data}, pmid = {19006919} }
Diukova, G.M., Zamergrad, M.V., Golubev, V.L., Adilova, S.M. and Makarov, S.A.	[Functional (psychogenic) vertigo]. [Abstract] [BibTeX]	2017	Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova Vol. 117(6), pp. 91-98	article	DOI
Abstract: Psychogenic (functional) vertigo is in second place by frequency after benign positional paroxysmal vertigo. It is often difficult to make the diagnosis, diagnostic program is expensive and traditional treatment often is not effective. This literature review covers current concepts on the terminology, clinical signs, pathogenesis and treatment approaches with regard to functional vertigo. Special attention is given to cerebral mechanisms of the pathogenesis including cognitive aspects.
BibTeX: @article{Diukova2017, author = {Diukova, G M and Zamergrad, M V and Golubev, V L and Adilova, S M and Makarov, S A}, title = {[Functional (psychogenic) vertigo].}, journal = {Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova}, year = {2017}, volume = {117}, issue = {6}, pages = {91--98}, doi = {https://doi.org/10.17116/jnevro20171176191-98}, keywords = {Humans; Vertigo, classification, diagnosis, drug therapy, physiopathology; clinical signs; functional; pathogenesis; postural phobic vertigo; therapy}, pmid = {28745678} }
Zamysłowska-Szmytke, E., Szostek-Rogula, S. and Śliwińska-Kowalska, M.	[Functional assessment of patients with vertigo and dizziness in occupational medicine]. [Abstract] [BibTeX]	2018	Medycyna pracy Vol. 69(2), pp. 179-189	article	DOI
Abstract: Balance assessment relies on symptoms, clinical examination and functional assessment and their verification in objective tests. Our study was aimed at calculating the assessment compatibility between questionnaires, functional scales and objective vestibular and balance examinations. A group of 131 patients (including 101 women; mean age: 59±14 years) of the audiology outpatient clinic was examined. Benign paroxysmal positional vertigo, phobic vertigo and central dizziness were the most common diseases observed in the study group. Patients' symptoms were tested using the questionnaire on Cawthworne-Cooksey exercises (CC), Dizziness Handicap Inventory (DHI) and Duke Anxiety-Depression Scale. Berg Balance Scale (BBS), Dynamic Gait Index (DGI), the Tinetti test, Timed Up and Go test (TUG), and Dynamic Visual Acuity (DVA) were used for the functional balance assessment. Objective evaluation included: videonystagmography caloric test and static posturography. The study results revealed statistically significant but moderate compatibility between functional tests BBS, DGI, TUG, DVA and caloric results (Kendall's W = 0.29) and higher for posturography (W = 0.33). The agreement between questionnaires and objective tests were very low (W = 0.08-0.11).The positive predictive values of BBS were 42% for caloric and 62% for posturography tests, of DGI - 46% and 57%, respectively. The results of functional tests (BBS, DGI, TUG, DVA) revealed statistically significant correlations with objective balance tests but low predictive values did not allow to use these tests in vestibular damage screening. Only half of the patients with functional disturbances revealed abnormal caloric or posturography tests. The qualification to work based on objective tests ignore functional state of the worker, which may influence the ability to work. Med Pr 2018;69(2):179-189.
BibTeX: @article{Zamyslowska-Szmytke2018, author = {Zamysłowska-Szmytke, Ewa and Szostek-Rogula, Sylwia and Śliwińska-Kowalska, Mariola}, title = {[Functional assessment of patients with vertigo and dizziness in occupational medicine].}, journal = {Medycyna pracy}, year = {2018}, volume = {69}, issue = {2}, pages = {179--189}, doi = {https://doi.org/10.13075/mp.5893.00645}, keywords = {Adult; Benign Paroxysmal Positional Vertigo, diagnosis; Disability Evaluation; Dizziness, diagnosis; Female; Humans; Male; Middle Aged; Occupational Medicine, methods; Postural Balance; Severity of Illness Index; Surveys and Questionnaires; Vertigo, diagnosis; Vestibular Function Tests; Berg Balance Scale; dynamic gait index; posturography; unbalance; vertigo; videonystagmography}, pmid = {29493628} }
of Chinese Journal of Otorhinolaryngology Head, E.B., Surgery, N., of Otorhinolaryngology Head, S. and Association, N.S.C.M.	[Guideline of diagnosis and treatment of benign paroxysmal positional vertigo (2017)]. [BibTeX]	2017	Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery Vol. 52(3), pp. 173-177	article	DOI
BibTeX: @article{ChineseJournalofOtorhinolaryngologyHead2017, author = {Editorial Board of Chinese Journal of Otorhinolaryngology Head and Neck Surgery and Society of Otorhinolaryngology Head and Neck Surgery Chinese Medical Association}, title = {[Guideline of diagnosis and treatment of benign paroxysmal positional vertigo (2017)].}, journal = {Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery}, year = {2017}, volume = {52}, issue = {3}, pages = {173--177}, doi = {https://doi.org/10.3760/cma.j.issn.1673-0860.2017.03.003}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis, therapy; Humans; Practice Guidelines as Topic}, pmid = {28395487} }
Sanchez-Hanke, M., Tolsdorff, B. and Leuwer, R.	[Histomorphological study of experimentally induced canalolithiasis]. [Abstract] [BibTeX]	2005	HNO Vol. 53(6), pp. 548-553	article	DOI
Abstract: Free otoconia in the posterior semicircular canal (pSCC) are regarded as the main reason for benign paroxysmal positional vertigo. We investigated the distribution of otoconia in the membranous labyrinth of guinea pigs (n = 34) after a defined rotatory/angular kinetic acceleration. The angular kinetic energy of the rotatory experiment produced a dislocation of the otoconia and sometimes of the complete gelatinous otolithic membrane of the utricular and saccular macula. The otoconia could be observed in all three semicircular canals but predominated in the dark cell areas of the utricular side of the lateral SCC. A total obstruction of the semicircular canal could never be seen. Close to the lateral crista, perilymphatic hemorrhage could frequently be observed. The saccular otoconia were located in the amalgamation between endolymphatic membrane and saccule. The results of this histological study can form the basis for different theories about the genesis of canalolithiasis and cupulolithiasis and the vertigo which accompanies them.
BibTeX: @article{Sanchez-Hanke2005, author = {Sanchez-Hanke, M and Tolsdorff, B and Leuwer, R}, title = {[Histomorphological study of experimentally induced canalolithiasis].}, journal = {HNO}, year = {2005}, volume = {53}, issue = {6}, pages = {548--553}, doi = {https://doi.org/10.1007/s00106-005-1254-x}, keywords = {Acceleration, adverse effects; Animals; Disease Models, Animal; Guinea Pigs; Lithiasis, etiology, pathology; Physical Stimulation, adverse effects, methods; Vestibular Diseases, etiology, pathology}, pmid = {15912339} }
Bertholon, P., Oletski, A. and Martin, C.	[Horizontal and anterior canal benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2007	Annales d'oto-laryngologie et de chirurgie cervico faciale : bulletin de la Societe d'oto-laryngologie des hopitaux de Paris Vol. 124(4), pp. 202-204	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is suspected when the patient complains of brief episodes of vertigo induced by changes in the head position. The direction of the positional nystagmus during the positional maneuvers is essential to affirm the canal involved. There is a consensus for the diagnosis of a PC-BPPV and HC-BPPV (geotropic and ageotropic form) as well as for the treatment of a PC-BPPV and a geotropic HC-BPPC. However, there is still a debate for the diagnosis of an AC-BPPV and the treatment of an ageotropic HC-BPPV and an AC-BPPV.
BibTeX: @article{Bertholon2007, author = {Bertholon, P and Oletski, A and Martin, C}, title = {[Horizontal and anterior canal benign paroxysmal positional vertigo].}, journal = {Annales d'oto-laryngologie et de chirurgie cervico faciale : bulletin de la Societe d'oto-laryngologie des hopitaux de Paris}, year = {2007}, volume = {124}, issue = {4}, pages = {202--204}, doi = {https://doi.org/10.1016/j.aorl.2007.04.002}, keywords = {Ear Canal, physiopathology; Head, physiology; Humans; Posture, physiology; Vertigo, diagnosis, physiopathology, therapy}, pmid = {17673158} }
Zur, O., Ilan, O., Ben-Rubi Shimron, H. and Carmeli, E.	[HORIZONTAL CANAL - BENIGN PAROXYSMAL POSITIONAL VERTIGO (HC-BPPV) - CLINICAL DIAGNOSTIC PROCEDURES]. [Abstract] [BibTeX]	2017	Harefuah Vol. 156(3), pp. 176-180	article
Abstract: Horizontal canal benign paroxysmal positional vertigo (HCBPPV) is one form of benign paroxysmal positional vertigo. HC-BPPV is characterized by intermittent recurrent episodes of vertigo following a change in head position relative to gravity. HC-BPPV prevalence ranges from 5%-33% of all dizziness cases seen in otolaryngology, neurology and family physician clinics. Various factors, such as ear and head injury, can cause HC-BPPV. Cardiovascular disease and iatrogenic reasons are also implicated. Despite the prevalence of the disease, there are various forms of diagnostic procedures, some of which are unfamiliar to the therapist and some are controversial. This review aims to present the full range of methods of diagnosis of HC-BPPV, presenting their advantages and disadvantages.
BibTeX: @article{Zur2017, author = {Zur, Oz and Ilan, Ophir and Ben-Rubi Shimron, Hadas and Carmeli, Eli}, title = {[HORIZONTAL CANAL - BENIGN PAROXYSMAL POSITIONAL VERTIGO (HC-BPPV) - CLINICAL DIAGNOSTIC PROCEDURES].}, journal = {Harefuah}, year = {2017}, volume = {156}, issue = {3}, pages = {176--180}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis; Diagnosis, Differential; Humans; Semicircular Canals}, pmid = {28551938} }
Takaya, S. and Yamamoto, T.	[Horizontal canal benign paroxysmal positional vertigo (HC-BPPV) with direction-changing apogeotropic nystagmus: a case with the more-triggering side altering over a short-term]. [Abstract] [BibTeX]	2002	No to shinkei = Brain and nerve Vol. 54(4), pp. 321-325	article
Abstract: We report a 44-year-old man who had apogeotropic nystagmus with the rotation of his head to either side from the supine position. His nystagmus lasted more than 2 minutes and was difficult to treat with. There were no neurological abnormalities except for the nystagmus and no findings suggesting intracranial disease on MRI. The head-position in which more intense nystagmus was evoked changed again and again in a short term. We diagnosed his illness as cupulolithiasis of horizontal canal, however, the affected ear could not be explained by any of the previously supposed mechanisms. In our case, we speculate the following mechanism. Otoliths were located on the right utricular side of the cupula. All of them were attached on the cupula at the beginning(attached phase) and then, some of them were detached from it(detached phase). The extent of the cupular deviation differed in each phase when the otoliths were beneath the cupula with his head turned to the left lateral position. According to Ewald's second law, more intense nystagmus is evoked when the cupula deviates toward the utricle than away from it. The patient's head-position in which more intense nystagmus was evoked changed according to the balance between the effect of Ewald's second law and the amount of otoliths detached from cupula. Our case showed that, in HC-BPPV with direction-changing apogeotropic nystagmus, we could not be certain about which ear was diseased. Therefore, it may be difficult to apply exercise therapy by determining the affected ear based on the head-position in which more intense nystagmus is evoked.
BibTeX: @article{Takaya2002, author = {Takaya, Shigetoshi and Yamamoto, Toru}, title = {[Horizontal canal benign paroxysmal positional vertigo (HC-BPPV) with direction-changing apogeotropic nystagmus: a case with the more-triggering side altering over a short-term].}, journal = {No to shinkei = Brain and nerve}, year = {2002}, volume = {54}, issue = {4}, pages = {321--325}, keywords = {Adult; Electronystagmography; Humans; Male; Nystagmus, Pathologic, physiopathology; Posture; Vertigo, physiopathology}, pmid = {11993160} }
Takaya, S. and Yamamoto, T.	[Horizontal canal benign paroxysmal positional vertigo: the dynamism of otoliths]. [BibTeX]	2002	No to shinkei = Brain and nerve Vol. 54(4), pp. 298-305	article
BibTeX: @article{Takaya2002a, author = {Takaya, Shigetoshi and Yamamoto, Toru}, title = {[Horizontal canal benign paroxysmal positional vertigo: the dynamism of otoliths].}, journal = {No to shinkei = Brain and nerve}, year = {2002}, volume = {54}, issue = {4}, pages = {298--305}, keywords = {Adult; Electronystagmography; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, physiopathology; Otolithic Membrane, physiology; Saccule and Utricle, physiology; Vertigo, diagnosis, etiology, physiopathology}, pmid = {11993157} }
Fujita, N., Yamanaka, T., Okamoto, H. and Hosoi, H.	[Horizontal canal benign paroxysmal positional vertigo--its affected side and horizontal semicircular canal function]. [Abstract] [BibTeX]	2005	Nihon Jibiinkoka Gakkai kaiho Vol. 108(3), pp. 202-206	article
Abstract: We report horizontal canal BPPV (HC-BPPV) targeting its pathophysiology, the affected side, and the function of the horizontal semicircular canal, together with a review of the literature. Subjects were 13 patients with HC-BPPV visiting our vertigo outpatient clinic at Nara medical university hospital and a related hospital in the 2.5 years from January 2000 to June 2002. Subjects were classified into 7 with canalolithiasis and 6 patients of cupulolithiasis after a neurotological examination. CP was positive in 54% of all patients, 71% of those with canalolithiasis, and 33% of those with cupulolithiasis. To determine the affected side in HC-BPPV, we used the affected side by using the law of Ewald in canalolithaisis patients and the detection of a neutral diminishing nystagmus in cupulolithiasis patients. CP positive in caloric testing indicated insignificant dysfunction of the horizontal semicircular canal in canalolithiasis patients compared to that in cupulolithasis patients. The mechanism behind caloric nystagmus was thought to be a convection of endolymphatic fluid interrupted consequently by an otolith in the semicircular canal in canalolithiasis patients. In contrast, CP was positive in cupulolithiasis patients regarded as having no convection of endolymphatic fluid. The mechanism causing a difference in caloric test results between canalolithiasis and cupulolithiasis patients thus requires a larger patient population and further examination to be conclusive.
BibTeX: @article{Fujita2005, author = {Fujita, Nobuya and Yamanaka, Toshiaki and Okamoto, Hideyuki and Hosoi, Hiroshi}, title = {[Horizontal canal benign paroxysmal positional vertigo--its affected side and horizontal semicircular canal function].}, journal = {Nihon Jibiinkoka Gakkai kaiho}, year = {2005}, volume = {108}, issue = {3}, pages = {202--206}, keywords = {Aged; Aged, 80 and over; Female; Humans; Labyrinth Diseases, physiopathology; Lithiasis, physiopathology; Male; Middle Aged; Nystagmus, Pathologic, physiopathology; Posture; Rotation; Semicircular Canals, physiopathology; Vertigo, physiopathology}, pmid = {15828285} }
Comacchio, F., Poletto, E., Meneghetti, G. and Marini, B.	[Idiopathic cupulolithiasis: vasomotor reactivity evaluation of the vertebro-basilar artery by transcranial doppler ultrasonography and acetazolamide test]. [Abstract] [BibTeX]	1993	Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale Vol. 13(6), pp. 495-504	article
Abstract: Benign paroxysmal positional vertigo (BPPV) or cupulolithiasis is one of the more common peripheral vestibular disorders. Diagnosis is made on the observation of typical positioning nystagmus brought about by the Hallpike manoeuver. In most cases of BPPV, etiology is unknown. Microcirculatory disorders have often been considered responsible for idiopathic BPPV. Few reports have been published on this specific aspect of the problem. In our study we evaluated vertebro-basilar haemodynamics and vasomotory reactivity after Acetazolamide administration in 12 patients with idiopathic BPPV. The results obtained reveal the absence of macrocirculatory impairment in the vertebro-basilar district in basal conditions, but significative vasoreactivity variation after acetazolamide, both in vertebral and basilar arteries. Poor vasomotor reactivity in one vertebral artery was observed in 5 patients and, in two cases, in the basilar artery. Altered vasoreactivity in the middle cerebral arteries was not observed in any case. In the light of these findings, we suggest that a possible inadequate response if microcirculation in the labyrinth, in some particular haemodynamic situations, might cause otolithic damage.
BibTeX: @article{Comacchio1993, author = {Comacchio, F and Poletto, E and Meneghetti, G and Marini, B}, title = {[Idiopathic cupulolithiasis: vasomotor reactivity evaluation of the vertebro-basilar artery by transcranial doppler ultrasonography and acetazolamide test].}, journal = {Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale}, year = {1993}, volume = {13}, issue = {6}, pages = {495--504}, keywords = {Acetazolamide, pharmacology; Adult; Aged; Basilar Artery, drug effects; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic; Ultrasonography, Doppler, Transcranial, methods; Vertebral Artery, drug effects; Vertigo, diagnosis}, pmid = {7911639} }
Wang, W.-q., Sun, Q. and Ren, T.-l.	[Importance of re-examinations in the diagnosis of benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2011	Zhonghua yi xue za zhi Vol. 91(46), pp. 3254-3256	article
Abstract: To evaluate the importance of re-examinations in the diagnosis of benign paroxysmal positional vertigo (BPPV) and its clinical characteristics. The medical records of 288 BPPV patients treated during January 2009 to December 2010 were reviewed and analyzed. The definite diagnosis was established by re-examinations. Among them, 39 (13.5%) were diagnosed by re-examinations or return visits. And 25 patients received a correct diagnosis on the first visit and 14 were diagnosed on return visits. Their ages, gender distribution and the times of particle-repositioning maneuver were the same as the overall profiles. The rate of horizontal semicircular canal BPPV was higher in the 39 re-examined patients than the overall rate (46.15% vs 22.22%). And the latencies decreased during the second examination in 18 patients. Re-examinations and return visits are useful for diagnostic clarifications in the suspected BPPV patients.
BibTeX: @article{Wang2011, author = {Wang, Wu-qing and Sun, Qin and Ren, Tong-li}, title = {[Importance of re-examinations in the diagnosis of benign paroxysmal positional vertigo].}, journal = {Zhonghua yi xue za zhi}, year = {2011}, volume = {91}, issue = {46}, pages = {3254--3256}, keywords = {Adult; Benign Paroxysmal Positional Vertigo; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, diagnosis; Physical Examination; Retrospective Studies; Semicircular Canals; Vertigo, diagnosis, pathology}, pmid = {22333144} }
Sekine, K., Sato, G. and Takeda, N.	[Incidence of vertigo and dizziness disorders at a university hospital]. [Abstract] [BibTeX]	2005	Nihon Jibiinkoka Gakkai kaiho Vol. 108(9), pp. 842-849	article
Abstract: Subjects were 626 patients reporting vertigo or dizziness seen at the University Hospital Department of Otolaryngology from April 2001 to September 2003. Patients were diagnosed based on diagnostic criteria prescribed by the Japan Society for Equilibrium Research. The most common peripheral vestibular disorder was benign paroxysmal positional vertigo (32%), followed by Meniere's disease (12%). All peripheral vestibular disorders accounted for 65%. Central vestibular disorder accounted for 7%, of which space-occupying lesions in the posterior fossa accounted for 1.0% and cerebral infarction 1.9%. Dizziness due to orthostatic hypotension accounted for 4.0%. Among past reports on clinical statistics of vertigo, the incidence of vertigo and dizziness disorders differed greatly, but our research and the past 2 reports based on diagnostic criteria prescribed by the Japan Society for Equilibrium Research showed almost the same incidence, i.e., BPPV of 30-40%, Meniere's disease of 7-10%, other peripheral vestibular disorders of 15-20%, and central vestibular disorder of 6-8%. Unified diagnostic criteria are thus important in the statistical analysis of vertigo disorders.
BibTeX: @article{Sekine2005, author = {Sekine, Kazunori and Sato, Go and Takeda, Noriaki}, title = {[Incidence of vertigo and dizziness disorders at a university hospital].}, journal = {Nihon Jibiinkoka Gakkai kaiho}, year = {2005}, volume = {108}, issue = {9}, pages = {842--849}, keywords = {Adolescent; Adult; Aged; Child; Dizziness, diagnosis, epidemiology; Female; Humans; Male; Middle Aged; Vertigo, diagnosis, epidemiology}, pmid = {16218442} }
Westhofen, M.	[Indications for operative therapy of vestibular vertigo and the associated success rates]. [Abstract] [BibTeX]	2013	HNO Vol. 61(9), pp. 752-761	article	DOI
Abstract: The indications for surgical treatment of labyrinthine vertigo associated with severe impairment and a lack of response to medication are heterogeneous. Due to different therapeutic goals and success parameters, the results of treatments can only be compared to a limited extent. This overview of the current literature and procedures performed by the author contains recommendations for indications and outlines the risks associated with operative therapy of vestibular vertigo. Results of function-preserving and ablative therapies are compared. Surgical treatment of Menière's syndrome (non-idiopathic) using tympanostomy tubes is indicated in cases of increased middle ear pressure; Meniere's disease (idiopathic) in its early stages can be treated with the endolymphatic shunt operation to preserve hearing and balance functions and where these techniques fail, with vestibular neurectomy for preservation of hearing or with cochleosacculotomy in the case of deafness. Rare indications are intractable benign paroxysmal positional vertigo and superior semicircular canal dehiscence syndrome (SCDS). The function preservation success rate in cases of Meniere's syndrome and disease is 70-88 %, ablative procedures are effective in > 90 % of cases and occlusion of the superior or posterior canals is successful in > 95 % of patients.
BibTeX: @article{Westhofen2013, author = {Westhofen, M}, title = {[Indications for operative therapy of vestibular vertigo and the associated success rates].}, journal = {HNO}, year = {2013}, volume = {61}, issue = {9}, pages = {752--761}, doi = {https://doi.org/10.1007/s00106-013-2749-5}, keywords = {Causality; Comorbidity; Evidence-Based Medicine; Humans; Meniere Disease, diagnosis, epidemiology, surgery; Otologic Surgical Procedures, statistics & numerical data; Prevalence; Treatment Outcome; Vertigo, diagnosis, epidemiology, surgery}, pmid = {24002727} }
Esteban-Sánchez, J., Rueda-Marcos, A., Sanz-Fernández, R. and Martín-Sanz, E.	[Inferior vertical nystagmus: is magnetic resonance imaging mandatory?]. [Abstract] [BibTeX]	2016	Revista de neurologia Vol. 62(3), pp. 107-112	article
Abstract: The presentation of a down-beating nystagmus force to discard vascular pathology of brain and cervical joint with magnetic resonance imagine (MRI). Recent studies support the low profitability of this study and is subjected that this oculomotor sign has a peripheral origin especially when the patient has a benign paroxysmal positional vertigo (BPPV) with affection of the superior semicircular canal. To evidence the profitability of MRI in a population of patients with positional down-beating nystagmus. We present a retrospective study with 42 consecutive patients. A complete clinical history and physical examination was performed. All of them perform vestibular tests (caloric and rotatory), cranial and cervical MRI. Fifty-two percent of patients present clinical manifestations and physical exploration compatible with BPPV. MRI was normal in 67%. We found spondylopathy in 26% and vascular cerebral pathology in 5%. Prevalence of type I Arnold-Chiari malformation was 9% in our population. None of them was founded when the main symptom was suggestive of BPPV. Results obtained of vestibular tests didn't contribute additional information to give an ethiologic diagnosis. The profitability of vestibular tests and MRI in our population with down beating nystagmus was very low. We must evaluate the real necessity of this test with the clinical context.
BibTeX: @article{Esteban-Sanchez2016, author = {Esteban-Sánchez, Jonathan and Rueda-Marcos, Almudena and Sanz-Fernández, Ricardo and Martín-Sanz, Eduardo}, title = {[Inferior vertical nystagmus: is magnetic resonance imaging mandatory?].}, journal = {Revista de neurologia}, year = {2016}, volume = {62}, issue = {3}, pages = {107--112}, keywords = {Adult; Aged; Aged, 80 and over; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Nystagmus, Pathologic, diagnostic imaging; Retrospective Studies; Young Adult}, pmid = {26815847} }
Kong, W.J., Liu, B., Leng, Y.M. and Zhang, S.L.	[Intensive reading of the guidelines of diagnosis and treatment of Meniere disease and benign paroxysmal positional vertigo]. [BibTeX]	2017	Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery Vol. 52(3), pp. 178-189	article	DOI
BibTeX: @article{Kong2017, author = {Kong, W J and Liu, B and Leng, Y M and Zhang, S L}, title = {[Intensive reading of the guidelines of diagnosis and treatment of Meniere disease and benign paroxysmal positional vertigo].}, journal = {Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery}, year = {2017}, volume = {52}, issue = {3}, pages = {178--189}, doi = {https://doi.org/10.3760/cma.j.issn.1673-0860.2017.03.004}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis, therapy; Humans; Meniere Disease, diagnosis, therapy; Practice Guidelines as Topic; Reading}, pmid = {28395488} }
Pongrácz, E.	[Interdisciplinary approach to vestibular system impairment]. [Abstract] [BibTeX]	2011	Ideggyogyaszati szemle Vol. 64(3-4), pp. 101-109	article
Abstract: In the first part of this review the definition of vertigo/dizziness was discussed. The major difference between the two signs is the existence of the direction, which is specific for vertigo. Dizziness is a frequent complaint in the clinical practice. Its frequency is increasing with advance of age, to intimate the play of declining cognitive process in the pathogenesis of its. The popular health significance of vertigo is in the rowing number of the patients. The onset of the most cases with acute vertigo appears between secundums and minutes so the patients will be provided in circumstances of emergency department. First of all three form should be take into account: neuronitis vestibularis, benign paroxysmal positional vertigo and Meniere syndrome. Without typical periferal signs of vertigo, central cause should be searched, principally stroke (lysis possibility). The differential diagnose of the different dizziness/vertigo forms according to the elapsed time of the onset or congenital and acquired nystagmus was created in tables. The recommendations of the therapy of acute and chronic dizziness/vertigo syndromes are, lack of results of evidence based trials doubtful. The more often used drugs based on clinical trials are discussed as vinpocetine, betahistine and piracetam. The in vitro and in vivo data suggest that the last molecule is eligible to use both in periferal and central type of vertigo syndromes.
BibTeX: @article{Pongracz2011, author = {Pongrácz, Endre}, title = {[Interdisciplinary approach to vestibular system impairment].}, journal = {Ideggyogyaszati szemle}, year = {2011}, volume = {64}, issue = {3-4}, pages = {101--109}, keywords = {Acute Disease; Algorithms; Chronic Disease; Diagnosis, Differential; Dizziness, etiology, physiopathology; Emergencies; Humans; Interdisciplinary Communication; Nystagmus, Pathologic, etiology, physiopathology; Severity of Illness Index; Time Factors; Vertigo, etiology; Vestibular Diseases, complications, diagnosis, epidemiology, physiopathology, therapy}, pmid = {21545007} }
Wu, P.X., Wang, J., Li, W.Y. and Li, H.W.	[Interpretation of updated version of BPPV clinical practice guideline: diagnosis and examination]. [Abstract] [BibTeX]	2018	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 32(10), pp. 723-727	article	DOI
Abstract: In 2008, American Academy of Otolaryngology-Head and Neck Surgery Foundation（AAO-HNSF）published the first clinical practice guideline for Benign Paroxysmal Positional Vertigo (BPPV) based on evidence-based methodology. The primary purposes of this guideline were to improve quality of care and outcomes for BPPV by enhancing the accuracy and efficacy of diagnosis of BPPV, reduce the inappropriate use of vestibular suppressant, and decrease the inappropriate use of ancillary examinations. The guideline was updated in 2017. This paper aimed at interpreting the updated guideline with a focus on diagnosis and ancillary tests section. Changes from the prior guideline include removal of the "no recommendation" for audiometric; expansion of the recommendations with respect to radiographic and vestibular testing, and broadening out the overall framework of differential diagnosis regarding BPPV.
BibTeX: @article{Wu2018b, author = {Wu, P X and Wang, J and Li, W Y and Li, H W}, title = {[Interpretation of updated version of BPPV clinical practice guideline: diagnosis and examination].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2018}, volume = {32}, issue = {10}, pages = {723--727}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2018.10.001}, keywords = {Audiometry; Benign Paroxysmal Positional Vertigo, diagnosis, therapy; Diagnosis, Differential; Humans; Practice Guidelines as Topic; Vestibule, Labyrinth; benign paroxysmal positional vertigo; clinical practice guideline; guideline interpretation}, pmid = {29873206} }
Wu, P.X., Wang, J., Li, W.Y. and Li, H.W.	[Interpretation of updated version of BPPV clinical practice guideline: treatment and patient education]. [Abstract] [BibTeX]	2018	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 32(18), pp. 1367-1371	article	DOI
Abstract: In 2008, American Academy of Otorhinolaryngology Head and Neck Surgery(AAOHNSF) published the first clinical practice guideline for benign paroxysmal positional vertigo (BPPV), in which 13 key action statements for BPPV diagnosis, treatment, and patient education were proposed. The updated version of guideline was published in 2017. This article aimed at interpreting the updated guideline with particular focus on BPPV treatment and patient education.
BibTeX: @article{Wu2018, author = {Wu, P X and Wang, J and Li, W Y and Li, H W}, title = {[Interpretation of updated version of BPPV clinical practice guideline: treatment and patient education].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2018}, volume = {32}, issue = {18}, pages = {1367--1371}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2018.18.001}, keywords = {benign paroxysmal positional vertigo; clinical practice guideline; guideline interpretation}, pmid = {30550163} }
Schratzenstaller, B., Wagner-Manslau, C., Strasser, G. and Arnold, W.	[Intractable and atypical benign paroxysmal vertigo. Pathological results of high-resolution three-dimensional MR-tomography of the vestibular organ]. [Abstract] [BibTeX]	2005	HNO Vol. 53(12), pp. 1063-6, 1068-70, 1072-3	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most frequent vestibular disorder and a most common cause of dizziness and vertigo. The modern canalolithiasis theory postulates the existence of free-floating dense otolithic particles in the endolymph of the posterior semicircular canal. The symptoms were exactly described by Dix and Hallpike; BPPV is normally a self-limited disease with spontaneous recovery. There is however a small number of patients who do not respond to any treatment or who present with otolithic vertigo which does not fit all Dix-Hallpike criteria (atypical BPPV). While BPPV in its typical appearance cannot be diagnosed with radiologic imaging, the authors succeeded in identifying structural changes in the vestibular organs of patients suffering from intractable or atypical BPPV using three-dimensional magnetic resonance imaging.
BibTeX: @article{Schratzenstaller2005a, author = {Schratzenstaller, B and Wagner-Manslau, C and Strasser, G and Arnold, W}, title = {[Intractable and atypical benign paroxysmal vertigo. Pathological results of high-resolution three-dimensional MR-tomography of the vestibular organ].}, journal = {HNO}, year = {2005}, volume = {53}, issue = {12}, pages = {1063--6, 1068-70, 1072-3}, doi = {https://doi.org/10.1007/s00106-005-1268-4}, keywords = {Aged; Aged, 80 and over; Female; Humans; Image Enhancement, methods; Imaging, Three-Dimensional, methods; Magnetic Resonance Imaging, methods; Male; Middle Aged; Treatment Failure; Vertigo, diagnosis, therapy; Vestibule, Labyrinth, pathology}, pmid = {15942752} }
Zhou, F., Fu, M., Zhang, N., Xu, Y. and Ge, Y.	[Investigation of the relationship between chronic diseases and residual symptoms of benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2015	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 29(18), pp. 1627-1629	article
Abstract: To investigate the prognosis-related influence factors of the residual symptoms after the canalith repositioning procedure (CRP) for the benign paroxysmal positional vertigo (BPPV) in the second affiliated hospital of dalian medical university. Among patients who were diagnosed with BPPV and treated by CRP, the one that still show residual symptoms were enrolled in our study, then make a follow-up irregularly about the tendency of their residual symptoms' self-healing,and respectively record in their gender, age and chronic diseases and so on. Single-factor analysis and multi-factors analysis was utilized to investigate the residual symptoms' related influencing factors. In this study, 149 cases of patients were in record, for the residual symptoms, 71 patients can go to self-healing, 78 patients can not; age is 23-88, 30 cases in the young group, 46 cases in the middle aged group, 47 cases in the young elderly group, 26 cases in the elderly group; patients suffering from high blood pressure are 76 cases, 76 cases had diabetes, 47 cases had hyperlipidemia, 110 cases had heart disease, 43 cases had ischemic encephalopathy. The residual symptoms in the elderly females patients and patients suffering from the hypertension, diabetes, heart disease patients and ischemic encephalopathy are not easy to heal by itself, in which, the older and the fact suffering from the hypertension and diabetes are the risk factors influencing the prognosis of the residual symptoms.
BibTeX: @article{Zhou2015b, author = {Zhou, Fengjie and Fu, Min and Zhang, Nan and Xu, Ye and Ge, Ying}, title = {[Investigation of the relationship between chronic diseases and residual symptoms of benign paroxysmal positional vertigo].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2015}, volume = {29}, issue = {18}, pages = {1627--1629}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, complications, therapy; Chronic Disease; Diabetes Mellitus; Female; Heart Diseases, complications; Humans; Hypertension, complications; Male; Middle Aged; Patient Positioning; Prognosis; Risk Factors; Young Adult}, pmid = {26790263} }
Wen, C., Chen, T., Chen, F., Liu, Q., Li, S., Cheng, Y. and Lin, P.	[Investigation of the reverse phase nystagmus in positioning test for benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2014	Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery Vol. 49(5), pp. 384-389	article
Abstract: To investigate the clinical significances and formation mechanism by analyzing the characteristics of the reverse phase nystagmus parameters from benign paroxysmal positional vertigo (BPPV) positioning test. There were 183 cases with BPPV, including 108 cases (59.0%) of posterior semicircular canal canalithiasis, 55 cases (30.1%) of horizontal semicircular canal canalithiasis, and 15 cases (8.2%) of horizontal and posterior semicircular canal cupulolithiasis and 5 cases (2.7%) of anterior semicircular canalithiasis . The video-nystagmography was utilized in positioning tests to induce nystagmus. The direction, intensity, time parameters characteristic of vertical nystagmus in Dix-Hallpike test and horizontal nystagmus in roll test were analyzed and compared. There were no reversal phase nystagmus in 15 cases of semicircular canal cupulolithiasis and 5 cases of anterior semicircular canalithiasis. After the disappearance of vertical nystagmus which induced by hanging position (the first phase nystagmus) in 108 cases of posterior semicircular canalithiasis of Dix-Hallpike test, there was 54 cases(50.0%) of posterior semicircular canal canalithiasis displayed downward vertical nystagmus (reverse phase nystagmus) . The latency, duration time and intensity of the first phase nystagmus and reverse phase nystagmus were [(2.00 ± 1.10) s, (3.54 ± 1.42) s], [ (16.27 ± 4.95) s, (61.65 ± 33.69)s] and [ (51.80 ± 25.25) °/s, (10.65 ± 6.29)°/s] respectively; 43 cases(78.2%) of horizontal semicircular canal canalithiasis displayed the opposite to turning head (reverse phase nystagmus) after the horizontal nystagmus, similar with turning head disappeared in Roll test. The latency, duration time and intensity of the first phase of nystagmus and reverse phase nystagmus were [ (1.67 ± 1.07) s, (3.57 ± 1.89)s], [ (25.19 ± 9.74) s, (70.48 ± 40.26)s] and [ (68.47 ± 30.18) °/s, (11.22 ± 8.78)°/s] respectively. Comparing with the latency, duration time, intensity of first phase nystagmus and reverse phase nystagmus of posterior and horizontal semicircular canal canalithiasis, the differences had statistical significances (P < 0.05). Comparing with the first phase nystagmus of reverse phase and no reverse phase nystagmus canalithiasis, the difference of nystagmus intensity had statistical significances (P < 0.05); but the differences of latency and duration of nystagmus had no significant difference (P > 0.05). It is common in PSC-Can and HSC-Can patients that reverse phase nystagmus is one of the clinical features of canalithiasis. It appears in side head position of Rolling test or the hanging of Dix- Hallpike test. More power of the first phase nystagmus has, reverse phase nystagmus will be induced much easier. In comparison of the reverse phase nystagmus, the first phase nystagmus has the shorter incubation and duration, but it has more power. It is helpful to avoid interruptions of clinical statolith positioning and reset since we recognize the reverse phase nystagmus. The mechanism might be similar to the vestibular mirror image nystagmus. It is another form of the vestibular mirror image nystagmus in BPPV patients.
BibTeX: @article{Wen2014, author = {Wen, Chao and Chen, Taisheng and Chen, Feiyun and Liu, Qiang and Li, Shanshan and Cheng, Yan and Lin, Peng}, title = {[Investigation of the reverse phase nystagmus in positioning test for benign paroxysmal positional vertigo].}, journal = {Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery}, year = {2014}, volume = {49}, issue = {5}, pages = {384--389}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, physiopathology; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, physiopathology; Semicircular Ducts, pathology; Vestibular Function Tests}, pmid = {25017222} }
Pardal Refoyo, J.L., Pérez Plasencia, D. and Beltrán Mateos, L.D.	[Ischemia of the anterior vestibular artery (Lindsay-Hemenway syndrome). Review and comments]. [Abstract] [BibTeX]	1998	Acta otorrinolaringologica espanola Vol. 49(8), pp. 599-602	article
Abstract: The Lindsay and Hemenway syndrome is produced by ischemia in the territory of the anterior vestibular artery and is characterized by an initial episode of acute vertigo followed by benign paroxysmal positional vertigo and decreased or abolished caloric response. To determine the incidence of anterior vestibular artery syndrome in patients with benign paroxysmal positional vertigo. A 3-year retrospective study (January 1994 to December 1996). Patients with benign paroxysmal positional vertigo of the Zamora and Salamanca (Spain) health districts seen in two outpatients clinics. Ninety-eight patients with benign paroxysmal positional vertigo. Sixteen patients diagnosed as anterior vestibular artery syndrome were revised (16.3%). Although the literature is scarce, the incidence of Lindsay-Hemenway syndrome seems to be underestimated.
BibTeX: @article{PardalRefoyo1998, author = {Pardal Refoyo, J L and Pérez Plasencia, D and Beltrán Mateos, L D}, title = {[Ischemia of the anterior vestibular artery (Lindsay-Hemenway syndrome). Review and comments].}, journal = {Acta otorrinolaringologica espanola}, year = {1998}, volume = {49}, issue = {8}, pages = {599--602}, keywords = {Adult; Aged; Brain Ischemia, complications, pathology; Female; Humans; Labyrinth Diseases, etiology, pathology; Male; Middle Aged; Retrospective Studies; Syndrome; Time Factors; Vertigo, etiology; Vestibule, Labyrinth, blood supply}, pmid = {9951076} }
Garov, E.V., Antonian, R.G. and Sheremet, A.S.	[Laser destruction of labyrinthine receptors as a treatment for benign paroxysmal postural vertigo and otolith symptoms]. [Abstract] [BibTeX]	2007	Vestnik otorinolaringologii(1), pp. 8-10	article
Abstract: Outcomes of surgical laser treatment are presented for 15 patients with resistant to conservative therapy benign paroxysmal postural vertigo (BPPV) and otolith-related disorders. Nine patients with Meniere's disease with BPPV (n=3) and otoliths (in all the patients) were exposed to laser impulses on the bony wall of the horizontal semicircular canal. The impulse was directed in the lumen of the canal in 6 patients with BPPV and otolith symptoms. In Meniere's patients vertigo stopped, hearing was at the preoperative level. Neither threy had BPPV nor otolith problems. The same results were obtained in 6 patients with the other diseases. Vestibular excitability of all surgically treated patients decreased to the fifth degree.
BibTeX: @article{Garov2007, author = {Garov, E V and Antonian, R G and Sheremet, A S}, title = {[Laser destruction of labyrinthine receptors as a treatment for benign paroxysmal postural vertigo and otolith symptoms].}, journal = {Vestnik otorinolaringologii}, year = {2007}, issue = {1}, pages = {8--10}, keywords = {Ear, Inner, metabolism, surgery; Endolymph, metabolism; Humans; Laser Therapy, methods; Otolithic Membrane, physiopathology; Severity of Illness Index; Vertigo, physiopathology, surgery}, pmid = {17495795} }
Schaaf, H. and Hesse, G.	[Low frequency fluctuating hearing loss without labyrinthine vertigo--a genuine disease? A follow up study after 4 and 10 years]. [Abstract] [BibTeX]	2007	HNO Vol. 55(8), pp. 630-637	article	DOI
Abstract: Besides the typical attacks of dizziness, recurrent low-frequency sensory hearing loss--together with mostly low-frequency tinnitus--is also a characteristic sign of Menière's disease. It is therefore often assumed to be a prodromal sign of Menière's disease, even without dizziness. During our longitudinal study, which was started in 1995, we reported that there were 81 patients with recurrent low-frequency hearing loss with no initial vertigo in the first suspense year of 1999. After a further 6 years, we investigated 46 (57%) of these original 81 patients in the second suspense year, 2005, for new components of vertigo, with the questions of development of Menière's disease and further development of the patients' hearing ability and psychic situation in mind. In all, 12 (26%) of the 81 former patients suffered from vertigo, but only 4 (9%) had developed the typical signs of full-blown Menière's disease with the typical labyrinthine vertigo. Of the 12 patients who suffered from vertigo, 6 (13% of the 81 with vertigo) were diagnosed with psychogenic vertigo, 1 (1%) suffered from benign and treatable paroxysmal positional vertigo and 1 (1%) had developed vertigo after acoustic neurinoma surgery. We conclude from our observations that, although almost every patient with Menière's disease suffers from recurrent low-frequency hearing loss, only a few patients with recurrent hearing loss develop Menière's disease. However, many patients with low-frequency sensory hearing loss develop anxiety leading to psychogenic dizziness in fearful expectation of "imminent" Menière's disease. We found that 26% of the patients had persisting bilateral normacusis in the low-frequency ranges, while 34% had unilateral hearing loss that was sufficiently severe to affect their lives and 39%, bilateral hearing loss; however, none of the patients became completely deaf.
BibTeX: @article{Schaaf2007, author = {Schaaf, H and Hesse, G}, title = {[Low frequency fluctuating hearing loss without labyrinthine vertigo--a genuine disease? A follow up study after 4 and 10 years].}, journal = {HNO}, year = {2007}, volume = {55}, issue = {8}, pages = {630--637}, doi = {https://doi.org/10.1007/s00106-006-1495-3}, keywords = {Adolescent; Child; Comorbidity; Diagnosis, Differential; Female; Follow-Up Studies; Germany, epidemiology; Hearing Loss, Sensorineural, classification, diagnosis, epidemiology; Humans; Male; Meniere Disease, classification, diagnosis, epidemiology; Terminology as Topic; Vertigo, classification, diagnosis, epidemiology}, pmid = {17115089} }
Klokker, M. and Vesterhauge, S.	[Malfunction of the inner ear is the most frequent cause of dizziness]. [Abstract] [BibTeX]	2013	Ugeskrift for laeger Vol. 175(45), pp. 2706-2708	article
Abstract: Half of all dizziness patients suffer from a malfunction of the inner ear and benign paroxysmal positional vertigo causes 25-30% of these malfunctions. During the latest two decades new vestibular test equipment has been developed and has made it possible to refine the vestibular diagnoses and consequently treat patients more efficiently. This brief overview describes the benefit of Epley's Omniax Chair, video head impulse tests and the Vestibular Autorotation Test. The need for vestibular rehabilitation programmes and for a closer collaboration between physicians and the social authorities is pointed out.
BibTeX: @article{Klokker2013, author = {Klokker, Mads and Vesterhauge, Søren}, title = {[Malfunction of the inner ear is the most frequent cause of dizziness].}, journal = {Ugeskrift for laeger}, year = {2013}, volume = {175}, issue = {45}, pages = {2706--2708}, keywords = {Benign Paroxysmal Positional Vertigo, complications, diagnosis; Dizziness, diagnosis, epidemiology, etiology; Humans; Labyrinth Diseases, complications, diagnosis; Meniere Disease, complications, diagnosis; Migraine Disorders, complications, diagnosis; Vertigo, complications, diagnosis; Vestibular Diseases, complications, diagnosis; Vestibular Neuronitis, complications, diagnosis}, pmid = {24629232} }
Carnevale, C., Muñoz-Proto, F., Rama-López, J., Ferrán-de la Cierva, L., Rodríguez-Villalba, R., Sarría-Echegaray, P., Mas-Mercant, S. and Tomás-Barberán, M.	[Management of benign paroxysmal positional vertigo in first care centers]. [Abstract] [BibTeX]	2014	Semergen Vol. 40(5), pp. 254-260	article	DOI
Abstract: The benign paroxysmal positional vertigo is the most common disease in the group of peripheral vertigo. It's characterized by vertiginous sensation triggered by the positional changes of the head and usually lasts less than one minute. It is most frequently seen in middle-aged patients (40-50 years old) and in up 50% of cases we do not know the cause, so we refer to them as idiopathic benign paroxysmal positional vertigo. Because of the high incidence of benign paroxysmal positional vertigo in general population, it is of utmost importance to be aware of the differential diagnosis and to be able to treat this pathology with efficacy, because in most cases we can achieve excellent results performing specific and simple maneuvers.
BibTeX: @article{Carnevale2014, author = {Carnevale, C and Muñoz-Proto, F and Rama-López, J and Ferrán-de la Cierva, L and Rodríguez-Villalba, R and Sarría-Echegaray, P and Mas-Mercant, S and Tomás-Barberán, M}, title = {[Management of benign paroxysmal positional vertigo in first care centers].}, journal = {Semergen}, year = {2014}, volume = {40}, issue = {5}, pages = {254--260}, doi = {https://doi.org/10.1016/j.semerg.2014.01.001}, keywords = {Adult; Benign Paroxysmal Positional Vertigo, diagnosis, epidemiology, therapy; Diagnosis, Differential; Humans; Middle Aged; Primary Health Care; Benign paroxysmal positional vertigo; Canales semicirculares; Canalicular reposition maneuvers; Dizziness; Maniobras de reposicionamiento canalicular; Mareo; Positional vertigo; Semicircular canals; Vértigo posicional; Vértigo posicional paroxístico benigno}, pmid = {24717672} }
Zhao, F., Zhuang, J., Xie, X., Jin, Z., Chen, Y. and Zhao, Z.	[Management of bilateral benign paroxysmal positional vertigo with Dix-Hallpike test]. [Abstract] [BibTeX]	2014	Zhonghua nei ke za zhi Vol. 53(10), pp. 764-767	article
Abstract: To explore the diagnosis and treatment of benign paroxysmal positional vertigo (BPPV) with bilateral positive Dix-Hallpike test. This is a retrospective study based on the clinical data of BPPV patients diagnosed in the Dizziness Clinic of Changzheng Hospital from January 2012 to December 2012. Totally 490 patients with vertigo and nystagmus provoked by Dix-Hallpike maneuver were included in the present analysis. Among all the patients, 55 (11.2%) of them presented with bilateral nystagmus by the provocative test. According to the type of nystagmus provoked by Dix-Hallpike maneuver, the 55 patients can be divided into the following four categories. (1) Bilateral geotropic (n = 16) and apogeotropic nystagmus (n = 5): all these patients were diagnosed with horizontal canal BPPV and free of vertigo after head side-shaking exercise in supine position and Barbecue maneuver. (2) Bilateral predominant down-beating nystagmus (n = 2): patients in this group were diagnosed with anterior canal BPPV, and got recovered after Kim maneuver. (3) Bilateral torsional up-beating geotropic nystagmus (n = 20): after a lying-down test, 6 of the patients manifested as vertical up-beating nystagmus and 14 patients remained torsional up-beating nystagmus. The former were diagnosed with bilateral posterior canal BPPV, and were cured after bilateral PRM therapy, and the latter were diagnosed with horizontal canal BPPV, who were cured after Barbecue maneuver. (4) Torsional up-beating geotropic nystagmus on one side and down-beating nystagmus on the other side (n = 12). The down-beating nystagmus on the other side disappeared when the patients was firstly seated up with head down in 30 degrees for half an hour before second Dix-Hallpike maneuver. These patients were diagnosed with unilateral posterior canal BPPV and cured by PRM therapy. It is common for vertigo patients with bilateral nystagmus induced by Dix-Hallpike test. The diagnoses should be made by the types of nystagmus provoked step by step before maneuver therapy.
BibTeX: @article{Zhao2014, author = {Zhao, Fei and Zhuang, Jianhua and Xie, Xuewei and Jin, Zhe and Chen, Ying and Zhao, Zhongxin}, title = {[Management of bilateral benign paroxysmal positional vertigo with Dix-Hallpike test].}, journal = {Zhonghua nei ke za zhi}, year = {2014}, volume = {53}, issue = {10}, pages = {764--767}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis; Exercise; Humans; Physical Examination; Posture; Retrospective Studies; Semicircular Canals; Vertigo}, pmid = {25567145} }
Bouccara, D., Rubin, F., Bonfils, P. and Lisan, Q.	[Management of vertigo and dizziness]. [Abstract] [BibTeX]	2018	La Revue de medecine interne Vol. 39(11), pp. 869-874	article	DOI
Abstract: Balance disorders presenting with symptoms of dizziness and vertigo are due to various diseases. Clinical approach gives the opportunity to identify emergency situations and most common causes, among them the first one being the benign paroxysmal positional vertigo. Oculomotor assessment is pertinent as major clinical orientation, particularly between peripheral and central diseases. These clinical findings support the respective indication of modern imaging and/or vestibular tests, focused on the direction of presupposed diagnosis. On elderly the risk of falls and their complications needs a specific evaluation.
BibTeX: @article{Bouccara2018, author = {Bouccara, D and Rubin, F and Bonfils, P and Lisan, Q}, title = {[Management of vertigo and dizziness].}, journal = {La Revue de medecine interne}, year = {2018}, volume = {39}, issue = {11}, pages = {869--874}, doi = {https://doi.org/10.1016/j.revmed.2018.02.004}, keywords = {Chute; Dizziness; Fall; Positional vertigo; Troubles de l’équilibre; Vertiges; Vertiges positionnels; Vertigo}, pmid = {29496272} }
Yang, X., Wu, S. and Ye, H.	[Measurements of semicircular canal space direction with MRI]. [Abstract] [BibTeX]	2015	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 29(19), pp. 1683-1686	article
Abstract: Measure the space direction of semicircular canals to provide the anatomical basis for the diagnosis and treatment of BPPV. We calculated angles among semicircular canals of 24 patients using MRI scaning with 3D-CISS sequence. The angle between the left and right posterior semicircular canals was 106.61 degress ± 8.58 degrees, so the angle among the posterior semicircular canals and sagittal head plane was 53.31 degrees ± 4.29 degrees. Pairs of contralateral synergistic canal planes were not parallel, forming 171.67 degrees ± 4.36 degrees between the left and right horizontal semicircular canal planes, 154.37 degrees ± 10.87 degrees between the left posterior and right anterior semicircular canal planes and 156.84 degrees ± 9.34 degrees between the right posterior and left anterior semicircular canal planes. Our measurement of the angles among semicircular canals coincided with those of previous reports. The angles between contralateral synergistic canal planes were close to parallel, but the angle between the posterior semicircular canals and sagittal head plane was great than 45 degrees that traditionally thought to be.
BibTeX: @article{Yang2015, author = {Yang, Xiaokai and Wu, Shuzhi and Ye, Hua}, title = {[Measurements of semicircular canal space direction with MRI].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2015}, volume = {29}, issue = {19}, pages = {1683--1686}, keywords = {Humans; Magnetic Resonance Imaging; Semicircular Canals, anatomy & histology}, pmid = {26999835} }
Schmidt, C.L.	[Mechanism of benign, peripheral, paroxysmal positional vertigo (BPPV)]. [Abstract] [BibTeX]	1998	Laryngo- rhino- otologie Vol. 77(9), pp. 485-495	article	DOI
Abstract: Positioning nystagmus of the peripheral benign type (BPPV) has long been considered to be due to cupulolithiasis-i.e. attachment of inorganic material to the cupula-of the posterior vertical semicircular canal. Meanwhile it has generally been recognized that not all characteristics of this type of nystagmus/vertigo can be explained by assuming a gravity-dependent reaction of the posterior canal. Canalolithiasis-i.e. floating material within the canal, heavier than endolymphe-of the posterior semicircular canal is now widely regarded as the cause of BPPV. Again, however, this is a concept far too simple to explain most of the properties of BPPV. Clearly defined, carefully performed positioning and positional maneuvers were carried out on 79 patients suffering from typical BPPV in order to reveal those positioning movements and positions necessary to elicit BPPV. Detailed analysis of those positioning maneuvers necessary to elicit BPPV clearly reveals that canalolithiasis cannot be the cause of BBPV. BPPV is a combination of positioning, and positional-dependent reactions in which the otolithic organs, and particularly the sacculus, seem to be involved.
BibTeX: @article{Schmidt1998, author = {Schmidt, C L}, title = {[Mechanism of benign, peripheral, paroxysmal positional vertigo (BPPV)].}, journal = {Laryngo- rhino- otologie}, year = {1998}, volume = {77}, issue = {9}, pages = {485--495}, doi = {https://doi.org/10.1055/s-2007-997011}, keywords = {Adult; Aged; Calcinosis, physiopathology; Endolymph, physiology; Female; Humans; Male; Meniere Disease, etiology, physiopathology; Middle Aged; Orientation, physiology; Otolithic Membrane, physiopathology; Semicircular Canals, physiopathology; Tilt-Table Test; Vestibular Function Tests}, pmid = {9795925} }
von Brevern, M., Lezius, F., Tiel-Wilk, K. and Lempert, T.	[Medical management of patients with benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2002	Der Nervenarzt Vol. 73(6), pp. 538-542	article
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most common vestibular disorder which can be simply diagnosed. The evolution of highly effective positioning maneuvers has made BPPV the most successfully treatable cause of vertigo. We evaluated patients with BPPV with regard to past medical history and disease-related diagnostic and therapeutic procedures. Forty-two patients were recruited from a specialised dizziness clinic, and a further 29 patients were recruited from a neurological practice. The mean duration of the disease was 3.2 years, with an average of 2.4 episodes lasting typically several weeks to months. More than half of the patients felt severely disabled by BPPV. On average, three different medical specialities were consulted. Cerebral imaging (42%), caloric testing (46%), and audiometry (49%) were performed more often than diagnostic positioning (28%). Most patients received ineffective or no therapy, and only 4% were treated with a specific therapeutic positioning maneuver. Benign paroxysmal positional vertigo is a long-lasting and frequently recurrent disease which leads to significant morbidity and medical costs. The recent progress in the diagnosis and therapy of BPPV has not yet been widely established in medical practice in Germany.
BibTeX: @article{Brevern2002, author = {von Brevern, M and Lezius, F and Tiel-Wilk, K and Lempert, T}, title = {[Medical management of patients with benign paroxysmal positional vertigo].}, journal = {Der Nervenarzt}, year = {2002}, volume = {73}, issue = {6}, pages = {538--542}, keywords = {Adult; Aged; Aged, 80 and over; Chronic Disease; Cross-Sectional Studies; Female; Germany, epidemiology; Humans; Male; Middle Aged; Patient Care Team, statistics & numerical data; Prognosis; Recurrence; Referral and Consultation, statistics & numerical data; Treatment Failure; Vertigo, diagnosis, epidemiology, therapy}, pmid = {12243001} }
López-Escámez, J., González-Sánchez, M. and Salinero, J.	[Meta-analysis of the treatment of benign paroxysmal positional vertigo by Epley and Semont maneuvers]. [Abstract] [BibTeX]	1999	Acta otorrinolaringologica espanola Vol. 50(5), pp. 366-370	article
Abstract: To determine the effectiveness of Epley and Semont maneuvers in treating benign paroxysmal positional vertigo (BPPV). Systematic search of the medical literature to identify studies that used Epley or Semont maneuvers in randomized controlled trials to treat BPP'V. Studies were examined blind and the results of the studies with a satisfactory methodological quality were pooled. Four studies of adults with a clinical diagnosis of BPPV. Subjective sensation of vertigo 7 and 30 days after treatment, positional objective nystagmus and vertigo evoked by the Dix-Hallpike test (DHT) 7 and 30 days after treatment. Seventy percent of Epley maneuver-treated adults and 95% of placebo-treated adults reported new episodes of vertigo at 7 days. Moreover, 100% had a positive DHT (odds ratio 0.11; p = 0. 0072). However, 30 days after treatment 59% of treated adults (Epley or Semont) remained asymptomatic and 89% were unresponsive to DHT. Subjective remission of BPPV occurred in 47% of placebo-treated subjects, but only 27% had a negative DHT (odds ratio 0.05 for Epley maneuver-treated evaluated by DHT). The Epley canalith repositioning procedure or Semont maneuver had a significantly higher efficacy rate in patients with BPPV than placebo procedures, but results must be evaluated at 30 days by DHT. DHT is an easy, low-cost and effective method for assessing the outcome of treatment in patients with BPPV.
BibTeX: @article{Lopez-Escamez1999a, author = {López-Escámez, J and González-Sánchez, M and Salinero, J}, title = {[Meta-analysis of the treatment of benign paroxysmal positional vertigo by Epley and Semont maneuvers].}, journal = {Acta otorrinolaringologica espanola}, year = {1999}, volume = {50}, issue = {5}, pages = {366--370}, keywords = {Adult; Double-Blind Method; Evaluation Studies as Topic; Humans; Nystagmus, Pathologic, complications; Posture; Retrospective Studies; Vertigo, complications, therapy}, pmid = {10491472} }
Prim-Espada, M.P., De Diego-Sastre, J.I. and Pérez-Fernández, E.	[Meta-analysis on the efficacy of Epley's manoeuvre in benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2010	Neurologia (Barcelona, Spain) Vol. 25(5), pp. 295-299	article
Abstract: Benign paroxysmal positional vertigo (BPPV) is one of the most common conditions that cause the physiognomy of peripheral vertigo. To evaluate the effectiveness of Epley's manoeuvre (EM) in the treatment of BPPV using a critical review of the medical literature and a meta-analysis. Searches were made in the databases of MEDLINE (PubMed), in the Cochrane collection (Cochrane Register of controlled studies), BIREME and LILACS (all of them up to December 2008). The search words used were: canalith repositioning procedure, canalith repositioning manoeuvre, Epley manoeuvre, Dix-Hallpike, benign vertigo, benign positional vertigo, benign paroxysmal positional vertigo and BPPV. The meta-analysis was performed using the program RevMan 5.0. The patients on whom an EM was performed had a six and half times more chance of their clinical symptoms improving compared to the control group of patients (OR=6.52; 95% CI, 4.17-10.20). Similarly, the likelihood of having a negative Dix-Hallpike (DH) test are 5 times greater in patients had the EM performed than in those who did not (OR=5.19; 95% CI, 2.41-11.17). The EM is effective in controlling BPPV.
BibTeX: @article{Prim-Espada2010, author = {Prim-Espada, M P and De Diego-Sastre, J I and Pérez-Fernández, Elia}, title = {[Meta-analysis on the efficacy of Epley's manoeuvre in benign paroxysmal positional vertigo].}, journal = {Neurologia (Barcelona, Spain)}, year = {2010}, volume = {25}, issue = {5}, pages = {295--299}, keywords = {Databases, Factual; Humans; Neurosurgical Procedures, methods; Treatment Outcome; Vertigo, surgery}, pmid = {20643039} }
Qian, S.X., Li, F., Zhuang, J.H., Chen, Y., Yang, H.L., Zhou, X.W., Gu, H.H. and Gao, B.	[Misdiagnosis and associated costs of benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2017	Zhonghua yi xue za zhi Vol. 97(14), pp. 1057-1060	article	DOI
Abstract: The aims of this study were to investigate the misdiagnosis of benign paroxysmal positional vertigo (BPPV) and to estimate the associated costs. During October 2015 to December 2015, eighty patients were diagnosed with BPPV in the outpatient dizziness clinic of Shanghai Changzheng Hospital and the clinical data of all the 80 patients were collected including the demographic and clinical characteristics, the history of diagnosis, inappropriate diagnostic tests, costs of the medical tests, transportation and accommodation. All the data were investigated to estimate the misdiagnosis of benign paroxysmal positional vertigo and the associated costs in Shanghai, China. This study showed that the misdiagnosis rate of BPPV was 60.0% (48/80) and the common inappropriate diagnostic tests for BPPV included Cranial CT and MRI test, cervical MRI, cervical and cerebrovascular investigations et al. There was no significant difference between the misdiagnosis patients (48) and patients without misdiagnosis (32) in gender, age, duration of symptom, involved canal and type of BPPV.Complications were significantly more frequent in the misdiagnosis group than for those without[81.3%(39 /48) vs 34.4%(11 /32)]. The estimated costs for each misdiagnosed individual were 8 502.98 China Yuan (CNY) and one-year economic burden associated with the misdiagnosis of BPPV in Shanghai was 13.184 7-78.862 1 million CNY. Our study suggests that the misdiagnosis rate of BPPV is high and the financial impact on patients and society with this disease is huge. The cost-effective Dix-Hallpike or supine roll test maneuver should be used before applying other expensive medical tests in order to minimize misdiagnosis and the waste of health care resources.
BibTeX: @article{Qian2017, author = {Qian, S X and Li, F and Zhuang, J H and Chen, Y and Yang, H L and Zhou, X W and Gu, H H and Gao, B}, title = {[Misdiagnosis and associated costs of benign paroxysmal positional vertigo].}, journal = {Zhonghua yi xue za zhi}, year = {2017}, volume = {97}, issue = {14}, pages = {1057--1060}, doi = {https://doi.org/10.3760/cma.j.issn.0376-2491.2017.14.006}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis; China; Diagnostic Errors; Dizziness; Humans; Magnetic Resonance Imaging; Tomography, X-Ray Computed; Transportation; Benign paroxysmal positional vertigo; Cost; Misdiagnosis}, pmid = {28395428} }
Amor, J.C., Juiz, P., Rubio, J.P. and Rossi, J.	[Modification of particle replacement in a case of benign paroxysmal positional vertigo (BPPV) of the horizontal canal]. [Abstract] [BibTeX]	1999	Acta otorrinolaringologica espanola Vol. 50(2), pp. 159-163	article
Abstract: A variant of the particle repositioning maneuver was used in a patient diagnosed as benign paroxysmal positional vertigo of the horizontal canal. The patient was treated initially with Lempert's maneuver, but a paradoxical response was elicited by videonystagmography so we had to develop a maneuver adapted to the location of the patients otoliths. The likely physiopathology is discussed in the light of videonystagmographic events.
BibTeX: @article{Amor1999, author = {Amor, J C and Juiz, P and Rubio, J P and Rossi, J}, title = {[Modification of particle replacement in a case of benign paroxysmal positional vertigo (BPPV) of the horizontal canal].}, journal = {Acta otorrinolaringologica espanola}, year = {1999}, volume = {50}, issue = {2}, pages = {159--163}, keywords = {Ear Canal, physiopathology; Electronystagmography; Female; Humans; Middle Aged; Posture; Vertigo, diagnosis, therapy; Video Recording}, pmid = {10217692} }
Magnano, M., Canale, G., Lacilla, M., Roberto, C. and Albera, R.	[Modified Semont's maneuver in the treatment of benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	1990	Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale Vol. 10(5), pp. 499-503	article
Abstract: Benign paroxysmal positional vertigo (BPPV) is one of the most frequent causes of vertigo. It is characterized by a peripheral balance impairment which occurs during specific movements or positions of the head. The etiology of BPPV is not clear although recent studies by Harada have given more weight to the otolithic theory. The present author has found frequent otoconia attached to the dark cell area around the crista of the semicircular canals. The treatment of BPPV is based on functional re-education of the patient (Semont maneuvers, the Brandt Daroff technique, Norre's V.H.T). The present study involves 62 patients affected by BPPV. The Hallpike maneuver was employed to define the affected side and then the modified Semont maneuver was performed. Recovery was obtained in all patients. The cure rate proved to be 82% after the first examination. The modified Semont maneuver is easier to perform than the traditional maneuver and has given excellent therapeutic results.
BibTeX: @article{Magnano1990, author = {Magnano, M and Canale, G and Lacilla, M and Roberto, C and Albera, R}, title = {[Modified Semont's maneuver in the treatment of benign paroxysmal positional vertigo].}, journal = {Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale}, year = {1990}, volume = {10}, issue = {5}, pages = {499--503}, keywords = {Adolescent; Adult; Aged; Evaluation Studies as Topic; Female; Humans; Male; Middle Aged; Posture; Vertigo, diagnosis, therapy}, pmid = {2095109} }
Yan, H.Q. and Wang, H.	[Multi-canal benign paroxysmal positional vertigo combined anterior canal]. [BibTeX]	2018	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 32(3), pp. 228-230	article	DOI
BibTeX: @article{Yan2018, author = {Yan, H Q and Wang, H}, title = {[Multi-canal benign paroxysmal positional vertigo combined anterior canal].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2018}, volume = {32}, issue = {3}, pages = {228--230}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2018.03.018}, keywords = {semicircular canals; vertigo}, pmid = {29775029} }
Yagi, K.	[Multivariate statistical analysis in stabilometry in human upright standing (second report)--pattern recognition of a stabilogram]. [Abstract] [BibTeX]	1989	Nihon Jibiinkoka Gakkai kaiho Vol. 92(6), pp. 909-922	article
Abstract: A pattern of a figure which is displayed by an X-Y recorder or by a polygraph in stabilometry may present several qualitative facts about the standing ability of a test-subject. The purpose of this study was to make a quantitative evaluation of the body stability in both normal and ataxic patients who were standing erect. The technique utilised was pattern-recognition, composed of principal component analysis and discriminant analysis. Stabilometrical examinations were carried out in 20 normal subjects, 39 with peripheral vestibular disturbance and 11 with disturbance of the central origin. Each examinee was ordered to keep an upright posture for 60 seconds both with the eyes open and with the eyes closed. The following parameters were used: the area of the ellipse for rejection by a statokinesigram, the maximum width and the total length of body excursion, the root mean square, the velocity, the acceleration and the average frequency in the horizontal plane. These were the same parameters that were used in the first report. Each component predicting a specific character in stabilometry was identified by this study of principal component analysis. The relationship between the components in order and its prediction were as follows: the first component predicted the size of the body movement, the second the force, the third the density, the fourth the difference between body movement with the eyes open and with the eyes closed and the fifth the direction of body sway. Furthermore, the principal components were successfully utilized to allow the classification of the test subjects into three groups: those who were normal, those with peripheral vestibular disturbance and those with disturbance of the central origin. Discriminant functions were also used to classify the above mentioned three groups and another five groups, namely: those who were normal, those with vestibular neuronitis, those with positional vertigo of the benign paroxysmal type, those with Ménière's disease and those with cerebellar ataxia. In classification of the three groups, the significant parameters used for discrimination were as follows (P less than 0.05): the root mean square with the eyes open, the distance and the maximum width of body excursion in the Y direction with the eyes open, the area of the ellipse for rejection both with the eyes open and with the eyes closed, the maximum width and the average frequency in the X direction with the eyes closed.(ABSTRACT TRUNCATED AT 400 WORDS)
BibTeX: @article{Yagi1989, author = {Yagi, K}, title = {[Multivariate statistical analysis in stabilometry in human upright standing (second report)--pattern recognition of a stabilogram].}, journal = {Nihon Jibiinkoka Gakkai kaiho}, year = {1989}, volume = {92}, issue = {6}, pages = {909--922}, keywords = {Adult; Analysis of Variance; Ataxia, physiopathology; Female; Humans; Male; Middle Aged; Pattern Recognition, Automated; Postural Balance; Posture; Vestibular Diseases, physiopathology}, pmid = {2809863} }
Morawiec-Bajda, A. and Wasilewski, B.	[Myogenic vestibular evoked potentials used to objective estimation of effectiveness of central action drugs]. [Abstract] [BibTeX]	2000	Otolaryngologia polska = The Polish otolaryngology Vol. 54(3), pp. 327-336	article
Abstract: In this paper possibility of employing vestibular evoked myogenic potentials (VEMPs) was evaluated to following efficacy of drug effect in patients with central and peripheral vestibular disorders of various aetiologies. Also influence of antihomotoxic remedies on sacculo-collic reflex function were followed. Treatment concerned 23 ills that is 20 women and 3 men in age from 20 to 68 years, average age being 46,82 years. The studied population included 8 patients were diagnosed to have Meniere's disease, 5 ills suffered from neuronitis vestibularis, 5 patients complained of vertigo of vertebrobasilar arterial insufficiency. 3 patients were diagnosed to have vertigo after head trauma, 1 patient suffered from benign paroxysmal positional vertigo and one's cause of disease was unknown. Patients with tumor of ponto-cerebellaris angle or VIII nerve were excluded. Registration of VEMPs was done in all patients treated before starting and after stopping therapy. After using of Cerebrum comp. improvement of vestibulo-spinal reflex function was affirmed in the form of shorted latencies and higher amplitudes of VEMPs in the most patients. Using sublingually of Vertigoheel distinct greater amplitudes were observed in significant numbers of patients after therapy. Administered of placebo did not essential influence on values of VEMPs parameters.
BibTeX: @article{Morawiec-Bajda2000, author = {Morawiec-Bajda, A and Wasilewski, B}, title = {[Myogenic vestibular evoked potentials used to objective estimation of effectiveness of central action drugs].}, journal = {Otolaryngologia polska = The Polish otolaryngology}, year = {2000}, volume = {54}, issue = {3}, pages = {327--336}, keywords = {Adult; Aged; Central Nervous System Agents, therapeutic use; Drug Combinations; Evoked Potentials, physiology; Female; Humans; Male; Meniere Disease, diagnosis, drug therapy, physiopathology; Middle Aged; Minerals, therapeutic use; Phytotherapy; Picrotoxin, therapeutic use; Plant Extracts, therapeutic use; Plants, Medicinal, therapeutic use; Treatment Outcome; Vestibule, Labyrinth, physiopathology}, pmid = {10917061} }
Lu, H.H., Zhao, Y., Chen, T.S., Xu, K.X., Wang, W., Liu, Q., Wen, C., Li, S.S., Li, X.J., Han, X. and Lin, P.	[Necessity of repeated roll test in horizontal semicircular canalithasis positioned diagnosis]. [Abstract] [BibTeX]	2016	Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery Vol. 51(4), pp. 256-261	article	DOI
Abstract: To investigate the influence of repeated roll test in horizontal semicircular canalithasis(HSC-Can) positioned diagnosis, so as to investigate the cecessity of repeated roll test. The patients with a chief complaint of positional vertigo accepted two consecutive cycles roll test, the evoked nystagmus characteristics of each cycle recorded by video-nystagmuograph(VNG), whose direction, intensity, time and other parameters characteristics were analyzed in 51 HSC-Can. Horizontal nystagmus in the same direction with turning were induced in HSC-Can roll test. In 51 HSC-Can, roll test cycle 1 and cycle 2 induced nystagmus same strength side in 26 cases(51.0%), of which 19 cases with stronger nystagmus intensity in cycle 2, another 7 cases were weaker; the opposite strength side of the two loops induced nystagmus, and cycle 1 evoked nystagmus intensity were weaker than cycle 2, based on cycle 2 results determined HSC-Can affected side in 25 cases (49.0%). Lesion and normal side in cycle 1 induced nystagmus duration (x±s, the same below) were (13.4±11.5)s and (14.1±9.9)s, respectively intensity (18.1±22.4)°/s and (13.0±12.0)°/s; as in cycle 2 induced nystagmus duration was (20.7±10.2)s and (18.0±12.0)s, strength respectively(40.4±28.0)°/s and (15.6 ±11.2)°/s. Cycle 2 ipsilateral rotor position evoked nystagmus showed longer duration and stronger intensity than cycle 1. Between two cycle induced ipsilateral nystagmus duration, intensity differences were statistically significant (t values were -4.233 and -5.154, P=0.000). 51 HSC-Can patients, 44 patients selected repositioning maneuver, after 1-2 times of maneuver, 41 cases (93.2%) showed complete resolution of symptoms, all cases's symptoms were improved; other 7 patients selected medication only. The proposed suspicious HSC-Can patients should receive at least two cycles roll test, and mainly in the second cycle could determine the location of the responsible semicircular canals.
BibTeX: @article{Lu2016, author = {Lu, H H and Zhao, Y and Chen, T S and Xu, K X and Wang, W and Liu, Q and Wen, C and Li, S S and Li, X J and Han, X and Lin, P}, title = {[Necessity of repeated roll test in horizontal semicircular canalithasis positioned diagnosis].}, journal = {Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery}, year = {2016}, volume = {51}, issue = {4}, pages = {256--261}, doi = {https://doi.org/10.3760/cma.j.issn.1673-0860.2016.04.003}, keywords = {Benign Paroxysmal Positional Vertigo, physiopathology; Diagnostic Techniques, Otological; Humans; Nystagmus, Pathologic, etiology, physiopathology; Semicircular Canals; Time Factors}, pmid = {27095716} }
Scherer, H.	[Neck-induced vertigo]. [Abstract] [BibTeX]	1985	Archives of oto-rhino-laryngology. Supplement = Archiv fur Ohren-, Nasen- und Kehlkopfheilkunde. Supplement Vol. 2, pp. 107-124	article
Abstract: Cervicogenic vertigo can be elicited by hyperactivity of spinovestibular afferents and, much more seldomly, by episodic reduction of blood flow in the vertebral artery. The afferent hyperactivity to the vestibular system derives from a "circulus vitiosus" involving false posture, pain, joint dysfunction, which in turn exacerbates the false posture - and so on. This is to be observed in the joints CO/C1 and C1/C2 and their short muscles. This dysfunction of the upper cervical spine can be determined by exact anamnesis, careful investigation of neck mobility, joint play and muscle tension. The cervical nystagmus observed during the neck torsion test is short (seconds) in functional diseases (hyperactivity) and longlasting (minutes) in cases of vascular disorder. Cervical vertigo should be differentiated from other atactic disorders, especially those arising from benign paroxysmal positional vertigo and from Menière's disease.
BibTeX: @article{Scherer1985, author = {Scherer, H}, title = {[Neck-induced vertigo].}, journal = {Archives of oto-rhino-laryngology. Supplement = Archiv fur Ohren-, Nasen- und Kehlkopfheilkunde. Supplement}, year = {1985}, volume = {2}, pages = {107--124}, keywords = {Brain, physiopathology; Cervical Vertebrae, innervation; Humans; Muscles, innervation; Neck Muscles, innervation; Neural Pathways, physiopathology; Nystagmus, Pathologic, physiopathology; Oculomotor Nerve, physiopathology; Spinal Cord, physiopathology; Vertebrobasilar Insufficiency, physiopathology; Vertigo, physiopathology; Vestibular Nerve, physiopathology; Vestibular Nuclei, physiopathology}, pmid = {3868980} }
Hernández Montero, E., Fraile Rodrigo, J.J., De Miguel García, F., Sampériz, L.C., Damborenea Tajada, J., Llorente Arenas, E. and Ortiz García, A.	[Non-benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2003	Acta otorrinolaringologica espanola Vol. 54(8), pp. 591-594	article
Abstract: Positional vertigo is a frequent clinical manifestation of vertigo of very different etiologies, being the benign paroxystic positional vertigo (BPPV) the most frequent one of them, representing in some series even the most found etiology of peripheral vertigo. Usually of severe entities, positional vertigo may appear in the context of severe entities and of difficult diagnosis. In these cases, the bearing of the symptoms in spite of the repositioning manoeuvers, the association with otological or neurological symptoms, and the atypical nystagmus evoked by Dix-Hallpike manoeuver, must take the otolaryngologist to suspect of a feasible non benign pathology. We report a case of positional paroxysmal vertigo caused by an intracranial tumour and we review the clinical signs that shoved help us to suspect of non benign pathologies that can mimic a positional vertigo.
BibTeX: @article{HernandezMontero2003, author = {Hernández Montero, E and Fraile Rodrigo, J J and De Miguel García, F and Sampériz, L Carmen and Damborenea Tajada, J and Llorente Arenas, E and Ortiz García, A}, title = {[Non-benign paroxysmal positional vertigo].}, journal = {Acta otorrinolaringologica espanola}, year = {2003}, volume = {54}, issue = {8}, pages = {591--594}, keywords = {Female; Humans; Meningeal Neoplasms, complications; Meningioma, complications; Middle Aged; Vertigo, diagnosis, etiology}, pmid = {14755921} }
Antonenko, L.M. and Parfenov, V.A.	[Non-drug therapy of vertigo]. [Abstract] [BibTeX]	2018	Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova Vol. 118(8), pp. 38-42	article	DOI
Abstract: To study the efficacy of various methods of non-drug therapy of diseases manifested by vertigo and dizziness in neurological practice. Referral and final diagnoses were compared after neurovestibular examination of 599 patients (177 men and 422 women), aged 25 to 79 years (mean age 55 years), with various causes of vertigo. Patients underwent vestibular rehabilitation, trainings on the stabiloplatform with biological feedback (biofeedback), repositioning maneuvers in patients with benign paroxysmal positional vertigo (BPPV). Severity of dizziness on a Visual analogue scale of dizziness (VAS-d) and balance on stabilography before and after a course of vestibular rehabilitation was analyzed. Before neurovestibular examination, the diagnoses of vertebrobasilar insufficiency (44%), hypertensive or atherosclerotic encephalopathy (35%), cervical spondyloarthrosis (8%), autonomic dystonia (11%)) are often considered mistakenly as the causes of vertigo and dizziness. After neurovestibular examination, the diagnoses were as follows: BPPV (39%), phobic postural vertigo (29%), Ménière's disease (14%), vestibular neuritis (11%), multisensory dizziness in elderly (5%). The effectiveness of repositioning maneuvers in BPPV was 90,2% after the first session and 100% after the second session. After a course of vestibular exercises and trainings on the stabiloplatform with biofeedback, there was the marked improvement in indicators of stabilography and VAS-d in patients with vestibular neuritis, Meniere's disease, phobic postural vertigo (p<0.05). Vestibular rehabilitation was most effective if started within the first month after vestibular neuritis. There was the high efficacy of complex rehabilitation, including vestibular exercises and trainings on stabilographic platform with biofeedback, in patients with Meniere's disease. In the rehabilitation of patients with phobic postural vertigo, better results were achieved when vestibular exercises were combined with trainings on stabilographic platform with biofeedback and psychotherapy. The results demonstrated the low accuracy of diagnosis of diseases manifested by vertigo and dizziness and high efficacy of non-drug therapy in most cases, especially BPPV, vestibular neuritis, Meniere's disease, postural phobic vertigo.
BibTeX: @article{Antonenko2018, author = {Antonenko, L M and Parfenov, V A}, title = {[Non-drug therapy of vertigo].}, journal = {Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova}, year = {2018}, volume = {118}, issue = {8}, pages = {38--42}, doi = {https://doi.org/10.17116/jnevro201811808138}, keywords = {Meniere’s disease; benign paroxysmal positional vertigo; bilateral vestibulopathy; multisensory instability; phobic postural vertigo; repositioning maneuvers; vestibular neuritis; vestibular rehabilitation}, pmid = {30251976} }
Ruggieri, V.L. and Arberas, C.L.	[Non-epileptic motor paroxysmal phenomena in wakefulness in childhood]. [Abstract] [BibTeX]	2013	Revista de neurologia Vol. 57 Suppl 1, pp. S105-S114	article
Abstract: Paroxysmal events in childhood are a challenge for pediatric neurologists, given its highly heterogeneous clinical manifestations, often difficult to distinguish between phenomena of epileptic seizure or not. The non-epileptic paroxysmal episodes are neurological phenomena, with motor, sensory symptoms, and/or sensory impairments, with or without involvement of consciousness, epileptic phenomena unrelated, so no electroencephalographic correlative expression between or during episodes. From the clinical point of view can be classified into four groups: motor phenomena, syncope, migraine (and associated conditions) and acute psychiatric symptoms. In this paper we analyze paroxysmal motor phenomena in awake children, dividing them according to their clinical manifestations: extrapyramidal episodes (paroxysmal kinesiogenic, non kinesiogenic and not related to exercise dyskinesias, Dopa responsive dystonia) and similar symptoms of dystonia (Sandifer syndrome); manifestations of startle (hyperekplexia); episodic eye and head movements (benign paroxysmal tonic upward gaze nistagmus deviation); episodic ataxia (familial episodic ataxias, paroxysmal benign vertigo); stereotyped and phenomena of self-gratification; and myoclonic events (benign myoclonus of early infancy). The detection of these syndromes will, in many cases, allow an adequate genetic counseling, initiate a specific treatment and avoid unnecessary additional studies. Molecular studies have demonstrated a real relationship between epileptic and non-epileptic basis of many of these entities and surely the identification of the molecular basis and understanding of the pathophysiological mechanisms in many of them allow us, in the near future will benefit our patients.
BibTeX: @article{Ruggieri2013, author = {Ruggieri, Víctor L and Arberas, Claudia L}, title = {[Non-epileptic motor paroxysmal phenomena in wakefulness in childhood].}, journal = {Revista de neurologia}, year = {2013}, volume = {57 Suppl 1}, pages = {S105--S114}, keywords = {Anticonvulsants, therapeutic use; Ataxia, diagnosis, etiology, physiopathology; Benign Paroxysmal Positional Vertigo; Child; Child, Preschool; Diagnosis, Differential; Dyskinesias, diagnosis, etiology, physiopathology; Dystonia, diagnosis, drug therapy, physiopathology; Electroencephalography; Exercise; Humans; Movement Disorders, diagnosis, drug therapy, physiopathology; Myoclonus, diagnosis, etiology, physiopathology; Seizures, diagnosis, drug therapy, genetics, physiopathology; Self Stimulation; Stereotypic Movement Disorder, diagnosis, physiopathology; Stiff-Person Syndrome, diagnosis, physiopathology; Vertigo, diagnosis; Wakefulness, physiology}, pmid = {23897137} }
Wang, H., Li, X.Y., Yao, Q.X. and Yu, D.Z.	[Nystagmus characteristics of the horizontal semicircular canal light cupula]. [Abstract] [BibTeX]	2018	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 32(17), pp. 1332-1334	article	DOI
Abstract: To analyze the nystagmus characteristics of 9 patients with horizontal semicircular canal light cupula. Patients who visited the department of otolaryngology of Shanghai sixth people's hospital from September 2017 to December 2017 with a typical history of positional vertigo and roll test evoked horizontal geotropic direction changing nystagmus that lasted more than one minute were enrolled in the study.Nystagmus was monitored using the videonystagmoscopy (VNG), and parameters of nystagmus,including latency, duration and the intensity of nystagmus were analyzed. Barbecue maneuvers were tried for all patients and no other treatment was performed. Nine patients were enrolled,DixHallpike test had no nystagmus, Roll test showed a persistent geotropic DCPN, the recorded average duration of nystagmus was (64.2±13.7)s (longer actually), and averaged latency was (5.3±4.7)s.In some cases, positional nystagmus increased rapidly in intensity and then declined slowly as seen in patients with canalolithiasis. Immediate effectiveness is 0 after barbecue maneuver,but 4 patients recovered within one week,2 patients improved within 1 week,and recovered within 2 weeks, 1 patient transferred into posterior semicircular canal BPPV, and 2 cases had not been followed up. Nystagmus of horizontal canal light cupula has a latency of several seconds,with a crescendodecrescendo pattern of intensity.Barbecue maneuver may be not effective in resolving nystagmus,but the prognosis is good for those patients.
BibTeX: @article{Wang2018a, author = {Wang, H and Li, X Y and Yao, Q X and Yu, D Z}, title = {[Nystagmus characteristics of the horizontal semicircular canal light cupula].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2018}, volume = {32}, issue = {17}, pages = {1332--1334}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2018.17.009}, keywords = {latency; light cupula; nystagmus; vertigo}, pmid = {30282188} }
Johkura, K.	[Nystagmus the diagnosis of vertigo and dizziness]. [Abstract] [BibTeX]	2013	Brain and nerve = Shinkei kenkyu no shinpo Vol. 65(9), pp. 1057-1069	article
Abstract: Vertigo or dizziness is primarily caused by peripheral vestibular disorders, such as benign paroxysmal positional vertigo (BPPV) and vestibular neuritis. BPPV can be diagnosed from associated positional torsional or direction-changing horizontal nystagmus and can be treated with canalith repositioning procedures. In contrast, vestibular neuritis and other acute peripheral vestibulopathies can be diagnosed from associated unidirectional horizontal nystagmus. Evaluation of nystagmus is essential for the diagnosis of peripheral vestibular disorders. Vertigo/dizziness caused by disorders in the brainstem or upper cerebellum is usually associated with other neurological signs or symptoms, such as motor palsy, sensory deficit, dysarthria, ocular motor palsy, and limb ataxia. In contrast, vertigo/dizziness caused by disorders in the lower cerebellum is not associated with these signs or symptoms; however, truncal ataxia becomes apparent in a standing position. Small lesions in the lower cerebellum can rarely cause unidirectional horizontal nystagmus directed toward the side of the lesions or direction-changing apogeotropic positional nystagmus; both types of nystagmus are enhanced when a patient lies on the non-affected side. This positional enhancement suggests that the same pathogenetic mechanism is involved in both types of nystagmus. The cerebellar lesions may disinhibit both semicircular-ocular and otolith-ocular reflexes. Semicircular-ocular reflex-dominant disinhibitions may result in the ipsilateral horizontal nystagmus, whereas otolith-ocular reflex-dominant disinhibitions may result in the direction-changing apogeotropic positional nystagmus.
BibTeX: @article{Johkura2013, author = {Johkura, Ken}, title = {[Nystagmus the diagnosis of vertigo and dizziness].}, journal = {Brain and nerve = Shinkei kenkyu no shinpo}, year = {2013}, volume = {65}, issue = {9}, pages = {1057--1069}, keywords = {Dizziness, diagnosis; Humans; Nystagmus, Pathologic, diagnosis; Nystagmus, Physiologic, physiology; Vertigo, diagnosis, therapy; Vestibular Function Tests, methods}, pmid = {24018742} }
Jutila, T. and Hirvonen, T.P.	[Nystagmus]. [Abstract] [BibTeX]	2013	Duodecim; laaketieteellinen aikakauskirja Vol. 129(8), pp. 807-816	article
Abstract: Physiological nystagmus stabilizes gaze during head movements and pathological nystagmus reflects a disorder of the vestibulo-ocular reflex (VOR). Pathological nystagmus appears or strengthens usually during change in head position. Therefore, dizziness or nystagmus associated with head movements is not specific to benign paroxysmal positional vertigo unless it is verified in specific positional test. Peripheral nystagmus decelerates during visual fixation, accelerates when gaze is turned towards the fast phase, does not change direction, and is usually composed of several directional components unlike central nystagmus. The velocity and frequency of the slow phase of nystagmus can be measured with electronystagmography or video-oculography.
BibTeX: @article{Jutila2013, author = {Jutila, Topi and Hirvonen, Timo P}, title = {[Nystagmus].}, journal = {Duodecim; laaketieteellinen aikakauskirja}, year = {2013}, volume = {129}, issue = {8}, pages = {807--816}, keywords = {Benign Paroxysmal Positional Vertigo; Electronystagmography; Fixation, Ocular; Head Movements, physiology; Humans; Nystagmus, Pathologic, physiopathology; Reflex, Vestibulo-Ocular, physiology; Vertigo, physiopathology; Vestibular Function Tests}, pmid = {23720948} }
Chen, F.-y., Chen, T.-s., Wen, C., Li, S.-s., Lin, P., Zhao, H. and Liu, Q.	[Objective characteristics of nystagmus in horizontal semicircular canal benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2013	Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery Vol. 48(8), pp. 622-627	article
Abstract: To discuss the objective characteristics and mechanism of nystagmus direction, intensity and time in horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV) . A total of 233 patients with HSC-BPPV, whereas 179 horizontal semicircular canalithasis (HSC-Can) and 54 horizontal semicircular cupulolithiasis (HSC-Cup) were involved respectively. The induced nystagmus in roll tests recorded by video-nystagmograph(VNG) , whose direction, intensity and time characteristics were compared in various BPPV. Horizontal nystagmus was both induced by turning left or right in HSC-BPPV roll tests. The direction of the induced nystagmus was the same with turning in HSC-Can. The latency, duration time and intensity ([AKx(-)D] ± s) turning to lesion and normal side were (1.922 ± 1.501)s and (1.447 ± 0.855)s, (25.620 ± 10.409)s, and (22.110 ± 10.931)s, (56.441 ± 33.168)°/s and (24.239 ± 13.892) °/s in HSC-Can. The latency, duration time and intensity turning to lesion side were larger than normal side (t = 3.715, 15.219 and 4.070, P < 0.01) , the difference was statistically significant, and the intensity rate was about 2: 1. The direction of the induced nystagmus was opposite to turning in HSC-Cup. The intensity turning to normal side was larger than lesion side obviously. The intensity rate was about 2: 1, the difference was statistically significant (t = -7.634, P < 0.01) . While the latency and intensity of turning to lesion side in HSC-Can were larger than turn to normal side in HSC-Cup, and the difference detected no statistically significant difference (t = 1.554 and 0.305, P > 0.05). The induced nystagmus intensity of head to two sides in roll tests for HSC-BPPV both follow Ewald's law, and the ratio between stronger and weaker are both 2: 1. These nystagmus parameters of VNG in roll tests are an objective guideline for BPPV diagnosis.
BibTeX: @article{Chen2013, author = {Chen, Fei-yun and Chen, Tai-sheng and Wen, Chao and Li, Shan-shan and Lin, Peng and Zhao, Hui and Liu, Qiang}, title = {[Objective characteristics of nystagmus in horizontal semicircular canal benign paroxysmal positional vertigo].}, journal = {Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery}, year = {2013}, volume = {48}, issue = {8}, pages = {622--627}, keywords = {Benign Paroxysmal Positional Vertigo, complications, diagnosis; Electronystagmography; Head; Humans; Nystagmus, Pathologic, complications, diagnosis; Semicircular Canals; Vertigo}, pmid = {24195816} }
Lin, S.-Z., Sun, A.-h., Tian, S.-C. and Cao, P.-Y.	[Occlusion the posterior semicircular canal using laser for treatment the complex benign paroxysmal positional vertigo]. [BibTeX]	2005	Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery Vol. 40(1), pp. 77	article
BibTeX: @article{Lin2005, author = {Lin, Shun-Zhang and Sun, Ai-hua and Tian, Shu-Chang and Cao, Peng-Yu}, title = {[Occlusion the posterior semicircular canal using laser for treatment the complex benign paroxysmal positional vertigo].}, journal = {Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery}, year = {2005}, volume = {40}, issue = {1}, pages = {77}, keywords = {Female; Humans; Laser Therapy, methods; Middle Aged; Semicircular Canals, surgery; Vertigo, etiology, surgery}, pmid = {15906534} }
Doménech Campos, E., Armengot Carceller, M. and Barona de Guzmán, R.	[Oculographic findings in 145 patients with benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2006	Acta otorrinolaringologica espanola Vol. 57(8), pp. 339-344	article
Abstract: Benign paroxysmal positional vertigo (BPPV) can be produced by specific manoeuvres and be studied by electrooculography (EOG). It allows an exhaustive study of features in the positional nystagmus. Although most of the patients with BPPV express typical nystagmus, there exists a group of them that exhibit a non typical form. In this work, a comparative study was carried out between two groups of patients. We have studied retrospectively 145 patients with BPPV and Dix-Hallpicke (D-H) positive manoeuvre registered by EOG techniques. All patients were explored in a complete EOG tests. Two groups were identified: typical response/atypical response according to the features of nystagmus response. Possible alterations in other EOG tests in each group were investigated and differences between both types of response were analyzed. 83.5% of cases showed typical nystagmus and atypical in the rest. Other EOG alterations observed in these patients, were (group typical response/atypical response): caloric hypofunction (17.3%/23%), positional nystagmus (12.4%/62.5%), alterations in visual-oculomotor function tests (10%/50%). Frequent alterations were observed in the classic manoeuvres and also in the rest of EOG tests. Probably atypical response in the first is due to or can explain the existence of the second.
BibTeX: @article{DomenechCampos2006a, author = {Doménech Campos, E and Armengot Carceller, M and Barona de Guzmán, R}, title = {[Oculographic findings in 145 patients with benign paroxysmal positional vertigo].}, journal = {Acta otorrinolaringologica espanola}, year = {2006}, volume = {57}, issue = {8}, pages = {339--344}, keywords = {Adult; Aged; Electrooculography; Female; Humans; Male; Middle Aged; Retrospective Studies; Vertigo, physiopathology}, pmid = {17117689} }
López Escámez, J.A., Molina, M.I., Zapata, C., Palma, M.J., Gómez Fiñana, M., Gámiz, M.J. and Fernández Pérez, A.	[Oculomotor response to the vertical cephalic autorotatory test in patients with benign paroxistic positional vertigo of the posterior canal]. [Abstract] [BibTeX]	2006	Acta otorrinolaringologica espanola Vol. 57(5), pp. 210-216	article
Abstract: To evaluate the eye movement response to the head auto-rotation test (HART) in the vertical plane in patients with benign paroxysmal positional vertigo. A transversal, descriptive study. SETTING UP: Outpatient clinic in a general Hospital. 34 posterior canal BPPV cases with a video-oculographic diagnosis, older than 18 years old, 7 of them were not able to perform the HART. HART was performed by a an electrooculographic system with simultaneous recording of head movement by an acelerometer in the vertical plane (Vorteq, Micromedical Instruments). The HART with eyes fixation was performed 3 times to determine its reliability. Gain, asymmetry and phase for the vertical VOR respectively. A statistical analysis was carried out to determine the test reliability and the number of individuals with an abnormal result. Gain is the only variable that showed a reproducible result in the HART for the active head movement at 1-2 Hz (test-retest reliability 0.83-0.89). The values of gain showed a moderate correlation at the frequencies 1-3 Hz (correlation 0.60-0.87). Asymmetry and phase were not reproducible variables (correlation < 0.55). Thirteen of 27 (48%) patients presented a decrease of the vertical gain, another 13 showed normal values and one case showed raised values. Gain is the only useful variable in the vertical HART. Forty-eight percent of patients with posterior canal BPPV have a reduced vertical gain, suggesting an impairment of inferior vestibular nerve function.
BibTeX: @article{LopezEscamez2006, author = {López Escámez, J A and Molina, M I and Zapata, C and Palma, M J and Gómez Fiñana, M and Gámiz, M J and Fernández Pérez, A}, title = {[Oculomotor response to the vertical cephalic autorotatory test in patients with benign paroxistic positional vertigo of the posterior canal].}, journal = {Acta otorrinolaringologica espanola}, year = {2006}, volume = {57}, issue = {5}, pages = {210--216}, keywords = {Adult; Aged; Aged, 80 and over; Cross-Sectional Studies; Eye Movements; Female; Head Movements; Humans; Male; Middle Aged; Vertigo, physiopathology}, pmid = {16768198} }
Walther, L.E. and Brusis, T.	[Of the expert office: expert evaluation of benign paroxysmal positional vertigo (BPPV) to current criteria]. [BibTeX]	2012	Laryngo- rhino- otologie Vol. 91(1), pp. 36-39	article	DOI
BibTeX: @article{Walther2012, author = {Walther, L E and Brusis, T}, title = {[Of the expert office: expert evaluation of benign paroxysmal positional vertigo (BPPV) to current criteria].}, journal = {Laryngo- rhino- otologie}, year = {2012}, volume = {91}, issue = {1}, pages = {36--39}, doi = {https://doi.org/10.1055/s-0031-1291365}, keywords = {Diagnosis, Differential; Disability Evaluation; Electronystagmography; Expert Testimony, legislation & jurisprudence; Humans; Recurrence; Reflex, Vestibulo-Ocular; Vertigo, diagnosis, etiology}, pmid = {22231966} }
Maurer, J., Ecke, U., Laemmers, B. and Mann, W.	[Orientational evaluation of otolith function by eye counter-rolling in patients with various kinds of vertigo]. [Abstract] [BibTeX]	1999	Laryngo- rhino- otologie Vol. 78(4), pp. 210-216	article	DOI
Abstract: Measurement of ocular counterrolling (OCR) is well known as a simple method to evaluate the peripheral vestibular organ, especially the otolith organ. But it has rarely been used because of the difficulty in differentiating between pathologically reduced OCR and the wide physiological variation of this parameter. In this study, the OCR of 55 patients with unclarified vertigo (n = 20), vestibular neuronitis (n = 15), Menière's disease (n = 10), and benign paroxysmal positional nystagmus (n = 10) were evaluated and compared to a control group (n = 30) with the intention of diagnosing peripheral vestibular dysfunction and establishing a differential diagnosis. The test sequence was carried out with Vesta goggles by Panares and included head tilts of 5 degrees, 15 degrees, and 30 degrees to the left and right. The results show a significantly reduced OCR in patients suffering from peripheral vestibular disorders when compared to the control group. There is no specific finding for a specific type of vestibular lesion, but otolith function is affected in several disorders as measured by ocular counterrolling.
BibTeX: @article{Maurer1999, author = {Maurer, J and Ecke, U and Laemmers, B and Mann, W}, title = {[Orientational evaluation of otolith function by eye counter-rolling in patients with various kinds of vertigo].}, journal = {Laryngo- rhino- otologie}, year = {1999}, volume = {78}, issue = {4}, pages = {210--216}, doi = {https://doi.org/10.1055/s-2007-996859}, keywords = {Adult; Aged; Diagnosis, Differential; Electronystagmography, instrumentation; Equipment Design; Female; Head Movements, physiology; Humans; Male; Meniere Disease, diagnosis, etiology, physiopathology; Middle Aged; Orientation, physiology; Otolithic Membrane, physiopathology; Reference Values; Reflex, Vestibulo-Ocular, physiology; Signal Processing, Computer-Assisted, instrumentation; Vestibular Function Tests, instrumentation; Vestibular Nerve, physiopathology}, pmid = {10407828} }
Walther, L.E.	[Otoconia : Current aspects of research]. [Abstract] [BibTeX]	2016	HNO Vol. 64(10), pp. 767-776	article	DOI
Abstract: Otoconia are calcite-based nanocomposites containing >90 % calcite and <10 % organic material. The mean size is approximately 10 µm. The external structure of all otoconia in the utricle and saccule is similar, with a cylindrical bulbous body with a slightly hexagonal contour. The internal structure consists of a composite with varying volume thickness, dense branching structures (branches) and less dense surrounding areas (bellies). Intact otoconia can be clearly identified only by scanning electron microscopy. In the case of morphological changes (e.g. due to "degeneration") the origin of even very small particles of otoconia can be assigned using physical and chemical analytical methods. The inorganic component of otoconia (calcite) is extremely sensitive to chemical influences, which leads to morphological alterations. A "degeneration" of otoconia can be objectively accomplished in vitro by alterations in pH, electrolyte imbalance and by the influence of complex formation. These three main processes then lead to irreversible morphological alterations. Artificial (biomimetic) otoconia serve as a suitable model system for detailed investigation of growth and degenerative processes.
BibTeX: @article{Walther2016, author = {Walther, L E}, title = {[Otoconia : Current aspects of research].}, journal = {HNO}, year = {2016}, volume = {64}, issue = {10}, pages = {767--776}, doi = {https://doi.org/10.1007/s00106-016-0234-7}, keywords = {Animals; Benign Paroxysmal Positional Vertigo, diagnostic imaging, pathology; Biomimetic Materials, chemistry; Humans; Otolithic Membrane, chemistry, ultrastructure; Inner ear; Otoconia; Saccule; Utricle; Vertigo}, pmid = {27590488} }
Krause, E., Gürkov, R. and Hempel, J.M.	[Otogenic (labyrinthine) vertigo--when the ear fails to keep us in equilibrium]. [Abstract] [BibTeX]	2007	MMW Fortschritte der Medizin Vol. 149(1-2), pp. 29-32; quiz 33	article
Abstract: The peripheral vestibular organ within the bony labyrinth of the inner ear is closely connected to the other parts of the equilibrium system. As a result of its constant active interaction with the other elements, it plays a major role in ensuring that we can maintain our balance. In the event of a disorder, otogenic vertigo can occur. Important evidence of a peripheral-vestibular disturbance is provided by the patient's history of dizziness, and confirmation of the suspected diagnosis is achieved by clinical and other appropriate examinations and tests. Common differential diagnoses include benign paroxysmal positional vertigo, Ménière's disease, and vestibular neuropathy. These can be readily differentiated by applying a systematic approach, and usually respond to treatment. In recent years, improved diagnostic tools have made it possible to test the functioning of the otolith organs, and this may lead to new therapeutic options in labyrinthine vertigo in the future.
BibTeX: @article{Krause2007, author = {Krause, Eike and Gürkov, Robert and Hempel, John Martin}, title = {[Otogenic (labyrinthine) vertigo--when the ear fails to keep us in equilibrium].}, journal = {MMW Fortschritte der Medizin}, year = {2007}, volume = {149}, issue = {1-2}, pages = {29--32; quiz 33}, keywords = {Diagnosis, Differential; Humans; Meniere Disease, diagnosis; Physical Therapy Modalities; Vertigo, etiology, therapy; Vestibular Function Tests; Vestibular Neuronitis, diagnosis}, pmid = {17632860} }
Casas-Limón, J., Ordás-Bandera, C.M., Matías-Guiu, J.A., Barahona-Hernando, R., Abarrategui-Yagüe, B., García-Ramos, R. and Porta-Etessam, J.	[Otosyphilis as the cause of skew deviation and benign paroxysmal positional vertigo]. [BibTeX]	2012	Revista de neurologia Vol. 55(1), pp. 62-64	article
BibTeX: @article{Casas-Limon2012, author = {Casas-Limón, Javier and Ordás-Bandera, Carlos M and Matías-Guiu, Jordi A and Barahona-Hernando, Raúl and Abarrategui-Yagüe, Belén and García-Ramos, Rocío and Porta-Etessam, Jesús}, title = {[Otosyphilis as the cause of skew deviation and benign paroxysmal positional vertigo].}, journal = {Revista de neurologia}, year = {2012}, volume = {55}, issue = {1}, pages = {62--64}, keywords = {Aged; Anti-Bacterial Agents, therapeutic use; Benign Paroxysmal Positional Vertigo; Cerebellar Neoplasms, diagnosis; Diagnosis, Differential; Diplopia, etiology; Hearing Loss, Sensorineural, etiology; Humans; Labyrinthitis, complications, diagnosis, drug therapy; Male; Neurosyphilis, complications, diagnosis, drug therapy; Ocular Motility Disorders, etiology; Penicillin G, therapeutic use; Stroke, diagnosis; Vertigo, etiology}, pmid = {22718411} }
Mike, A. and Tamás, T.L.	[Paradigm shift in management of patients with vertigo and imbalance]. [Abstract] [BibTeX]	2018	Ideggyogyaszati szemle Vol. 71(7-08), pp. 221-235	article	DOI
Abstract: Dizziness is one of the most common causes of medical visits. Management of the dizzy patient may be challenging both for the general practitioner, in emergency departments, and special clinics, as behind a seemingly homogeneous clinical presentation several very different etiologies may occur. Research of the last two century enriched our knowledge about physiology and pathophysiology of the vestibular system. Much knowledge is now available about the labyrinth being able to sense head motions and gravity, processing of afferent vestibular stimuli, reflectory oculomotor and postural control, or recovery of the vestibular system. Based on scientific results new beside tests have been introduced including provocation maneuvers for detecting ectopic otoliths in different semicircular canals, head impulse test to examine function of the vestibulo-ocular reflex, and the HINTS+ battery for differentiation of peripheral or central origin of an acute vestibular syndrome. Technical innovations like videooculography and vestibular evoked myogenic potentials enable us to selectively and side-specifically examine the function of all six semicircular canals and two otolith organs. Pathomechanism of disorders with vertigo and dizziness became more clear resulting in the development or amendment of diagnostic criteria of several vestibular disorders including vestibular migraine, Menière's disease, benign paroxysmal positional vertigo, persistent postural-perceptual dizziness, bilateral vestibulopathy. Broader knowledge about the pathomechanism promoted the development of new therapeutic methods like different repositioning maneuvers in benign paroxysmal positional vertigo, pharmaceutical therapies, vestibular rehabilitation, and psychotherapy. We aimed to summarize the novelties in the field of oto-neurology.
BibTeX: @article{Mike2018, author = {Mike, Andrea and Tamás, T László}, title = {[Paradigm shift in management of patients with vertigo and imbalance].}, journal = {Ideggyogyaszati szemle}, year = {2018}, volume = {71}, issue = {7-08}, pages = {221--235}, doi = {https://doi.org/10.18071/isz.71.0221}, keywords = {benign paroxysmal positional vertigo; head impulse test; stroke; vertigo; vestibulare migraine}, pmid = {30113791} }
Xing, G. and Bu, X.	[Particle repositioning maneuver for benign paroxysmal positional vertigo of posterior semicircular canal]. [Abstract] [BibTeX]	1999	Zhonghua er bi yan hou ke za zhi Vol. 34(3), pp. 163-165	article
Abstract: To determine the effectiveness of particle repositioning maneuver (PRM) for the treatment of benign paroxysmal positional vertigo (BPPV). Thirty one patients with BPPV of the posterior semicircular canal treated between July 1996 and June 1998 were retrospectively analyzed. Patients received a single treatment of PRM based on the hypothesis that the vertigo and nystagmus of BPPV were due to debris floating in the long arm of the posterior canal (canalithiasis). Treatment outcome was classified as cure (asymptomatic), improvement reduction of symptoms > 50%, or no change. After a single treatment of PRM, complete remission of vertigo and nystagmus were found in 67.7% of the patients and improvement of the symptoms was found in 19.4% of the patients. The total improvement rate was 87.1%. The particle repositioning maneuver was effective for most of the patients with benign paroxysmal positional vertigo and can be recommended as the first-line treatment modality.
BibTeX: @article{Xing1999, author = {Xing, G and Bu, X}, title = {[Particle repositioning maneuver for benign paroxysmal positional vertigo of posterior semicircular canal].}, journal = {Zhonghua er bi yan hou ke za zhi}, year = {1999}, volume = {34}, issue = {3}, pages = {163--165}, keywords = {Adult; Aged; Female; Follow-Up Studies; Gravitation; Humans; Male; Middle Aged; Physical Therapy Modalities, methods; Posture; Retrospective Studies; Rotation; Semicircular Canals; Vertigo, physiopathology, therapy; Vestibular Diseases, therapy}, pmid = {12764809} }
Chen, X., Lin, S.-L., Wu, Z.-M. and Zhang, R.	[Pathogenesis of benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2008	Zhongguo yi xue ke xue yuan xue bao. Acta Academiae Medicinae Sinicae Vol. 30(6), pp. 677-679	article
Abstract: To explore the etiological factors of benign paroxysmal positional vertigo (BP-PV). The clinical data of 145 patients with BPPV were retrospectively reviewed. The impacts of gender and age on BPPV were analyzed. The relationship between the onset of BPPV and the internal ear ischemia was also explored. The abnormality rate of auditory brainstem response (ABR) under high stimulus rate was 59.3% (86/145) in all the patients with, including 22.1% (32/145) in male and 37.2% (54/ 145) in female (P > 0.05). The abnormality rate of ABR under high stimulus rate were 37.9% (55/145) and 21.4% (31/145) in middle-aged (30-55 years) and old ( > 55 years) patients, respectively (P > 0.05). The onset of BPPV may relate to ischemic internal ear but is not relevant with gender and age.
BibTeX: @article{Chen2008, author = {Chen, Xi and Lin, Shao-Lian and Wu, Zi-Ming and Zhang, Rong}, title = {[Pathogenesis of benign paroxysmal positional vertigo].}, journal = {Zhongguo yi xue ke xue yuan xue bao. Acta Academiae Medicinae Sinicae}, year = {2008}, volume = {30}, issue = {6}, pages = {677--679}, keywords = {Adult; Age Factors; Age of Onset; Aged; Evoked Potentials, Auditory, Brain Stem; Female; Humans; Male; Middle Aged; Retrospective Studies; Time Factors; Vertigo, etiology, pathology, physiopathology; Young Adult}, pmid = {19180915} }
Ushio, K.	[Pathological localization of benign paroxysmal positional vertigo--from three-dimensional analysis of nystagmus]. [Abstract] [BibTeX]	1997	Nihon Jibiinkoka Gakkai kaiho Vol. 100(2), pp. 276-282	article
Abstract: Although it has been speculated that benign paroxysmal positional vertigo (BPPV) derives from the utricle or posterior semicircular canal, the origin of BPPV is still controversial. In this study, we investigated the role of the utricle and semicircular canals (especially the vertical semicircular canal) relative to BPPV by three-dimensional analysis, focusing on the horizontal, vertical, and torsional positions by applying our computerized eye movement analysis system. In 13 subjects who were diagnosed as having BPPV, we carried out the positioning nystagmus tests, and analyzed three components of nystagmus. By using a pendular rotation stimulus, we also measured three components of eye movement elicited from the vertical semicircular canals in 5 normal subjects and 2 subjects from whom acoustic tumors were removed by the translabyrinthine approach. We compared two components (vertical and torsional) of BPPV with those of eye movements elicited from the vertical semicircular canals. In BPPV, the slow phase velocity of the torsional component was greater than that of the vertical component. Conversely, the amplitude of the vertical component from the vertical semicircular canals was greater than that of the torsional component. From these results, by analyzing the vestibuloocular reflex of vertical semicircular canals, it is difficult to support the idea that the pathology of BPPV is located in the posterior semicircular canal alone.
BibTeX: @article{Ushio1997, author = {Ushio, K}, title = {[Pathological localization of benign paroxysmal positional vertigo--from three-dimensional analysis of nystagmus].}, journal = {Nihon Jibiinkoka Gakkai kaiho}, year = {1997}, volume = {100}, issue = {2}, pages = {276--282}, keywords = {Adult; Eye Movements; Female; Humans; Male; Middle Aged; Semicircular Canals, physiopathology; Vertigo, physiopathology}, pmid = {9071128} }
Schmidt, C.L.	[Pathophysiology of peripheral, paroxysmal benign position vertigo]. [Abstract] [BibTeX]	1985	Laryngologie, Rhinologie, Otologie Vol. 64(3), pp. 146-155	article
Abstract: Peripheral paroxysmal, benign positional vertigo is one of the most common peripheral vestibular disorders. According to the "cupulolithiasis hypothesis", it is assumed that inorganic material is attached to the cupula of the posterior vertical canal which renders this organ sensitive to gravitational forces rather than angular accelerations. Quantitative and well-controlled positioning manoeuvres, however, show that the characteristics of this kind of vertigo and the corresponding nystagmus cannot be explained by gravitation-dependent cupular reactions. It seems more probable that the typical symptoms are caused by disturbed utricular functions leading to disinhibited responses of the posterior vertical canal to adequate stimuli.
BibTeX: @article{Schmidt1985, author = {Schmidt, C L}, title = {[Pathophysiology of peripheral, paroxysmal benign position vertigo].}, journal = {Laryngologie, Rhinologie, Otologie}, year = {1985}, volume = {64}, issue = {3}, pages = {146--155}, keywords = {Adult; Ear, Inner, physiopathology; Gravitation; Humans; Meniere Disease, physiopathology; Middle Aged; Nystagmus, Physiologic; Otolithic Membrane, physiopathology; Otosclerosis, physiopathology; Postural Balance; Posture; Saccule and Utricle, physiopathology; Vestibule, Labyrinth, physiopathology}, pmid = {3872984} }
Pino Rivero, V., Rodríguez Carmona, M., Pardo Romero, G., Iglesias González, R.J. and del Castillo Beneyto, F.	[Peripheral vertiginous syndrome with osteocervical lytic pathology. Importance of the exploration and its differential diagnosis]. [Abstract] [BibTeX]	2007	Anales otorrinolaringologicos ibero-americanos Vol. 34(3), pp. 297-301	article
Abstract: We are reporting the case of a 52 years old male with a peripheral vertiginous syndrome which could have been diagnosed as a benign paroxysmal positional vertigo. In a craneocervical CT appeared an osteolytical lesion on C3 vertebral body. With this article we pretend to emphasize the importance of a complete exploration and the differential diagnosis in the peripheral vertiginous pathology.
BibTeX: @article{PinoRivero2007, author = {Pino Rivero, V and Rodríguez Carmona, M and Pardo Romero, G and Iglesias González, R J and del Castillo Beneyto, F}, title = {[Peripheral vertiginous syndrome with osteocervical lytic pathology. Importance of the exploration and its differential diagnosis].}, journal = {Anales otorrinolaringologicos ibero-americanos}, year = {2007}, volume = {34}, issue = {3}, pages = {297--301}, keywords = {Cervical Vertebrae, diagnostic imaging; Diagnosis, Differential; Humans; Male; Middle Aged; Osteolysis, complications, diagnosis, diagnostic imaging; Tomography, X-Ray Computed; Vertigo, diagnosis, etiology}, pmid = {17725174} }
Soto-Varela, A., Arán-González, I., López-Escámez, J.A., Morera-Pérez, C., Oliva-Domínguez, M., Pérez-Fernández, N., Pérez-Garrigues, H., Pérez-Vázquez, P., Rossi-Izquierdo, M. and Santos-Pérez, S.	[Peripheral vertigo classification of the Otoneurology Committee of the Spanish Otorhinolaryngology Society: diagnostic agreement and update (version 2-2011)]. [Abstract] [BibTeX]	2012	Acta otorrinolaringologica espanola Vol. 63(2), pp. 125-131	article	DOI
Abstract: In 2008, the Otoneurology committee of the SEORL-PCF published a classification of peripheral vertigo, based on clinical criteria. The objective of this study was to validate this classification through analysing the diagnostic agreement among several medical assessors. Seven medical assessors, all with clinical experience, from 6 different hospitals, participated in the study. One of them selected the clinical histories of 50 consecutive patients who had consulted as a result of balance disorders (24 men and 26 women) with an average age of 53.5 years. These clinical histories -without any information that would identify the patient, the diagnosis established and the treatment- were sent to another 6 assessors. Each of these investigators established their own diagnosis, trying to adjust it to the epigraphs of the classification. Of the 50 patients, there was substantial agreement as to the diagnosis (4 or more evaluators indicated the same one) in 31 cases (26 with a positive diagnosis and 5 with a negative one, which could not be included in any epigraph). The kappa index, which measures the level of accordance between 2 or more assessors, was 0.4198 (moderate level of agreement). Unanimity was achieved in only 7 cases (4 BPPV, 2 Ménière's disease and 1 vertigo associated with migraine). The current classification, with the criteria it includes, allows labelling with an acceptable consensus to only 62% of the patients. Therefore, a modification in the classification is proposed in relation with the probable BPPV epigraph, as well a revision of the entries for vertigo-migraine and vertigo associated with migraine.
BibTeX: @article{Soto-Varela2012a, author = {Soto-Varela, Andrés and Arán-González, Ismael and López-Escámez, José Antonio and Morera-Pérez, Constantino and Oliva-Domínguez, Manuel and Pérez-Fernández, Nicolás and Pérez-Garrigues, Herminio and Pérez-Vázquez, Paz and Rossi-Izquierdo, Marcos and Santos-Pérez, Sofía}, title = {[Peripheral vertigo classification of the Otoneurology Committee of the Spanish Otorhinolaryngology Society: diagnostic agreement and update (version 2-2011)].}, journal = {Acta otorrinolaringologica espanola}, year = {2012}, volume = {63}, issue = {2}, pages = {125--131}, doi = {https://doi.org/10.1016/j.otorri.2011.10.004}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Child; Consensus; Female; Humans; Male; Medical Records; Middle Aged; Observer Variation; Otolaryngology; Societies, Medical; Spain; Vertigo, classification, diagnosis, physiopathology; Young Adult}, pmid = {22169589} }
Morera, C., Pérez, H., Pérez, N., Soto, A. and de Otoneurología de la Sociedad Española de Otorrinolaringología, C.	[Peripheral vertigo classification. Consensus document. Otoneurology committee of the Spanish otorhinolaryngology society (2003-2006)]. [Abstract] [BibTeX]	2008	Acta otorrinolaringologica espanola Vol. 59(2), pp. 76-79	article
Abstract: There are many different vertigo classifications and different denominations are frequently used for the same clinical processes. The Otoneurology Committee of the Spanish Society for Otorhinolaryngology and Head and Neck Pathology proposes an eminently practical classification of peripheral vertigo to facilitate a common terminology that can be easily used by the general ENT practitioners. The methodology used has been by consensus within our Society and especially among the most outstanding work groups in the area of otoneurology in Spain. Initially vertigo is divided into single-episode vertigo and recurring attacks of vertigo, and these are then sub-divided into 2 groups, depending on whether or not hearing loss is present. Acute vertigo without hearing loss corresponds to vestibular neuritis and if it is associated with hearing loss, it is due to labyrinthitis of different aetiologies and cochleo-vestibular neuritis. Recurrent vertigos without hearing loss are classified as induced, either by posture (BPPV) or pressure (perilymphatic fistula), or as spontaneous, including migraine-associated vertigo, metabolic vertigo, childhood paroxysmal vertigo and vertigo of vascular causes (AITs, vertebral-basilar failure). Finally, recurrent vertigo with hearing loss includes Ménière's disease and others such as vertigo-migraine (with hearing loss), autoimmune pathology of the inner ear, syphilitic infection, and perilymphatic fistula (with hearing loss).
BibTeX: @article{Morera2008, author = {Morera, Constantino and Pérez, Herminio and Pérez, Nicolás and Soto, Andrés and Comisión de Otoneurología de la Sociedad Española de Otorrinolaringología}, title = {[Peripheral vertigo classification. Consensus document. Otoneurology committee of the Spanish otorhinolaryngology society (2003-2006)].}, journal = {Acta otorrinolaringologica espanola}, year = {2008}, volume = {59}, issue = {2}, pages = {76--79}, keywords = {Humans; Neurology, methods; Otolaryngology, methods; Societies, Medical; Spain; Vertigo, diagnosis, physiopathology}, pmid = {18341864} }
Ungureanu, L., Cozma, S., Rădulescu, L., Tomescu, C. and Mârţu, D.	[Peripheral vestibular syndrome intricated pathogenic issues. A case report]. [Abstract] [BibTeX]	2011	Revista medico-chirurgicala a Societatii de Medici si Naturalisti din Iasi Vol. 115(1), pp. 143-147	article
Abstract: Ménière's syndrome appears to be the final common pathway of the mechanisms the inner ear responds to almost any injury. Although the autoimmune disease seems to play a major role, exposure to intense noise can also be a trigger in the appearance and/or aggravation of the disease. The case of 41 years old musician with a history of ankylosing spondylitis, diagnosed with Ménière's syndrome 5 years ago, is presented. Recently the symptoms became more polymorphic, revealing the association between benign paroxysmal positional vertigo (BPPV), Ménière's syndrome and high frequency hearing loss in an autoimmune background. Besides general, neurological and ENT examination, the diagnostic workup comprised of tonal audiogram, brain stem auditory evoked potentials, computerized dynamic posturography and videonistagmography. The final diagnosis was acute noise trauma, Ménière's syndrome, left horizontal semicircular canal BPPV, bilateral sensorineural sudden aggravated hearing loss in high frequencies (above 9 kHz) and allegedly autoimmune inner ear disease. Treatment with an association of corticosteroids, vasodilators and vitamins combined with Vannucchi's maneuver were followed by a significant relief of the symptoms. Although no causal relationship was found between acoustic trauma and increased endolymphatic pressure, both literature data and the case presented show that intense and prolonged noise exposure may aggravate peripheral vestibular syndrome.
BibTeX: @article{Ungureanu2011, author = {Ungureanu, Loreta and Cozma, S and Rădulescu, Luminiţa and Tomescu, Cornelia and Mârţu, D}, title = {[Peripheral vestibular syndrome intricated pathogenic issues. A case report].}, journal = {Revista medico-chirurgicala a Societatii de Medici si Naturalisti din Iasi}, year = {2011}, volume = {115}, issue = {1}, pages = {143--147}, keywords = {Acoustic Impedance Tests; Adult; Autoimmunity; Drug Therapy, Combination; Evoked Potentials, Auditory, Brain Stem; Exercise; Glucocorticoids, therapeutic use; Hearing Loss, High-Frequency, diagnosis, immunology, physiopathology, therapy; Hearing Loss, Noise-Induced, diagnosis, immunology; Humans; Labyrinth Diseases, diagnosis, immunology; Male; Meniere Disease, diagnosis, immunology, pathology, physiopathology, therapy; Noise, adverse effects; Risk Factors; Spondylitis, Ankylosing, complications; Treatment Outcome; Vasodilator Agents, therapeutic use; Vitamins, therapeutic use}, pmid = {21688571} }
Strupp, M., Dieterich, M., Zwergal, A. and Brandt, T.	[Peripheral, central and functional vertigo syndromes]. [Abstract] [BibTeX]	2015	Der Nervenarzt Vol. 86(12), pp. 1573-84; quiz 1585-6	article	DOI
Abstract: Depending on the temporal course, three forms of vertigo syndrome can be differentiated: 1) vertigo attacks, e.g. benign paroxysmal positional vertigo (BPPV), Menière's disease and vestibular migraine, 2) acute spontaneous vertigo lasting for days, e.g. acute unilateral vestibulopathy, brainstem or cerebellar infarction and 3) symptoms lasting for months or years, e.g. bilateral vestibulopathy and functional vertigo. The specific therapy of the various syndromes is based on three principles: 1) physical treatment with liberatory maneuvers for BPPV and balance training for vestibular deficits, 2) pharmacotherapy, e.g. for acute unilateral vestibulopathy (corticosteroids) and Menière's disease (transtympanic administration of gentamicin or steroids and high-dose betahistine therapy); placebo-controlled pharmacotherapy studies are currently being carried out for acute unilateral vestibulopathy, vestibular paroxysmia, prophylaxis of BPPV, vestibular migraine, episodic ataxia type 2 and cerebellar ataxia; 3) psychotherapy for functional dizziness.
BibTeX: @article{Strupp2015, author = {Strupp, M and Dieterich, M and Zwergal, A and Brandt, T}, title = {[Peripheral, central and functional vertigo syndromes].}, journal = {Der Nervenarzt}, year = {2015}, volume = {86}, issue = {12}, pages = {1573--84; quiz 1585-6}, doi = {https://doi.org/10.1007/s00115-015-4425-3}, keywords = {Anti-Inflammatory Agents, administration & dosage; Combined Modality Therapy, methods; Evidence-Based Medicine; Humans; Physical Therapy Modalities; Psychotherapy, methods; Treatment Outcome; Vertigo, diagnosis, therapy; Acute unilateral vestibulopathy; Benign paroxysmal positional vertigo; Bilateral vestibulopathy; Menière’s disease; Vestibular paroxysmia}, pmid = {26643594} }
Schaaf, H. and Hesse, G.	[Persistent otolith dysfunction in benign paroxysmal positional vertigo and polyneuropathy]. [BibTeX]	2012	Laryngo- rhino- otologie Vol. 91(10), pp. 641-643	article	DOI
BibTeX: @article{Schaaf2012, author = {Schaaf, H and Hesse, G}, title = {[Persistent otolith dysfunction in benign paroxysmal positional vertigo and polyneuropathy].}, journal = {Laryngo- rhino- otologie}, year = {2012}, volume = {91}, issue = {10}, pages = {641--643}, doi = {https://doi.org/10.1055/s-0032-1321868}, keywords = {Benign Paroxysmal Positional Vertigo; Caloric Tests; Combined Modality Therapy; Cooperative Behavior; Electronystagmography; Female; Humans; Interdisciplinary Communication; Middle Aged; Neurofeedback; Otolithic Membrane, physiopathology; Patient Education as Topic; Polyneuropathies, diagnosis, physiopathology; Postural Balance, physiology; Reflex, Vestibulo-Ocular, physiology; Vertigo, diagnosis, physiopathology}, pmid = {22907650} }
Esin, R.G., Khairullin, I.K., Mukhametova, E.R. and Esin, O.R.	[Persistent postural-perceptual dizziness]. [Abstract] [BibTeX]	2017	Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova Vol. 117(4), pp. 28-33	article	DOI
Abstract: To study persistent postural perceptual dizziness (PPPD) in outpatients with benign paroxysmal positional vertigo (BPPV) and patients with presbiataxia (PAt). Eighty-four patients with PPPD, including 14 with Meniere's disease (MD), 19 with BPPV, 17 with a history of ischemic stroke (IS) in the vertebrobasilar system and 34 with Pat, were examined. For the diagnosis of anxiety, the original 15-point questionnaire with the Likert Scale structure was used. Patients received anvifen (aminophenylbutyric acid hydrochloride) in dose of 250 mg 3 times a day for 6 weeks. Results and сonclusion. The most common trigger of PPPD was sleep deprivation. The highest level of anxiety was identified in the PAt group (19,5±2,89). There was a good effect of the drug: it reduced anxiety in all patients studied. The quality of sleep was improved as well. The authors recommend anvifen as the drug of choice in patients with PPPD during vestibular rehabilitation and cognitive-behavioral therapy.
BibTeX: @article{Esin2017, author = {Esin, R G and Khairullin, I Kh and Mukhametova, E R and Esin, O R}, title = {[Persistent postural-perceptual dizziness].}, journal = {Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova}, year = {2017}, volume = {117}, issue = {4}, pages = {28--33}, doi = {https://doi.org/10.17116/jnevro20171174128-33}, keywords = {aminophenylbutyric acid hydrochloride; anvifen; anxiety; dizziness; persistent postural perceptual dizziness}, pmid = {28617375} }
Feil, K., Böttcher, N., Kremmyda, O., Muth, C., Teufel, J., Zwergal, A., Brandt, T. and Strupp, M.	[Pharmacotherapy of Vestibular Disorders, Nystagmus and Cerebellar Disorders]. [Abstract] [BibTeX]	2015	Fortschritte der Neurologie-Psychiatrie Vol. 83(9), pp. 490-498	article	DOI
Abstract: There are currently different groups of drugs for the pharmacotherapy of vertigo, nystagmus and cerebellar disorders: antiemetics; anti-inflammatories, antimenieres, and antimigraineous medications and antidepressants, anticonvulsants, aminopyridines as well as acetyl-DL-leucine. In acute unilateral vestibulopathy, corticosteroids improve the recovery of peripheral vestibular function, but currently there is not sufficient evidence for a general recommendation. There is insufficient evidence to support the view that 16 mg t. i. d. or 48 mg t. i. d. betahistine has an effect in Menière's disease. Therefore, higher dosages are recommended. In animal studies, it was shown that betahistine increases cochlear blood flow. In vestibular paroxysmia, oxcarbazepine was effective (one randomized controlled trial (RCT)). Aminopyridines are recommended for the treatment of downbeat nystagmus (two RCTs) and episodic ataxia type 2 (EA2, one RCT). There has been no RCT on the efficacy of beta-blockers or topiramate but one RCT on flunarizine in vestibular migraine. Based on clinical experience, a treatment analogous to that for migraine without aura can be recommended. Acetyl-DL-leucine improved cerebellar ataxia (two observational studies); it also accelerated central compensation in an animal model of acute unilateral lesion, but RCTs were negative. There are ongoing RCTs on treatment of vestibular paroxysmia with carbamazepine (VESPA), acute unilateral vestibulopathy with betahistine (BETAVEST), vestibular migraine with metoprolol (PROVEMIG), benign paroxysmal positional vertigo with vitamin D (VitD@BPPV), EA2 with 4-aminopyridine versus acetazolamide (EAT-2-TREAT), and cerebellar ataxias with acetyl-DL-leucine (ALCAT).
BibTeX: @article{Feil2015, author = {Feil, K and Böttcher, N and Kremmyda, O and Muth, C and Teufel, J and Zwergal, A and Brandt, T and Strupp, M}, title = {[Pharmacotherapy of Vestibular Disorders, Nystagmus and Cerebellar Disorders].}, journal = {Fortschritte der Neurologie-Psychiatrie}, year = {2015}, volume = {83}, issue = {9}, pages = {490--498}, doi = {https://doi.org/10.1055/s-0035-1553667}, keywords = {Animals; Cerebellar Diseases, drug therapy; Humans; Nystagmus, Pathologic, drug therapy; Vestibular Diseases, drug therapy}, pmid = {26421856} }
Feil, K., Böttcher, N., Kremmyda, O., Muth, C., Teufel, J., Zwergal, A., Brandt, T. and Strupp, M.	[Pharmacotherapy of Vestibular Disorders, Nystagmus and Cerebellar Disorders]. [Abstract] [BibTeX]	2018	Laryngo- rhino- otologie Vol. 97(1), pp. 14-23	article	DOI
Abstract: There are currently different groups of drugs for the pharmacotherapy of vertigo, nystagmus and cerebellar disorders: antiemetics; anti-inflammatories, antimenieres, and antimigraineous medications and antidepressants, anticonvulsants, aminopyridines as well as acetyl-DL-leucine. In acute unilateral vestibulopathy, corticosteroids improve the recovery of peripheral vestibular function, but currently there is not sufficient evidence for a general recommendation. There is insufficient evidence to support the view that 16 mg t. i. d. or 48 mg t. i. d. betahistine has an effect in Menière's disease. Therefore, higher dosages are recommended. In animal studies, it was shown that betahistine increases cochlear blood flow. In vestibular paroxysmia, oxcarbazepine was effective (one randomized controlled trial (RCT)). Aminopyridines are recommended for the treatment of downbeat nystagmus (two RCTs) and episodic ataxia type 2 (EA2, one RCT). There has been no RCT on the efficacy of beta-blockers or topiramate but one RCT on flunarizine in vestibular migraine. Based on clinical experience, a treatment analogous to that for migraine without aura can be recommended. Acetyl-DL-leucine improved cerebellar ataxia (two observational studies); it also accelerated central compensation in an animal model of acute unilateral lesion, but RCTs were negative. There are ongoing RCTs on treatment of vestibular paroxysmia with carbamazepine (VESPA), acute unilateral vestibulopathy with betahistine (BETAVEST), vestibular migraine with metoprolol (PROVEMIG), benign paroxysmal positional vertigo with vitamin D (VitD@BPPV), EA2 with 4-aminopyridine versus acetazolamide (EAT-2-TREAT), and cerebellar ataxias with acetyl-DL-leucine (ALCAT).
BibTeX: @article{Feil2018a, author = {Feil, K and Böttcher, N and Kremmyda, O and Muth, C and Teufel, J and Zwergal, A and Brandt, T and Strupp, M}, title = {[Pharmacotherapy of Vestibular Disorders, Nystagmus and Cerebellar Disorders].}, journal = {Laryngo- rhino- otologie}, year = {2018}, volume = {97}, issue = {1}, pages = {14--23}, doi = {https://doi.org/10.1055/s-0043-123487}, pmid = {29301160} }
Gordon, C.R., Zur, O., Furas, R., Kott, E. and Gadoth, N.	[Pitfalls in the diagnosis of benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2000	Harefuah Vol. 138(12), pp. 1024-7, 1087	article
Abstract: Benign paroxysmal positional vertigo (BPPV) is a common but often unrecognized cause of treatable vertigo. Possible causes of misdiagnosis of BPPV were studied by review of the records of 191 patients referred to our neurology clinic; 36 were identified as having BPPV not previously diagnosed. On referral the patients carried the following diagnoses: unspecified dizziness/vertigo (33%), transient ischemic attacks (28%), cervicogenic vertigo (19%), psychogenic dizziness/vertigo (11%), and others (8%). The paroxysmal nature of the vertigo and position-precipitating factors were not spontaneously reported by 31%. Atypical, even bizarre, symptoms including dizzy sensations were reported by 19%, and neck pain and headache were cardinal symptoms that accompanied vertigo. The Dix-Hallpike maneuver, which is essential for the diagnosis of BPPV, was not performed in any of the patients prior to referral. 30 (83%) experienced complete resolution of signs and symptoms after the first physical treatment session. We conclude that non-paroxysmal, non-positional vertigo does not rule out BPPV. Atypical and even bizarre complaints of dizziness, as well as neck pain and headache could be cardinal symptoms of BPPV. The Dix-Hallpike maneuver is mandatory in those complaining of dizziness and vertigo.
BibTeX: @article{Gordon2000, author = {Gordon, C R and Zur, O and Furas, R and Kott, E and Gadoth, N}, title = {[Pitfalls in the diagnosis of benign paroxysmal positional vertigo].}, journal = {Harefuah}, year = {2000}, volume = {138}, issue = {12}, pages = {1024--7, 1087}, keywords = {Adult; Aged; Aged, 80 and over; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Posture; Vertigo, diagnosis, etiology, physiopathology}, pmid = {10979424} }
BELLO, J.A., BOFFI, A. and FRIDMAN, L.	[Positional vertigo of the benign paroxysmal type. Changes of Fitzgerald's and Hallpike's caloric test]. [BibTeX]	1963	Practica oto-rhino-laryngologica Vol. 25, pp. 3-14	article
BibTeX: @article{BELLO1963, author = {BELLO, J A and BOFFI, A and FRIDMAN, L}, title = {[Positional vertigo of the benign paroxysmal type. Changes of Fitzgerald's and Hallpike's caloric test].}, journal = {Practica oto-rhino-laryngologica}, year = {1963}, volume = {25}, pages = {3--14}, keywords = {Caloric Tests; Humans; Vertigo; VERTIGO}, pmid = {13967157} }
Trinidad Ruiz, G., Pons García, M.A., Trinidad Ruiz, G., Pantoja Hernández, C., Mora Santos, E. and Blasco Huelva, A.	[Positional vertigo. Symptom, clinical sign, or disease?]. [Abstract] [BibTeX]	2008	Acta otorrinolaringologica espanola Vol. 59(1), pp. 21-29	article
Abstract: We present a prospective study with the aim of assessing the differences found between position-triggered vertiginous syndromes, those diagnosed as benign paroxysmal positional vertigos (BPPV) in primary care and non-specific clinics, and those classified as BPPV at an otoneurology unit. Over a 17 month period, 432 consecutive patients were included after evaluation at a otoneurology unit receiving all referrals for vestibular pathologies. The existence of trigger factors was investigated, as was the distribution of the diagnoses associated with a positional trigger. The characteristics of the patients with a final diagnosis of BPPV were also studied. Of this population, 217 patients (50.23%) reported a positional change as the trigger for their symptoms, 106 (24.53%) were referred from their initial care centres with a diagnosis of BPPV, and 128 (29.62%) were classified as truly BPPV. The coincidence between the preliminary diagnosis and the definitive one was 52.8%. A history of positional paroxysmal vertigo during seconds was linked to BPPV in 78% of cases. Only in 4.7% of the BPPV cases diagnosed at the otoneurology unit had provoking manoeuvres been performed. We have found that an adequate anamnesis is capable of providing accurate guidance for diagnostic purposes in most cases of BPPV, but the performance of provoking manoeuvres and the correct specific treatment for this pathology is of paramount importance when classifying a patient with suspected BPPV.
BibTeX: @article{TrinidadRuiz2008, author = {Trinidad Ruiz, Gabriel and Pons García, María Asunción and Trinidad Ruiz, Germán and Pantoja Hernández, Carlos and Mora Santos, Elena and Blasco Huelva, Antonio}, title = {[Positional vertigo. Symptom, clinical sign, or disease?].}, journal = {Acta otorrinolaringologica espanola}, year = {2008}, volume = {59}, issue = {1}, pages = {21--29}, keywords = {Diagnosis, Differential; Female; Humans; Male; Middle Aged; Prospective Studies; Risk Factors; Vertigo, diagnosis, etiology, physiopathology}, pmid = {18215386} }
Wang, N., Chen, T., Lin, P., Song, W. and Dong, H.	[Positioning diagnosis of benign positional paroxysmal vertigo by VNG]. [Abstract] [BibTeX]	2009	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 23(13), pp. 597-600	article
Abstract: To analyze the value of positioning diagnosis of VNG (Videonystagmograph) in patients with benign paroxysmal positional vertigo (BPPV). One hundred and twenty-six patients with BPPV were enrolled in this retrospective study. Their positional nystagmus recorded by VNG in Dix-Hallpike and roll tests were analyzed to summarize the characteristics of nystagmus on nystagmography of various BPPV. Of 126 patients with BPPV diagnosed in our center, the posterior semicircular canals (PSC) were involved in 98 patients (77.8%), whereas the horizontal semicircular canal (HSC) and anterior semicircular canal (ASC) were involved in 17 (13.5%) and 5 (3.9%), respectively. Six patients (4.8%) confirmed combined-BPPV had HSC-BPPV and ipsilateral PSC-BPPV. Twenty-eight patients with PSC-BPPV had reversal phase on nystagmography. The nystagmus of patients with P/ASC-canalithiasis showed upward/downward on the vertical phase of nystagmography and orientated the opposite side on horizontal phase in the head hanging position, and the nystagmus reversed when returned to sit. Nystagmus on horizontal phase could be provoked when the head turned to both sides of the roll tests in patients with HSC-BPPV. If the nystagmus and the head-turning shared the same direction, then HSC-canalithiasis was confirmed, and the direction of the head-turning which provoked the stronger nystagmus indicates the lesion side. If the nystagmus and the head-turning had the opposite direction, then HSC-cupulolithiasis was confirmed, and the direction of the head-turning which provoked the weaker nystagmus indicates the lesion side. Positional nystagmus can be recorded objectively using VNG, According to which positioning the semicircular canal involved would be easier and more accurate. The recording conserved also could be helpful for clinical diagnosis and repositioning of BPPV.
BibTeX: @article{Wang2009, author = {Wang, Na and Chen, Taisheng and Lin, Peng and Song, Wei and Dong, Hong}, title = {[Positioning diagnosis of benign positional paroxysmal vertigo by VNG].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2009}, volume = {23}, issue = {13}, pages = {597--600}, keywords = {Adolescent; Adult; Aged; Electronystagmography; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, diagnosis, etiology, physiopathology; Otolithic Membrane; Retrospective Studies; Semicircular Canals; Vertigo, diagnosis, physiopathology; Vestibular Function Tests; Young Adult}, pmid = {19894495} }
Liu, J., Gu, J., Yin, S. and Sun, L.	[Posterior semicircular canal occlusion with microwave assisted technique in guinea pigs]. [Abstract] [BibTeX]	2001	Lin chuang er bi yan hou ke za zhi = Journal of clinical otorhinolaryngology Vol. 15(1), pp. 28-30	article
Abstract: To study the effectiveness of posterior semicircular canal occlusion with microwave assisted technique. Posterior semicircular canal occlusion with microwave assisted technique was performed in 20 guinea pigs. Electronystagmography (ENG) and auditory brainstem response (ABR) were recorded preoperatively and postoperatively. Morphological changes were observed under light microscopy. Left and right nystagmus returned symmetrical on the 3rd postoperative day. Two ears showed normal symmetrical nystagmus to icc-water stimulation on preoperation and the 30th postoperative day. There were no significant changes of the thresholds of ABR before and after surgery. Histopathological findings revealed that posterior semicircular canal was completely occluded, and that Organ of Corti and crista ampullaris were normal. Posterior semicircular occlusion with microwave technique is suggested as an effective and safe treatment for the benign paroxysmal positional vertigo.
BibTeX: @article{Liu2001, author = {Liu, J and Gu, J and Yin, S and Sun, L}, title = {[Posterior semicircular canal occlusion with microwave assisted technique in guinea pigs].}, journal = {Lin chuang er bi yan hou ke za zhi = Journal of clinical otorhinolaryngology}, year = {2001}, volume = {15}, issue = {1}, pages = {28--30}, keywords = {Animals; Electronystagmography; Evoked Potentials, Auditory, Brain Stem; Guinea Pigs; Labyrinth Diseases, physiopathology, surgery; Male; Microwaves, therapeutic use; Semicircular Canals, surgery; Vertigo, surgery}, pmid = {12541881} }
Guo, X., Ye, F., Zhang, Z., Li, Y. and Yang, X.	[Posttraumatic benign paroxysmal positional vertigo: analysis of 23 cases]. [Abstract] [BibTeX]	2010	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 24(16), pp. 738-9, 742	article
Abstract: To compare the clinical presentation and outcome between patients with traumatic-BPPV (t-BPPV) and idiopathic-BBPV(i-BPPV). The clinical records of 186 patients with posterior canal BPPV were reviewed retrospectively. All patients were diagnosed using the Dix-Hallpike test and treated with the canalith repositioning procedure. The outcome of patients with t-BPPV was compared with patients with i-BPPV. Twenty-three of 186 patients with BPPV fulfilled the diagnostic criteria for t-BPPV. Women were affected i-BBPV more often than men (2.3:1), and women and men were equally affected t-BBPV (1:1). After one physical treatment, 34.8% of patients with t-BPPV had complete resolution of signs and symptoms in comparison to 85.3% of patients with i-BPPV (P < 0.05). During the 2-year follow-up, 56.5% of t-BPPV patients and 19.0% of i-BPPV patients had recurrent attacks (P < 0.05). The nature and severity of the traumas causing t-BPPV are diverse. It appears that t-BPPV is more difficult to treat than i-BPPV, and also has a greater tendency to recur.
BibTeX: @article{Guo2010, author = {Guo, Xiangdong and Ye, Fanglei and Zhang, Zhicheng and Li, Ying and Yang, Xiao}, title = {[Posttraumatic benign paroxysmal positional vertigo: analysis of 23 cases].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2010}, volume = {24}, issue = {16}, pages = {738--9, 742}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Female; Humans; Male; Middle Aged; Prognosis; Retrospective Studies; Vertigo, diagnosis, etiology; Young Adult}, pmid = {21033100} }
Oliva Domínguez, M., Bartual Magro, J., Dañino González, J.L., Dañino González, G., Roquette Gaona, J. and Bartual Pastor, J.	[Postural control related to age in patients with benign positional paroxysmal vertigo]. [Abstract] [BibTeX]	2005	Acta otorrinolaringologica espanola Vol. 56(8), pp. 354-360	article
Abstract: To study the relationship between age and posturography in patients with benign positional paroxysmal vertigo. Prospective study performed in 65 patients with benign positional paroxysmal vertigo (BPPV) in any variant. Sensory Organization Test outcomes were recorded and compared with their equivalents in a control group by means of scatter-plot diagrams and regression line. For statistical study, Mann-Whitney's U-test was used. Slope for regression lines in composite was -0.0934 in group NORMAL; in group BPPV it was -0.4284. This difference is due to conditions 5 and 6. Results were statistically significative. BPPV patients have a worse postural control than control group. The difference is bigger the older the patient is. It is due to a failure in conditions 5 and 6, so it should be from a vestibular origin.
BibTeX: @article{OlivaDominguez2005a, author = {Oliva Domínguez, M and Bartual Magro, J and Dañino González, J L and Dañino González, G and Roquette Gaona, J and Bartual Pastor, J}, title = {[Postural control related to age in patients with benign positional paroxysmal vertigo].}, journal = {Acta otorrinolaringologica espanola}, year = {2005}, volume = {56}, issue = {8}, pages = {354--360}, keywords = {Adult; Age Factors; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Posture; Prospective Studies; Severity of Illness Index; Vertigo, diagnosis, physiopathology}, pmid = {16285434} }
Alessandrini, M., Giacomini, P., Sorace, F. and Bruno, E.	[Postural stabilization after otolithic repositioning for posterior semicircular canal canalization]. [Abstract] [BibTeX]	1998	Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale Vol. 18(6), pp. 368-372	article
Abstract: Today the canal/cupulolithiasic pathogenesis of benign paroxysmal positional vertigo (BPPV) appears well defined; what is less clear is the origin of the postural "instability" often associated with rotatory vertigo. This form is less marked but still resists all know treatments. The purpose of the present study was to determine the actual postural arrangement of subjects suffering from canalolithiasis (CL) of the posterior semicircular canal (PSC) both before and after the positioning maneuver. In this case a personal method of spectral frequency analysis was used in an attempt to clarify the origin of the residual "instability" following otolithic repositioning. Static posturographic testing was performed on 20 patients with CL of the PSC and another 20 normal subjects of comparable age. In the present study the repositioning maneuver leads to a reduction in latero-lateral oscillation without any anterior-posterior variation. Such stabilization covers all the frequencies if a visual input is also present while it is limited to the lower frequencies when the visual content is lacking. In fact, in the latter case the subject maintains his posture using only vestibular and proprioceptive input. On the other hand, the anterior-posterior oscillations increase in all frequency ranges and this increase remains essentially unchanged after the repositioning maneuver. The authors feel that the anterior-posterior destabilization seen in CL of the PSC may stem from a proprioceptive-macular alteration linked to otolitic detachment rather than abnormal ampullar stimulation. The persistence and residual postural alterations found could, therefore, explain the persistent sense of instability that CL patients often complain of, even after the maneuvers which have encountered such success in controlling BPPV.
BibTeX: @article{Alessandrini1998, author = {Alessandrini, M and Giacomini, P and Sorace, F and Bruno, E}, title = {[Postural stabilization after otolithic repositioning for posterior semicircular canal canalization].}, journal = {Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale}, year = {1998}, volume = {18}, issue = {6}, pages = {368--372}, keywords = {Adult; Female; Humans; Lithiasis, complications, pathology; Male; Otolithic Membrane, physiology; Posture; Semicircular Canals, pathology; Vertigo, etiology, therapy}, pmid = {10388149} }
López-Escámez, J.A.	[Practical approach to recurrent benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2008	Acta otorrinolaringologica espanola Vol. 59(8), pp. 413-419	article
Abstract: Benign paroxysmal positional vertigo is the most common vestibular disorder and it has a significant impact on health-related quality of life. The disease is probably caused by the accumulation of lithiasis material from the otolithic membrane of the utricle. Patients experience multiple short vertigo crises lasting seconds when they go to bed or turn over. There are several clinical variants affecting posterior, horizontal or anterior canals and in some cases vestibular lithiasis can occur in two canals simultaneously. Diagnosis is by video-oculographic recording of positional nystagmus during positional tests to identify the canal affected. There are specific treatment manoeuvres for each clinical variant, which a high degree of short-term effectiveness.
BibTeX: @article{Lopez-Escamez2008, author = {López-Escámez, José A}, title = {[Practical approach to recurrent benign paroxysmal positional vertigo].}, journal = {Acta otorrinolaringologica espanola}, year = {2008}, volume = {59}, issue = {8}, pages = {413--419}, keywords = {Humans; Otolaryngology, methods; Recurrence; Vertigo, epidemiology, physiopathology, therapy}, pmid = {18928678} }
Huang, A., Gu, D., Wang, X., Cao, X. and Yuan, X.	[Primary benign paroxysmal positional vertigo vestibular detection of evoked myogenic potential significance]. [Abstract] [BibTeX]	2014	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 28(16), pp. 1215-1218	article
Abstract: To analyze the clinical significance of ocular vestibular evoked myogenic potentials (oVEMP) and cervical vestibular evoked myogenic potentials (cVEMP) in primary unilateral benign paroxysmal positional vertigo (BPPV). Fifty-two patients with unilateral primary BPPV (BPPV group) and 38 normal subjects (control group) received ocular vestibular evoked myogenic potential (oVEMP) and cervical vestibular evoked myogenic potential (cVEMP) test using tone burst stimuli. The response rate, latency and amplitude were analyzed. In BPPV group, the response rate of oVEMP was 46.15% in lesioned side and 48.08% in healthy side, respectively. The response rate of cVEMP was 67.31% in lesioned side and 65.38% in healthy side, respectively. In control group, the response rate on the left ear was 84.21% for oVEMP and 92.11% for cVEMP. On the right ear, was 81.58% for oVEMP and 94.74% for cVEMP in control group, there was no significant difference in cVEMP and oVEMP P1, N1 N1-P1 latency and amplitude between left and right ear. The interaural amplitude ratio and asymmetry of cVEMP and oVEMP was significantly different between BPPV group and control group (P<0.05). Unilateral primary BPPV with bilateral impaired vestibular otolith pathways function can be objectively evaluated by oVEMP and cVEMP detection. Abnormal oVEMP responses were more frequently detected than cVEMP.
BibTeX: @article{Huang2014, author = {Huang, Aiping and Gu, Dongsheng and Wang, Xiaojiao and Cao, Xiaoping and Yuan, Xunyi}, title = {[Primary benign paroxysmal positional vertigo vestibular detection of evoked myogenic potential significance].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2014}, volume = {28}, issue = {16}, pages = {1215--1218}, keywords = {Adult; Benign Paroxysmal Positional Vertigo, physiopathology; Case-Control Studies; Female; Humans; Male; Middle Aged; Prospective Studies; Vestibular Evoked Myogenic Potentials, physiology; Young Adult}, pmid = {25464560} }
Wei, X.	[Progress in diagnosis and treatment of benign paroxysmal positional vertigo]. [BibTeX]	2016	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 30(5), pp. 345-348	article
BibTeX: @article{Wei2016, author = {Wei, Xudong}, title = {[Progress in diagnosis and treatment of benign paroxysmal positional vertigo].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2016}, volume = {30}, issue = {5}, pages = {345--348}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis, therapy; Humans}, pmid = {27382671} }
Morgenstern, C. and Greven, C.	[Rare complications following stapes operation and their surgical treatment]. [Abstract] [BibTeX]	1986	HNO Vol. 34(8), pp. 325-326	article
Abstract: After stapedectomy otoliths were displaced from the endolymphatic space to the cupula of the posterior semicircular canal and caused a paroxysmal benign positional nystagmus which lasted 18 months. The positional nystagmus demonstrated a rotatory component during the Hallpike manoeuvre. The paroxysmal benign nystagmus disappeared after transtympanic nerve neurectomy of the inferior branch of the vestibular nerve (Gacek 1974). This procedure is only recommended for vertigo lasting longer than 1 year. The current findings support the theory that cupulolithiasis is the cause of paroxysmal benign positional nystagmus which can occur after stapedectomy. The rotatory nystagmus is generated in the posterior semicircular canal.
BibTeX: @article{Morgenstern1986, author = {Morgenstern, C and Greven, C}, title = {[Rare complications following stapes operation and their surgical treatment].}, journal = {HNO}, year = {1986}, volume = {34}, issue = {8}, pages = {325--326}, keywords = {Female; Humans; Meniere Disease, surgery; Middle Aged; Nystagmus, Pathologic, surgery; Otosclerosis, surgery; Postoperative Complications, surgery; Reoperation; Stapes Surgery; Vestibular Function Tests; Vestibular Nerve, surgery}, pmid = {3759514} }
Suzuki, M.	[Recent advancement of BPPV management]. [Abstract] [BibTeX]	2011	Rinsho shinkeigaku = Clinical neurology Vol. 51(11), pp. 1089-1091	article
Abstract: Benign paroxysmal positional vertigo (BPPV) is a common vestibular disorder. The recent development of diagnostic tools allowed clarification of its pathology. Dislodgement of the utricular otoconia is the basis of BPPV which leads to development of canalolithiasis or cupulolithiasis. Positional nystagmus test is a most essential bed side test. BPPV may involve multiple canals and utricle, thus showing complicated nystagmus pattern. Understanding the physiology of semicircular canals and vestibuloocular reflex allows proper diagnosis of a lesion side and types of BPPV. Based upon the basic and clinical findings, a lesion-specific physical therapy had been developed which turned out to be very effective. Nystagmus pattern can also be an index of the treatment outcome.
BibTeX: @article{Suzuki2011, author = {Suzuki, Mamoru}, title = {[Recent advancement of BPPV management].}, journal = {Rinsho shinkeigaku = Clinical neurology}, year = {2011}, volume = {51}, issue = {11}, pages = {1089--1091}, keywords = {Benign Paroxysmal Positional Vertigo; Humans; Vertigo, diagnosis, therapy}, pmid = {22277490} }
Blödow, A., Bloching, M., Hörmann, K. and Walther, L.E.	[Receptor function of the semicircular canals. Part 2: pathophysiology, diseases, clinical findings and treatment aspects]. [Abstract] [BibTeX]	2012	HNO Vol. 60(3), pp. 249-59; quiz 260-1	article	DOI
Abstract: Perturbation of semicircular canal function may result in a pathological angular vestibulo-ocular reflex (aVOR). The resulting impairment in gaze stabilization is perceived as "vertigo" or "dizziness" and may occur following receptor function impairment of all three semicircular canals. The head impulse test reveals hidden (covert-catchup) or visible (overt-catchup) saccades in disturbances of semicircular function. Most peripheral vestibular disorders can be treated conservatively. There are surgical treatment options for some diseases, such as intractable benign paroxysmal positional vertigo and superior semicircular canal dehiscence. Vestibular training promotes central reorganization of the VOR. Impaired semicircular receptor function, in particular bilateral vestibulopathy, may affect spatial orientation and cognitive processes. Balance prostheses could serve as a replacement for receptors in the future.
BibTeX: @article{Bloedow2012, author = {Blödow, A and Bloching, M and Hörmann, K and Walther, L E}, title = {[Receptor function of the semicircular canals. Part 2: pathophysiology, diseases, clinical findings and treatment aspects].}, journal = {HNO}, year = {2012}, volume = {60}, issue = {3}, pages = {249--59; quiz 260-1}, doi = {https://doi.org/10.1007/s00106-011-2438-1}, keywords = {Humans; Postural Balance; Reflex, Vestibulo-Ocular; Semicircular Canals, physiopathology; Sensory Receptor Cells; Vestibular Diseases, diagnosis, physiopathology, therapy}, pmid = {22402905} }
Pośpiech, L.	[Rehabilitation of benign paroxysmal positional vertigo in the experience of the Wrocław Clinics]. [Abstract] [BibTeX]	2000	Otolaryngologia polska = The Polish otolaryngology Vol. 54(5), pp. 557-560	article
Abstract: Mechanical disturbances in inner ear in cupulo-utricular complex are the cause of Benign Paroxysmal Positional Vertigo (BPPV). Pharmacotherapy is ineffective in such cases. The results of rehabilitation with the use of Semont of Epley manoeuvres in 46 patients were presented. The regression of symptoms in 24 cases treated with the use of Semont manoeuvre was achieved in 62% and in 22 cases treated with the use of Epley manoeuvre in 73%. Theoretical assumptions of effectiveness of treatment applied were discussed on the basis of cupulolithiasis and canalolithiasis theories.
BibTeX: @article{Pospiech2000, author = {Pośpiech, L}, title = {[Rehabilitation of benign paroxysmal positional vertigo in the experience of the Wrocław Clinics].}, journal = {Otolaryngologia polska = The Polish otolaryngology}, year = {2000}, volume = {54}, issue = {5}, pages = {557--560}, keywords = {Female; Humans; Male; Middle Aged; Posture; Remission Induction; Vertigo, rehabilitation}, pmid = {11202343} }
Liu, Y., Wang, W. and Gong, S.S.	[Related factors of benign paroxysmal positional vertigo:investigation of 310 patients]. [Abstract] [BibTeX]	2016	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 30(9), pp. 748-750	article	DOI
Abstract: To explore risk factors in the onset of benign paroxysmal positional vertigo(BPPV) by questionnaires and laboratory tests. Three hundred and ten cases of patients with BPPV were conducted. All patients' informations were collected, including age, smoking history, with or without high blood pressure, diabetes, cervical spondylosis, tinnitus, and vertigo. Laboratory tests including pure tone hearing level, electrical diagram of nystagmus,CT, TCD, cervical vertebra X-ray were performed, and data were analyzed. All 310 patients were a total of 215 females (69.4%) and 95 males(30.6%), aged from 20 to 84 years, with a median age of 54. There were 217 cases(70.0%) of PC-BPPV,88 cases(28.4%) of HC-BPPV, and 2 cases（0.6%）of AC-BPPV. Among patients, 106 patients(34.2%) had high blood pressure, 36 patients(11.6%) had diabetes, 123 patients(39.7%) had cervical disease, 91 cases were found cerebral infarction in CT, 152 patients(49.0%) had tinnitus, and 59 patients(19.0%) had history of smoking. Incidence of BPPV is related with gender and ages. Incidences of high blood pressure and brain ischemic change in BPPV patients were higher than that in the general population.
BibTeX: @article{Liu2016, author = {Liu, Y and Wang, W and Gong, S S}, title = {[Related factors of benign paroxysmal positional vertigo:investigation of 310 patients].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2016}, volume = {30}, issue = {9}, pages = {748--750}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2016.09.020}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, physiopathology; Cerebral Infarction, epidemiology; China, epidemiology; Diabetes Mellitus, epidemiology; Female; Humans; Hypertension, epidemiology; Incidence; Male; Middle Aged; Nystagmus, Pathologic, physiopathology; Surveys and Questionnaires; Tinnitus, epidemiology; Young Adult; benign paroxysmal positional vertigo; cervical disease; diabetes; high pressure}, pmid = {29771029} }
Maisin, J.P., Van Hellemont, V., Ben Jaballah, A., Minet, J.C., Monnoye, J.P., Levie, P., Verheyden, P.J. and Saerens, P.	[Relations between vasculotensional disease, sudden deafness and benign paroxysmal postural vertigo: value of anticochlear antibodies]. [Abstract] [BibTeX]	1995	Revue de laryngologie - otologie - rhinologie Vol. 116(3), pp. 179-182	article
Abstract: Some vasculotensional diseases may be associated, at a certain point of their evolution, with occurrences of sudden deafness or of benign paroxysmal positional vertigo. It seems that the efficiency of the treatments of sudden deafness and benign paroxysmal positional vertigo is not modified by those associations of pathologies. On the other side, the search for anticochlear antibodies gives a positive result in 45% of the vasculotensional diseases. When the vasculotensional disease is associated with sudden deafness, this percentage increases. On the contrary, it is lower when the vasculotensional disease is associated with benign paroxysmal positional vertigo. The presence of anticochlear antibodies may lead to a corticotherapy in case of failure of the classical treatments.
BibTeX: @article{Maisin1995, author = {Maisin, J P and Van Hellemont, V and Ben Jaballah, A and Minet, J C and Monnoye, J P and Levie, P and Verheyden, P J and Saerens, P}, title = {[Relations between vasculotensional disease, sudden deafness and benign paroxysmal postural vertigo: value of anticochlear antibodies].}, journal = {Revue de laryngologie - otologie - rhinologie}, year = {1995}, volume = {116}, issue = {3}, pages = {179--182}, keywords = {Antibodies, analysis; Cochlea, immunology; Hearing Loss, Sudden, drug therapy, immunology; Humans; Vascular Diseases, immunology, physiopathology, therapy; Vertigo, immunology}, pmid = {7569387} }
Wu, Y.Q., Lu, X.X., Fan, Z.Y., Zhou, M., Li, L., Yan, W., Gu, C.Y., Chen, C.J. and Han, W.W.	[Relationship between 25-hydroxyvitamin D levels and idiopathic benign paroxysmal positional vertigo in female patients]. [Abstract] [BibTeX]	2018	Zhonghua yi xue za zhi Vol. 98(16), pp. 1223-1226	article	DOI
Abstract: To investigate the relationship between serum 25-hydroxyvitamin D[25(OH) D] levels and idiopathic benign paroxysmal positional vertigo (BPPV) in female patients. A total of 67 women diagnosed with idiopathic BPPV were selected as the study group between January and December 2016 in Ningbo No.2 Hospital, and 95 healthy women without a history of vertigo or dizziness were selected as the control group. The data of height, weight, histories of hypertension and diabetes mellitus were collected, and serum 25(OH) D levels were measured. The number of the recurrence and canalith repositioning maneuvers were recorded during the one-year follow-up. No significant differences of age, body mass index, histories of hypertension and diabetes mellitus between patients with BPPV and healthy controls (all >0.05) .The serum 25 (OH) D levels were significantly lower in patients with idiopathic BPPV than in healthy controls [(50.56±13.36) nmol/L vs (56.55±16.21) nmol/L, =-2.485, =0.014]. BPPV patients with low level of 25(OH) D showed a significant increase in the number of canalith repositioning maneuvers required and the recurrence rate. The regression analyses demonstrated that 25(OH)D deficiency was associated with BPPV with an odds ratio of 2.054 (95% 1.088-3.877, =0.026). 25(OH) D deficiency may be a risk factor of BPPV.
BibTeX: @article{Wu2018c, author = {Wu, Y Q and Lu, X X and Fan, Z Y and Zhou, M and Li, L and Yan, W and Gu, C Y and Chen, C J and Han, W W}, title = {[Relationship between 25-hydroxyvitamin D levels and idiopathic benign paroxysmal positional vertigo in female patients].}, journal = {Zhonghua yi xue za zhi}, year = {2018}, volume = {98}, issue = {16}, pages = {1223--1226}, doi = {https://doi.org/10.3760/cma.j.issn.0376-2491.2018.16.007}, keywords = {Benign Paroxysmal Positional Vertigo; Female; Humans; Vitamin D, analogs & derivatives; Vitamin D Deficiency; 25-hydroxy vitamin D; Canalith repositioning maneuvers; Vertigo; Vestibular diseases}, pmid = {29747308} }
Vélez León, V., Lucero Gutiérrez, V., Escobar Hurtado, C. and Ramirez-Velez, R.	[Relationship between health-related quality of life and disability in women with peripheral vertigo]. [Abstract] [BibTeX]	2010	Acta otorrinolaringologica espanola Vol. 61(4), pp. 255-261	article	DOI
Abstract: To study the relationship between disability and health-related quality of life in women with vertigo of peripheral origin. Cross-sectional study in 26 women diagnosed with vertigo, classified by type of peripheral vestibular disturbance: benign paroxysmal positional vertigo (BPPV), vestibular neuritis, Ménière's disease, post-trauma and others. In a self-report interview, a 12-item short-form (SF-12) health survey on quality of life was applied; disability was assessed with the questionnaire "Dizziness Handicap Inventory" (DHI). Measures of central tendency, dispersion for the domains and types of vestibular disturbance were used and internal DHI consistency and inter-scale correlation were calculated. Patients in the vestibular neuritis and Ménière groups displayed a higher level of disability according to the DHI functional (29.5+/-5.5 vs. 27.0+/-8.8) and physical domains (23.0+/-4.1 vs. 21.5+/-6.6). Based on the SF-12 domains, greater deterioration in quality of life was perceived in physical (22.9+/-3.9 vs. 22.6+/-4.6) and emotional performance (15.4+/-5.0 vs. 11.3+/-6.0), respectively. Acceptable and significant inverse correlations were found between the physical component summary (PCS-12) of the SF-12 and the physical, emotional and functional aspects of the DHI questionnaire (r=-0.51 to -0.78, p<0.01). Internal consistency (Cronbach's alpha index) of the DHI questionnaire was appropriate for the sample. The DHI and the SF-12 are useful, practical and valid instruments for assessing the impact of dizziness on the quality of life of patients with this symptom.
BibTeX: @article{VelezLeon2010, author = {Vélez León, Vanessa and Lucero Gutiérrez, Vanessa and Escobar Hurtado, Celia and Ramirez-Velez, Robinson}, title = {[Relationship between health-related quality of life and disability in women with peripheral vertigo].}, journal = {Acta otorrinolaringologica espanola}, year = {2010}, volume = {61}, issue = {4}, pages = {255--261}, doi = {https://doi.org/10.1016/j.otorri.2010.03.001}, keywords = {Adult; Aged; Cross-Sectional Studies; Disability Evaluation; Female; Humans; Middle Aged; Quality of Life; Vertigo, diagnosis; Young Adult}, pmid = {20494821} }
Yuan, J., Chen, Y., Chen, Y., Niu, S., Li, S., Dong, Q. and Hu, W.	[Relationship between serum level of uric acid and benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2015	Zhonghua yi xue za zhi Vol. 95(5), pp. 344-348	article
Abstract: To confirm the possible relationships between serum level of uric acid (UA) and benign paroxysmal positional vertigo (BPPV). A total of 87 patients with BPPV and 36 age- and gender-matched control subjects were recruited from our hospital between July 1, 2013 and July 1, 2014. All patients underwent a complete audio-vestibular test battery, such as Dix-Hallpike maneuver for posterior semicircular canal and supine roll test for horizontal semicircular canal. All risk factors such as the histories of heart and cerebral vascular diseases, and routine hematological and biochemical analyses were analyzed between two groups. No significant inter-group differences existed in age, gender, histories of hypertension, diabetes mellitus, hyperlipidemia, coronary heart disease, smoking or drinking (P > 0.05). No significant differences existed between systolic blood pressure, diastolic blood pressure, ejection fraction, whole blood count, lipid profile, homocysteine, prealbumin and blood urea nitrogen in patients with BPPV compared with controls (P >0. 05). However, the values of UA (267 ± 86 vs 325 ± 75) µmol/L, hemoglobin ale (5.6 ± 1. 4 vs 6.5 ± 1. 0)%, albumin (36 ± 4 vs 40 ± 4) g/L and creatinine (72 ± 20 vs 81 ± 22) µmol/L were much lower in patients with BPPV versus controls (P < 0. 05). According to multiple Logistic regression model, the lower levels of hemoglobin ale and albumin were independently associated with BPPV (P <0. 05) with the odds ratio of 1. 473 (95% CI 1. 066 - 2. 037) and 1. 162 (95% CI 1. 025 - 1. 318), respectively. However, the level of UA was not independently correlated with the occurrence of BPPV [OR = 1. 005 (95% CI 1. 000 - 1. 011), P =0. 063]. The lower levels of hemoglobin alc and albumin are independently associated with BPPV. Although the value of UA is lower in patients with BPPV versus controls, it is not an independent risk factor for BPPV. Due to limited patient data, further studies are needed to clarify the association in a larger sample size of different ethnic groups or longer follow ups.
BibTeX: @article{Yuan2015a, author = {Yuan, Junliang and Chen, Yili and Chen, Yudan and Niu, Shiqin and Li, Shujuan and Dong, Qian and Hu, Wenli}, title = {[Relationship between serum level of uric acid and benign paroxysmal positional vertigo].}, journal = {Zhonghua yi xue za zhi}, year = {2015}, volume = {95}, issue = {5}, pages = {344--348}, keywords = {Benign Paroxysmal Positional Vertigo; Blood Pressure; Blood Urea Nitrogen; Coronary Artery Disease; Creatinine; Female; Humans; Male; Physical Examination; Risk Factors; Semicircular Canals; Uric Acid}, pmid = {26168668} }
Situ, J., Li, H., Chen, Z. and Zhang, J.	[Reports on one case of pneumonoconiosis patient experiencing recurring benign paroxysmal vertigo after lung lavage]. [BibTeX]	2015	Zhonghua lao dong wei sheng zhi ye bing za zhi = Zhonghua laodong weisheng zhiyebing zazhi = Chinese journal of industrial hygiene and occupational diseases Vol. 33(5), pp. 386	article
BibTeX: @article{Situ2015, author = {Situ, Jie and Li, Hui and Chen, Zhijun and Zhang, Jianjie}, title = {[Reports on one case of pneumonoconiosis patient experiencing recurring benign paroxysmal vertigo after lung lavage].}, journal = {Zhonghua lao dong wei sheng zhi ye bing za zhi = Zhonghua laodong weisheng zhiyebing zazhi = Chinese journal of industrial hygiene and occupational diseases}, year = {2015}, volume = {33}, issue = {5}, pages = {386}, keywords = {Benign Paroxysmal Positional Vertigo, physiopathology; Bronchoalveolar Lavage, adverse effects; Humans; Pneumoconiosis, physiopathology}, pmid = {26653240} }
Gufoni, M., Mastrosimone, L. and Di Nasso, F.	[Repositioning maneuver in benign paroxysmal vertigo of horizontal semicircular canal]. [Abstract] [BibTeX]	1998	Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale Vol. 18(6), pp. 363-367	article
Abstract: The introduction of the Lempert or Baloh "barbecue" maneuver in clinical practice has resolved many cases of paroxysmal positional vertigo of the horizontal semicircular canal. Unfortunately, this maneuver is rather difficult to perform in elderly or overweight patients and in those with reduced mobility. In such cases the Vannucchi "forced position" is the maneuver of choice. Diagnostic confirmation is, however, still a problem. The authors feel diagnosis is only confirmed when the positional nystagmus has been converted, inverted or disappears after the physical therapy maneuver. For this reason another maneuver has been developed and is described in the present work. Between May 10th and November 28th 1997 thirty cases of horizontal canalolithiasis were seen: 19 in the right vestibule, 11 the left vestibule (9 males, 21 females; age range 20 to 82 years). Of these cases, 24 (4 apogeotropic, 20 geotropic) were treated with a maneuver differing from the barbecue maneuver. Some parts of this maneuver are similar to the Semont maneuver, moving the patient from a seated position to a position on the right or left side, depending the pathology and type of vertigo (geotropic/apogeotropic). A favorable outcome was achieved in 22 cases and there was no result in 2 cases. The two non-responsive patients were then treated with forced positioning which resolved the condition. Benign paroxysmal positional vertigo from horizontal canalolithiasis responds to treatment with the above-mentioned maneuver.
BibTeX: @article{Gufoni1998, author = {Gufoni, M and Mastrosimone, L and Di Nasso, F}, title = {[Repositioning maneuver in benign paroxysmal vertigo of horizontal semicircular canal].}, journal = {Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale}, year = {1998}, volume = {18}, issue = {6}, pages = {363--367}, keywords = {Adult; Aged; Aged, 80 and over; Female; Humans; Labyrinth Diseases, etiology, pathology; Lithiasis, etiology, pathology; Male; Middle Aged; Posture; Retrospective Studies; Semicircular Canals, pathology; Severity of Illness Index; Treatment Outcome; Vertigo, diagnosis, etiology, therapy}, pmid = {10388148} }
Wolf, K.	[Retired patient with vertigo. Benign paroxysmal positional vertigo]. [BibTeX]	2002	Praxis Vol. 91(40), pp. 1662-1663	article	DOI
BibTeX: @article{Wolf2002, author = {Wolf, K}, title = {[Retired patient with vertigo. Benign paroxysmal positional vertigo].}, journal = {Praxis}, year = {2002}, volume = {91}, issue = {40}, pages = {1662--1663}, doi = {https://doi.org/10.1024/0369-8394.91.40.1662}, keywords = {Diagnosis, Differential; Female; Humans; Neurologic Examination; Nystagmus, Pathologic, diagnosis; Vertigo, diagnosis}, pmid = {12405036} }
Liu, X.W. and Sun, J.W.	[Risk factors analysis for recurrence of the idiopathic benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2018	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 32(15), pp. 1185-1187	article	DOI
Abstract: To study the risk factors of recurrence in patients with benign paroxysmal positional vertigo(BPPV) after successful repositioning treatment. Two hundred and two cases of confirmed BPPV patients, were followed-up for 10 months after particle repositioning, and the incidence of recurrence was analyzed. The risk factors for recurrence were analyzed by logistic regression. 51 out of 202 confirmed BPPV patients complained of recurrence. There was significant difference of the duration of vertigo before treatment, the times of repositioning and SDS between the two group( <0.05). While the sex, the age, the incubation period of BPPV, the duration time of BPPV, underlying diseases and the type of canal were not associated with the residual dizziness( >0.05). Logistic regression analysis showed that the times of repositioning and the SDS were the risk factor for residual dizziness. The effective repositioning and the psychological care are very important to reduce the recurrence of BPPV.
BibTeX: @article{Liu2018, author = {Liu, X W and Sun, J W}, title = {[Risk factors analysis for recurrence of the idiopathic benign paroxysmal positional vertigo].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2018}, volume = {32}, issue = {15}, pages = {1185--1187}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2018.15.014}, keywords = {manipulative reduction; recurrence; risk factors; vertigo}, pmid = {30282154} }
Wang, C.X. and Wang, J.M.	[Risk factors for recurrence of benign paroxysmal positional vertigo: a Meta analysis]. [Abstract] [BibTeX]	2018	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 32(17), pp. 1298-1303	article	DOI
Abstract: To investigate the risk factors for recurrence after otolith reduction of benign paroxysmal positional vertigo by Meta analysis. The relevant literatures of risk factors for recurrence of BPPV were searched by the database of PubMed, Embase, OVID, Springer, Proquest. Revman 5.3 software was used to perform Meta analysis of the included literature. A total of 15 articles were included in the final analysis and a total of 4 477 cases were included. Meta analysis results showed: the recurrent after otolith reduction of BPPV in patients with the hyperlipidemia and Meniere's disease increased significantly, compared to the patients without the hyperlipidemia and Meniere's disease, difference was statistically significant［ =1.74, 95% (1.14-2.65), =0.01; =4.57,95% (2.78-7.52), <0.01］. There was no significant difference in the recurrence after otolith reduction of BPPV in patients with diabetes and migraine compared without diabetes and migraine［ =1.14,95% (0.84-1.54), >0.05; =0.99, 95% (0.66-1.47), >0.05］. Hyperlipidemia and Meniere's disease are risk factors for the recurrence after otolith reduction of BPPV.
BibTeX: @article{Wang2018b, author = {Wang, C X and Wang, J M}, title = {[Risk factors for recurrence of benign paroxysmal positional vertigo: a Meta analysis].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2018}, volume = {32}, issue = {17}, pages = {1298--1303}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2018.17.003}, keywords = {benign paroxysmal positional vertigo; recurrence; risk factors}, pmid = {30282182} }
Toledo, H., Cortés, M.L., Pane, C. and Trujillo, V.	[Semont maneuver and vestibular rehabilitation exercises in the treatment of benign paroxysmal postural vertigo. A comparative study]. [Abstract] [BibTeX]	2000	Neurologia (Barcelona, Spain) Vol. 15(4), pp. 152-157	article
Abstract: Benign paraoxysmal postural vertigo (BPPV) is one of the most frequent causes of peripheral dizziness. Treatment based on vestibular rehabilitation exercises (VRE) is effective in 90% of the cases in an interval of 3 to 4 weeks. This treatment however is often abandoned by the patient. The only therapeutic maneuvers (based on otolyte release) are equally effective but present a high medium term recurrence. To compare the efficacy of the Semont maneuver (SM), the VRE and the combination of both in the treatment of BPPV at three months of follow up. Forty patients with the clinical and electronystagmographic diagnosis of BPPV were divided into three groups: 1. SM, 2. VRE and 3. SM + VRE. The results were compared in regard to the signs and symptoms observed in the three groups of patients at 15 days, one month and at three months of treatment. The SM was effective in 80% of the patients at 15 days of treatment versus 45% of those receiving only VRE. The third group of patients, receiving the combined treatment, demonstrated a cure in 100% of the cases when evaluated at three months while only 66% of the SM group were found to be asymptomatic at the same time period (p < 0.05). The SM is easy to perform, rapid and effective in the short term, however has high recurrence. The VRE are effective in the long term based on the patient persistence. Combination of the two treatment leads to symptom remission in 100% of the patients at three months of treatment.
BibTeX: @article{Toledo2000, author = {Toledo, H and Cortés, M L and Pane, C and Trujillo, V}, title = {[Semont maneuver and vestibular rehabilitation exercises in the treatment of benign paroxysmal postural vertigo. A comparative study].}, journal = {Neurologia (Barcelona, Spain)}, year = {2000}, volume = {15}, issue = {4}, pages = {152--157}, keywords = {Exercise; Female; Follow-Up Studies; Humans; Male; Middle Aged; Posture; Treatment Outcome; Vertigo, rehabilitation}, pmid = {10846882} }
Guo, P. and Li, J.	[Short and long term effect of quick repositioning maneuver for patients with benign paroxysmal positional vertigo induced in the straight head-hanging test]. [Abstract] [BibTeX]	2015	Zhonghua yi xue za zhi Vol. 95(25), pp. 1986-1989	article
Abstract: To investigate the clinical characteristics, short and long term effect of quick repositioning maneuver along the sagittal plane for patients with benign paroxysmal positional vertigo who were induced vertigo in the straight head-hanging test. The clinical data of 38 patients affected by benign paroxysmal positional vertigo who were induced vertigo in the straight head-hanging test from July 2009 to July 2014 in the Department of Otolaryngology Head and Neck Surgery of Navy General Hospital were retrospectively analyzed. After diagnosis, the patients were underwent quick repositioning maneuver along the sagittal plane. Of the 38 cases studied, 15 patients (39.5%) were males and 23 patients (60.5%) were females. The age of the patients ranged from 33 to 71 years with a mean of 55 ± 12 years. The median duration between symptoms and diagnosis was 8 days. The total improvement was 33 cases (86.8%) in patients with superior semicircular canal BPPV when they were re-evaluated at 1 week and 32 cases (84.2%) at 3 months time. Quick repositioning maneuver along the sagittal plane is an effective, easy alternative for treatment of the patients with benign paroxysmal positional vertigo induced vertigo in the straight head-hanging test. It is not necessary to identify the directions of the nystagmus.
BibTeX: @article{Guo2015a, author = {Guo, Pengfei and Li, Jinrang}, title = {[Short and long term effect of quick repositioning maneuver for patients with benign paroxysmal positional vertigo induced in the straight head-hanging test].}, journal = {Zhonghua yi xue za zhi}, year = {2015}, volume = {95}, issue = {25}, pages = {1986--1989}, keywords = {Adult; Aged; Asphyxia; Benign Paroxysmal Positional Vertigo; Female; Head; Humans; Male; Middle Aged; Nystagmus, Pathologic; Patient Positioning; Retrospective Studies; Semicircular Canals}, pmid = {26710805} }
Ju, J., Li, J.R. and Zou, S.Z.	[Short-term outcomes of Li's repositioning maneuver of different age groups patients of horizontal semicircular canal canalithiasis benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2018	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 32(13), pp. 1009-1012	article	DOI
Abstract: To analyse whether there is statistical difference between different age group short-term outcomes of horizontal semicircular canal canalithiasis benign paroxysmal positional vertigo (HC-BPPV) patients treated by Li's repositioning maneuver. Since October 2009 to July 2017, we included 169 unilateral HC-BPPV patients treated by Li's repositioning maneuver. Then we recorded and analyse 3-day and 1-week outcomes. Three-day efficacy rates of youth, middle aged, young elderly and elderly patients were 97.9%,93.9%,90.9% and 90.% ( =0.136), respectively. Rates of 1-week efficacy were 100.0%,98.5%,97.7%and 100.0% ( =0.799),respectively. There was no statistical difference. Treated by Li's repositioning maneuver,HC-BPPV patients of different age groups can both get good short-term outcomes without statistical difference.
BibTeX: @article{Ju2018, author = {Ju, J and Li, J R and Zou, S Z}, title = {[Short-term outcomes of Li's repositioning maneuver of different age groups patients of horizontal semicircular canal canalithiasis benign paroxysmal positional vertigo].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2018}, volume = {32}, issue = {13}, pages = {1009--1012}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2018.13.012}, keywords = {Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, therapy; Humans; Middle Aged; Patient Positioning; Semicircular Canals; Li's repositioning maneuver; age; benign paroxysmal positional vertigo; efficacy; horizontal semicircular canal}, pmid = {29986565} }
Liu, J., Guo, S., Wang, K., Li, Z., Du, Z., Xie, W. and Liu, Y.	[Significance of ENG and DPG in the vestibular function examination in patients suffering BPPV]. [Abstract] [BibTeX]	2012	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 26(7), pp. 289-292	article
Abstract: To detect the significance of the electronystagmography (ENG) and the dynamic posturography (DPG) in the vestibular function examination in patients suffering BPPV. Forty, 34 to 79 old vertigo patients were examined with DPG and ENG. DPG evaluation parameters includes sense organization test from vestibular sensory score, proprioception score, visual score, Romber's score and composite score. ENG examination include caloric test. Twenty-six out of 40 BPPV patients got abnormal caloric test results; 33 patients got DPG abnormality which led to a low vestibular perception scores. Twenty-four out of these patients got abnormal results in both caloric test and DPG, while in 9 patients that got normal caloric results came up with low vestibular perception scores, except for which there was no significant abnormality in SOT. Besides, the BPPV patients, compared with normal, got abnormal scores in caloric test of ENG and vestibular perception test of DPG (P < 0.05), if course of BPPV was over 12 months, higher abnormal degrees appeared (P < 0.05). ENG and DPG are important methods in vestibular function tests, a comprehensive analysis of both is applied to value the severity of vestibular function in patients with BPPV and the duration of BPPV directly affects the vestibular function.
BibTeX: @article{Liu2012, author = {Liu, Jianguo and Guo, Suying and Wang, Kun and Li, Zhen and Du, Zhaowen and Xie, Wen and Liu, Yuehui}, title = {[Significance of ENG and DPG in the vestibular function examination in patients suffering BPPV].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2012}, volume = {26}, issue = {7}, pages = {289--292}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo; Caloric Tests; Electronystagmography; Female; Humans; Male; Middle Aged; Postural Balance; Vertigo, physiopathology; Vestibular Function Tests}, pmid = {22737866} }
Wen, J.X., Ma, X.L. and Liu, D.L.	[Significance of five symptoms scoring sheet in the clinical diagnosis of BPPV]. [Abstract] [BibTeX]	2016	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 30(10), pp. 784-787	article	DOI
Abstract: To identify the validity of five symptoms scoring sheet that based on the patients who are suffering from benign paroxysmal positional vertigo(BPPV), and explore its effects and significance in the clinical diagnosis of BPPV. A total of 484 patients with vertigo were included. All the patients were firstly assessed with five symptoms scoring sheet(repeated transient vertigo or aggravating vertigo during looking up, bending, getting out of bed, rolling over in bed and quick head movements) before being confirmed by Dix-Hallpike test and rolling test. Evaluating the predictive ability of this scoring sheet in the diagnosis of BPPV with ROC analysis. According to the ROC analysis , the sensitivity and specificity were 95.4% and 80.3% respectively when the score >7, and an area under receiver operating characteristic curve(AUC) was 0.923. Five symptoms scoring sheet is useful and convenient in diagnosing BPPV, which can be used in BPPV screening and guide the vertigo patients to receive further test and treatment.
BibTeX: @article{Wen2016, author = {Wen, J X and Ma, X L and Liu, D L}, title = {[Significance of five symptoms scoring sheet in the clinical diagnosis of BPPV].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2016}, volume = {30}, issue = {10}, pages = {784--787}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2016.10.006}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis; Head Movements; Humans; ROC Curve; Sensitivity and Specificity; benign paroxysmal positional vertigo; diagnosis; vestibule}, pmid = {29798053} }
Li, Y., Li, J., Li, Q., Liu, X., Hong, X. and Liu, Y.	[Significance of the items for Dizziness Handicap Inventory in differential diagnosis of benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2018	Zhong nan da xue xue bao. Yi xue ban = Journal of Central South University. Medical sciences Vol. 43(10), pp. 1145-1150	article	DOI
Abstract: To explore the value of items for the Chinese version of Dizziness Handicap Inventory (DHI) in differential diagnosis of benign paroxysmal positional vertigo (BPPV) in patients with vertigo or dizziness first coming to the outpatient clinic.  Methods: A total of 322 patients with vertigo or dizziness, who came from Nanfang Hospital, Southern Medical University, were enrolled from April 2016 to February 2017. The Chinese version of DHI and Visual Analogue Scale (VAS) were completed by themselves. After detailed vestibular function examination, the patients were divided into a BPPV group, a normal vestibular group, and a abnormal vestibular group.  Results: The score of DHI-2 in the BPPV group was 5.52±2.10, which was higher than that in the normal vestibular group (3.94±2.91)(t=3.847, P<0.01) and the abnormal vestibular group (4.17±2.74)(t=4.149, P<0.01). There were significant differences in the DHI-2 among the 3 groups (F=9.870, t=4.515, P<0.01). The score of DHI-item 13 in the BPPV group was 3.09±1.39, which was higher than that in the normal vestibular group (1.97±1.63)(t=4.515, P<0.01) and the abnormal vestibular group (1.95±1.70)(t=5.305, P<0.01). There were significant differences in the DHI-item 13 among the 3 groups (F=16.402, P<0.01). There was significant difference in VAS scores among the 3 groups (P<0.05). However, the t-test analysis showed that there was significant difference between the BPPV group and the vestibular abnormal group (P<0.05), while there was no significant difference between the BPPV group and the vestibular normal group (P>0.05).  Conclusion: DHI-2 and DHI-item 13 should be included in the inquiry of disease history at the time of first diagnosis, which can be used to identify patients with BPPV quickly and effectively.
BibTeX: @article{Li2018, author = {Li, Yanfei and Li, Jingjing and Li, Qi and Liu, Xiaolong and Hong, Xuxing and Liu, Youli}, title = {[Significance of the items for Dizziness Handicap Inventory in differential diagnosis of benign paroxysmal positional vertigo].}, journal = {Zhong nan da xue xue bao. Yi xue ban = Journal of Central South University. Medical sciences}, year = {2018}, volume = {43}, issue = {10}, pages = {1145--1150}, doi = {https://doi.org/10.11817/j.issn.1672-7347.2018.10.016}, pmid = {30523237} }
Zhou, F.J., Yang, C.L. and Zhang, Z.	[Significance of the reverse phase nystagmus for the diagnosis of benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2018	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 32(13), pp. 969-971	article	DOI
Abstract: To investigate the significance of the reverse phase nystagmus for the diagnosis of benign paroxysmal positional vertigo when going on the positioning test. During the positioning test，there are 26 cases with reverse phase nystagmus in the 118 BPPV patients，note and analyse their nystagmus characteristics，then combine their disease history，to diagnose the affected side of the BPPV，and following with the corresponding treat of canalith repositioning procedure（CRP）. All the 26 cases with reverse phase nystagmus are the BPPV patients of horizontal semicircular postalcanalithasis，in which，RHSC-pCan for 15 cases，LHSC-pCan for 11 cases，with the treat of CRP，the significant effectivities are 4 cases，effectivities 15，uneffectivities 7，after single factor chi-square test，χ²=7.46, < 0.05. For the BPPV cases with reverse phase nystagmus during the positioning test，their efficacy difference of the CRP is significant statistically，that is the CRP treat is effective, the therapeutic diagnosis is established, which contributes to the analysis and judgment for the affected side of the semi-circular canals.
BibTeX: @article{Zhou2018a, author = {Zhou, F J and Yang, C L and Zhang, Z}, title = {[Significance of the reverse phase nystagmus for the diagnosis of benign paroxysmal positional vertigo].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2018}, volume = {32}, issue = {13}, pages = {969--971}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2018.13.002}, keywords = {Benign Paroxysmal Positional Vertigo, complications, diagnosis, therapy; Environment; Humans; Nystagmus, Pathologic, etiology; Patient Positioning; Semicircular Canals; benign paroxysmal positional vertigo; diagnosis; positioning test; reverse phase nystagmus}, pmid = {29986555} }
Liang, X.H., Sun, P.Y., Peng, X., Liu, J.M., Chen, Z. and Shan, X.Z.	[Significance of the seated supine positioning nystagmus for the diagnosis of benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2017	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 31(9), pp. 703-707	article	DOI
Abstract: To observe and assess the significance of seated supine positioning nystagmus (SSPN) in the diagnosis of benign paroxysmal positional vertigo(BPPV). Two hundreds patients who were diagnosed BPPV were tested with the seated supine positioning test(SSPT) to observe SSPN,then were tested Supine roll test(SRT) and Dix-Hallpike test(DHT). According to the result of SRT and DHT,patients were divided into different groups. The positive rate and feature of SSPN in different types of BPPV was analyzed. Among the 200 patients,116 cases(58.0%) of them showed SSPN. Among the 116 cases who were divided to the posterior semicircular canal BPPV(PSC-BPPV) group,72 cases of them showed SSPN. Horizontal semicircular canal BPPV(HSC-BPPV) group were 60 cases,44 cases showed SSPN. Anterior semicircular canal BPPV(ASC-BPPV) group were 4 cases and none of them showed SSPN. The direction of SSPN was a combination of torsional nystagmus with the upper pole of the eyes beating toward the affected side combined with vertical nystagmus beating upward (toward the forehead) typically in the PSC-BPPV group. Canalolithiasis of HSC were 41 cases,and 28 cases showed SSPN,and SSPN was contralesional in 22 cases(78.6%) and ipsilesional in 6 cases. Cupulolithiasis of HSC were 19 cases and 16 cases showed SSPN,and SSPN was ipsilesional in 16 cases. Significance of the seated supine positioning nystagmus in different types of BPPV is different.
BibTeX: @article{Liang2017, author = {Liang, X H and Sun, P Y and Peng, X and Liu, J M and Chen, Z and Shan, X Z}, title = {[Significance of the seated supine positioning nystagmus for the diagnosis of benign paroxysmal positional vertigo].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2017}, volume = {31}, issue = {9}, pages = {703--707}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2017.09.014}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis; Eye; Humans; Nystagmus, Pathologic, diagnosis; Posture; Semicircular Canals; benign paroxysmal positional vertigo; diagnosis; seated supine positioning nystagmus}, pmid = {29871352} }
Sakata, E. and Otsu, K.	[Simple method of differential diagnosis of peripheral and central vertigo--development of diagnostic method and studies of 178 cases]. [Abstract] [BibTeX]	1976	No to shinkei = Brain and nerve Vol. 28(2), pp. 187-196	article
Abstract: In patients who complain of vertigo or who have equilibrium disorders, it is often difficult to determine the etiology of the disorder, that is to determine whether it is dependent on a peripheral or central vestibular disorder. To attempt to determine the etiology in these cases, we divised a new method, the caloric eye tracking pattern test (CETP-Test). Seventeen normal subjects and 161 patients were tested. The latter group included 33 with peripheral disorders such as Meniere's disease, benign paroxysmal positional nystagmus, and others, and 128 with central disorders such as vertebral basilar artery insufficiency, cervical vertigo, and others, were tested. The cases of central disorders were limited to those patients whose eye tracking pattern before the caloric stimulation was normal. In normal subjects and in patients with peripheral disorders, it is well known that caloric nystagmus has little influence on the eye tracking pattern. In contrast, in patients with central vestibular disorders, caloric nystagmus evokes abnormalities on the eye tracking pattern, either superimposed or saccades, despite the fact that the eye tracking pattern before the caloric stimulation is normal. First we administer the eye tracking stimulation test using a target which moves horizontally at 0.3 cycle per second. Next, we perform the caloric test on the right ear, using 20 c.c. of ice water for 10 seconds. During the evoked caloric nystagmus we administer the eye tracking test once again. The eye tracking pattern is recorded for 20 seconds beginning 50 seconds after the start of the ice water injection. The procedure repeated on the left ear. The results on each case are presented as three patterns of ENG-recording. We may stat that in normal subjects and in patients with peripheral vestibular disorders, visual suppression of caloric nystagmus remains functional. Caloric induced nystagmus does not affect the CETP. In patients with central vestibular disorders, visual suppression of caloric nystagmus does not function properly because of defects in the visual suppression mechanism. Therefore, caloric nystagmus greatly influences the CETP. Consequently, the CETP may not be smooth when CETP test is administered to patients with central vestibular disorders. We may say also that the visual suppression to the vestibular nystagmus is evoked more strongly by pursuing a moving visual stimulus than by gazing a stational target. These results allow for a differential diagnosis between peripheral and central disorders.
BibTeX: @article{Sakata1976, author = {Sakata, E and Otsu, K}, title = {[Simple method of differential diagnosis of peripheral and central vertigo--development of diagnostic method and studies of 178 cases].}, journal = {No to shinkei = Brain and nerve}, year = {1976}, volume = {28}, issue = {2}, pages = {187--196}, keywords = {Adult; Caloric Tests, methods; Diagnosis, Differential; Eye Movements; Female; Humans; Meniere Disease, diagnosis; Middle Aged; Nystagmus, Pathologic, diagnosis; Vertigo, diagnosis; Vestibular Function Tests, methods}, pmid = {1036043} }
Xing, G., Chen, Z. and Bu, X.	[Simultaneous posterior and horizontal canal benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2003	Lin chuang er bi yan hou ke za zhi = Journal of clinical otorhinolaryngology Vol. 17(1), pp. 1-3	article
Abstract: To explore effective methods for the diagnosis and treatment of simultaneous posterior and horizontal canal benign paroxysmal positional vertigo (combined BPPV, C-BPPV). Epley's maneuver and Barbecue rotation were applied to four cases of C-BPPV separately with an interval of one day. Positional vertigo in all subjects disappeared completely after treatment and yielded excellent resolution of symptoms during period of follow-up. Clinical features in C-BPPV are combinations of both posterior and horizontal canal BPPV. Combined particle repositioning procedures of Epley's maneuver and Barbecue rotation is a successful method for treating the disorder.
BibTeX: @article{Xing2003, author = {Xing, Guangqian and Chen, Zhibin and Bu, Xingkuan}, title = {[Simultaneous posterior and horizontal canal benign paroxysmal positional vertigo].}, journal = {Lin chuang er bi yan hou ke za zhi = Journal of clinical otorhinolaryngology}, year = {2003}, volume = {17}, issue = {1}, pages = {1--3}, keywords = {Adult; Female; Follow-Up Studies; Humans; Male; Middle Aged; Posture; Semicircular Canals; Vertigo, diagnosis, therapy}, pmid = {12725174} }
Michel, O.	[Special forms of vertigo. Which therapy for which type of vertigo?]. [Abstract] [BibTeX]	2000	MMW Fortschritte der Medizin Vol. 142(45), pp. 41-44	article
Abstract: Paroxysmal vertigo, permanent vertigo, positional and postural vertigo, and transient vertigo are special forms, which are differentiated by their temporal course. Paroxysmal vertigo, together with hearing impairment and noises in the ear, is typical of Menière's disease. Persistent vertigo often occurs after the loss of a peripheral vestibular end organ (e.g. after trauma of infection). In the case of positional and postural vertigo, a differentiation must be made between benign paroxysmal positional vertigo due to "wandering" otoliths, and orthostatic vertigo, which occurs on changing rapidly from a lying to a sitting position. The diagnosis is verified by Epley or Semont positional maneuvers. Confirmation of a cervical vertigo is provided by the de Kleijn and Nieuwenhuyse test. Brief episodes of vertigo (transient vertigo) occur after transient ischemia, for example when craning to look at a high building. In the acute stage, treatment of vestibular vertigo consists in the damping of the threshold for vestibular stimuli with antiemetics. For long-term treatment, antihistaminics and histamine-like substances have proven of value.
BibTeX: @article{Michel2000, author = {Michel, O}, title = {[Special forms of vertigo. Which therapy for which type of vertigo?].}, journal = {MMW Fortschritte der Medizin}, year = {2000}, volume = {142}, issue = {45}, pages = {41--44}, keywords = {Diagnosis, Differential; Humans; Meniere Disease, etiology, therapy; Vertigo, etiology, therapy}, pmid = {11107823} }
Uno, A., Nagai, M., Sakata, Y., Moriwaki, K. and Kato, T.	[Statistical observation of vertigo and dizziness patients]. [Abstract] [BibTeX]	2001	Nihon Jibiinkoka Gakkai kaiho Vol. 104(12), pp. 1119-1125	article
Abstract: Subjects visiting the Department of Otolaryngology at Suita Municipal Hospital reporting vertigo or dizziness numbered 664 women and 343 men from April 1999 to December 2000. As a city hospital, we play an important role in the diagnosis and treatment of acute vertigo or dizziness. The frequency of diagnosis of these cases was divided almost equally into 5 groups: (1) benign paroxysmal positional vertigo (BPPV) 23%; (2) suspected BPPV, 18%; (3) peripheral vestibular disorders other than BPPV, 22%; (4) disorders other than peripheral origin, 18%; and (5) undiagnosed, 19%. Based on our results, BPPV, other peripheral vestibular disorders, and disorders of other origins should be differentiated from the first screening. BPPV was most frequent and diagnosed by typical positioning nystagmus. Many other peripheral vestibular disorders were accompanied by nystagmus. It is also important to differentiate serious illnesses such as cerebrovascular disease (7%), space-occupying lesions in the posterior fossa (1.2%), and cardio-circulatory disease (3.6%).
BibTeX: @article{Uno2001, author = {Uno, A and Nagai, M and Sakata, Y and Moriwaki, K and Kato, T}, title = {[Statistical observation of vertigo and dizziness patients].}, journal = {Nihon Jibiinkoka Gakkai kaiho}, year = {2001}, volume = {104}, issue = {12}, pages = {1119--1125}, keywords = {Adult; Aged; Cerebrovascular Disorders, complications; Dizziness, diagnosis, epidemiology; Female; Humans; Male; Meniere Disease, complications; Middle Aged; Peripheral Vascular Diseases, complications; Vertigo, diagnosis, epidemiology}, pmid = {11802445} }
Mizuta, K., Tokita, T., Ito, Y., Aoki, M. and Kuze, B.	[Studies on the largest Lyapunov exponents of the standing posture in patients with unilateral vestibular dysfunction]. [Abstract] [BibTeX]	2009	Nihon Jibiinkoka Gakkai kaiho Vol. 112(12), pp. 791-800	article
Abstract: In the present study, we investigated the body sway in patients with unilateral vestibular dysfunction by the largest Lyapunov exponents using a chaotic time series analysis. The largest Lyapunov exponent is regarded as a parameter indexing an orbital instability. Subjects consisted of 55 normal healthy subjects, 11 patients diagnosed as having vestibular neuritis (VN), 6 patients diagnosed as having sudden deafness (SD) with vertigo, 23 patients diagnosed as having Meniere disease (MD), 11 patients diagnosed as having benign paroxysmal positional vertigo (BPPV) and 14 patients diagnosed as having other vestibular disorders. Using a stabilometer, the sway of the body center of gravity in an upright standing position was recorded with eyes open and closed for 60 seconds under each condition. From the time series data obtained, the largest Lyapunov exponents were calculated using a chaos analysis program. In normal healthy subjects and patients with unilateral vestibular dysfunction, the largest Lyapunov exponents on right-left sway were larger than those on forward-backward sway with eyes open and closed. The largest Lyapunov exponents in patients with unilateral vestibular dysfunction on forward-backward sway with eyes closed were significantly larger than those in normal healthy subjects. A few patients with the instability of standing posture judged from conventional analysis (area of sway, locus length per time) showed higher values of the LLE. We investigated the variation of the values of the largest Lyapunov exponents in patients with unilateral vestibular dysfunction at each stage during recovery from their vestibular damage. The largest Lyapunov exponents at the early stage with stable standing posture were significantly higher than those at the late stable stage with stable standing posture. Some patients at the very early stage had lower values of the largest Lyapunov exponents. We speculate that the orbital instability indicated by the values of the largest Lyapunov exponents has a different significance from instability of standing posture indicated by a conventional analysis. We propose that the largest Lyapunov exponents may be an useful subsidiary measure to evaluate postural stability and its change due to vestibular dysfunction.
BibTeX: @article{Mizuta2009, author = {Mizuta, Keisuke and Tokita, Takashi and Ito, Yatsuji and Aoki, Mitsuhiro and Kuze, Bunya}, title = {[Studies on the largest Lyapunov exponents of the standing posture in patients with unilateral vestibular dysfunction].}, journal = {Nihon Jibiinkoka Gakkai kaiho}, year = {2009}, volume = {112}, issue = {12}, pages = {791--800}, keywords = {Adult; Aged; Gravitation; Humans; Male; Middle Aged; Postural Balance; Posture, physiology; Proprioception, physiology; Vestibular Diseases, diagnosis, physiopathology; Vestibular Function Tests, methods}, pmid = {20077839} }
Yang, X.K., Zheng, Y.Y. and Wu, S.X.	[Study of BPPV precise manipulation treatment]. [Abstract] [BibTeX]	2016	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 30(8), pp. 623-626	article	DOI
Abstract: To explore the effect of the BPPV precision manipulation treatment. With 3D SLICER software we segment structure such as semicircular canal, eye ball, orbital and ear rod from MRI or CT volume data of patients which underwent MRI or CT scaning of inner ear, for measuring the spatial direction of semicircular canals and building semicircular canal modules with standard space coordinate system and embedding into 3D PDF files. With the slice that divide the semicircular canal equally as the semicircular canal plane and the eyeball as reference object to determine whether it is symmetric, it is not only intuitive but also reliable for measuring the angle between the posterior semicircular canal. 3D PDF is intuitive, rotation angle can be adjusted according to the individual differences in the process of manipulation treatment, to observe and demonstrate the theoretical reduction effect before the actual operation. By reconstruction the three-dimensional semicircular canal structure from the inner ear image data of patients and measurement of the semicircular canal space direction, it is of a certain significance for BPPV precision manipulation treatment.
BibTeX: @article{Yang2016, author = {Yang, X K and Zheng, Y Y and Wu, S X}, title = {[Study of BPPV precise manipulation treatment].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2016}, volume = {30}, issue = {8}, pages = {623--626}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2016.08.010}, keywords = {Eye; Humans; Magnetic Resonance Imaging; Semicircular Canals, diagnostic imaging; Software; Tomography, X-Ray Computed; Vertigo, therapy; computer tomography; imaging, three-dimensional; magnetic resonance imaging; semicircular canals; vertigo}, pmid = {29871092} }
Gao, Y., Wang, D., Su, Q., Wang, H., Lan, L., Yin, Z., Yu, L., Wu, Z., Shan, X., Xue, X. and Wang, Q.	[Study of clinical characteristics and curative effects of sudden hearing loss patients with vertigo]. [Abstract] [BibTeX]	2015	Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery Vol. 50(7), pp. 529-535	article
Abstract: To analyze the clinical characteristics, prognosis and therapeutic effects of sudden sensorineural hearing loss (SSHL) patients associated with vertigo, and to investigate the strategy of diagnosis and treatment. We retrospectively analyzed the clinical characteristics of 240 patients diagnosed as SSHL with vertigo, who were treated in the Chinese PLA General Hospital from July 2008 to August 2012. Various factors affecting the therapeutic effects were analyzed, such as audiological features, vestibular function tests, genders, audiograms, lasting before seeing a doctor, courses of vertigo and vascular factors. Among the contemporaneous SSHL patients (873 cases), the cases with vertigo accounted for 27.49% (240/873). Among the 240 patients with vertigo, the cases with different hearing impaired degree of mild, moderate, severe and profound were 30, 13, 28 and 34, respectively, primarily by the profound cases. Detailed vestibular function tests were performed in 97 patients, with 54 cases having unilateral vestibular disfunction and 43 patients having normal vestibular function, among which 23 cases were diagnosed as benign paroxymal positional vertigo (BBPV). The relationship between vestibular function and different hearing impaired degrees or various audiogram types had no statistically significant difference. 219 cases had detailed records of the onset time of cochlear and vestibular symptoms, including 122 patients with cochlear symptoms and dizziness occurring simultaneously. After standardized drug treatment, the total effective rate was 46.67%, with recovery in 17 cases, excellent in 34 cases, better in 61 cases and poor in 128 cases, respectively. Statistical analysis showed that different genders, audiogram types, vertigo courses of time, the results of vestibular function and neck vascular ultrasounds were not related to the curative effects, while, the treatment time after onset was significantly associated with treatment effects. SSHL with vertigo has a high incidence, primarily single side affected, with relatively severe hearing impairment, and total deafness and downslope hearing curve mainly. Vestibular function can be normal or low in SSHL patients with vertigo, with a higher incidence of BPPV. Vestibular and cochlear symptoms occur simultaneously in more than half of the patients. The detection rate of vestibular dysfunction gradually increased, as the degree of hearing loss increased, without statistical significance although. The therapeutic effects of sudden hearing loss with vertigo cases have no relationship with dizziness duration or vestibular function, while the disease course plays an important role in treatment.
BibTeX: @article{Gao2015, author = {Gao, Yun and Wang, Dayong and Su, Qin and Wang, Hongyang and Lan, Lan and Yin, Zifang and Yu, Lan and Wu, Ziming and Shan, Xizheng and Xue, Xijun and Wang, Qiuju}, title = {[Study of clinical characteristics and curative effects of sudden hearing loss patients with vertigo].}, journal = {Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery}, year = {2015}, volume = {50}, issue = {7}, pages = {529--535}, keywords = {Benign Paroxysmal Positional Vertigo, complications; Cochlea, physiopathology; Deafness; Dizziness; Hearing Loss, Sensorineural; Hearing Loss, Sudden, complications; Hearing Tests; Humans; Prognosis; Retrospective Studies; Vestibular Function Tests; Vestibule, Labyrinth, physiopathology}, pmid = {26695972} }
Narita, S., Kurose, M., Kobayashi, K. and Himi, T.	[Study on 242 inpatients reporting vertigo and dizziness]. [Abstract] [BibTeX]	2003	Nihon Jibiinkoka Gakkai kaiho Vol. 106(1), pp. 21-27	article
Abstract: We studied 242 inpatients--men (34%) and women (66%) reporting vertigo and dizziness while hospitalized at Hakodate Municipal Hospital from July 1999 to June 2002. Adults over 65 years old accounted for 47.3% of all subjects. Reports of symptoms tended to increase in March, August, and December. Cases were classified into 4 groups: 1) peripheral disorders (35.7%), 2) central disorders (7.9%), 3) disorders of other origins (8.3%), and 4) disorders of unknown origin (47.1%). Group 1) involved vestibular neuritis (10.1% of all cases), Meniere diseases (12.4%), benign paroxysmal positional vertigo (BPPV) (5.8%), and sudden deafness with vertigo (5.8%). Patients with vestibular neuritis--25 subjects including men (68%) and women (32%)--tended to be admitted mainly in July. Vestibular compensation in 15 patients with vestibular neuritis was studied using the platform stabilometry. The total length of a locus and the area of surroundings with open eyes decreased significantly (p < 0.05) as the condition of patients improved. In conclusion, many subjects reporting vertigo and dizziness had vestibular neuritis and few had BPPV. We found platform stabilometry to be useful in estimation of improvement in patients with vestibular neuritis.
BibTeX: @article{Narita2003, author = {Narita, Shinichiro and Kurose, Makoto and Kobayashi, Kazutoyo and Himi, Testuo}, title = {[Study on 242 inpatients reporting vertigo and dizziness].}, journal = {Nihon Jibiinkoka Gakkai kaiho}, year = {2003}, volume = {106}, issue = {1}, pages = {21--27}, keywords = {Adult; Aged; Aged, 80 and over; Dizziness, etiology, physiopathology; Female; Humans; Male; Middle Aged; Vertigo, etiology, physiopathology; Vestibular Neuronitis, complications}, pmid = {12647320} }
Gu, C.Y., Han, W.W., Wu, Y.Q., Fan, Z.Y., Chen, C.J. and Chen, H.M.	[Study on bone metabolism in postmenopausal women with idiopathic benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2018	Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery Vol. 53(2), pp. 134-137	article	DOI
Abstract: To analyze the bone mineral density and serum osteocalcin levels in postmenopausal women with idiopathic benign paroxysmal positional vertigo. A total of 64 postmenopausal women with idiopathic BPPV were selected as the study group, and 98 postmenopausal healthy women were selected as the control group. Bone mineral density and serum osteocalcin levels were analyzed and compared between the groups.χ(2) test was used for numeration data and test was used for measurement data. The prevalence of osteoporosis or osteopenia in BPPV group 67.2% (43/64) was significantly higher than that in the control group 51.0% (50/98) (χ(2)=4.139, =0.042). Among BPPV subjects, there was a negative correlation between osteocalcin and bone density T ( =-0.469, <0.001). Osteocalcin was found in normal bone mass subgroup (13.61±4.32)μg/L, decreased bone mass subgroup (17.49±7.61)μg/L, and osteoporosis subgroup (20.83±6.72)μg/L, respectively, and the difference was statistically significant ( =5.39, =0.007). Bone mineral density in BPPV group is lower than that in control group. The lower the bone mineral density of the patients, the higher the osteocalcin in BPPV group.
BibTeX: @article{Gu2018a, author = {Gu, C Y and Han, W W and Wu, Y Q and Fan, Z Y and Chen, C J and Chen, H M}, title = {[Study on bone metabolism in postmenopausal women with idiopathic benign paroxysmal positional vertigo].}, journal = {Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery}, year = {2018}, volume = {53}, issue = {2}, pages = {134--137}, doi = {https://doi.org/10.3760/cma.j.issn.1673-0860.2018.02.010}, keywords = {Benign Paroxysmal Positional Vertigo, blood; Bone Density; Case-Control Studies; Female; Humans; Osteocalcin, blood; Osteoporosis, epidemiology; Postmenopause, blood; Prevalence; Bone density; Metabolism; Osteocalcin; Vertigo}, pmid = {29429184} }
Zhao, D. and Jiang, Z.G.	[Study on the characteristics and clinical significance of relief of nystagmus during the restoration of benign paroxysmal positional vertigo with posterior semicircular canal]. [Abstract] [BibTeX]	2018	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 32(15), pp. 1134-1138	article	DOI
Abstract: The features and parameters of the relief of nystagmus during the restoration of benign paroxysmal positional vertigo(PC-BPPV) in the posterior semicircular canal were observed to explore its clinical significance and mechanism. Sixty-eight patients with PC-BPPV were treated with the Epley method. According to the subject' nystagmus relief was present or not, they were divided into two groups: group A showed relief of nystagmus during the restoration process, and group B showed no relief of nystagmus during the restoration. The effect of restoration between group A and group B was compared, and the parameters of nystagmus between the detached nystagmus and the Hallpike position in group A patients with detachable nystagmus were compared. Of the 68 patients with PC-BPPV, 33(48.5%) experienced detachment of nystagmus in the same direction as the initial nystagmus(Group A) during the restoration; 35(51.5%) patients had no nystagmus during the restoration(Group B). After the instrument was reset for 2 h, Dix-Hallpike test was performed again. The success rate of reset was 100% in group A,and that was 57% in group B(20 cases were successfully repositioned, and 15 cases showed typical nystagmus). The success rate of reset was statistically different between groups A and B( <0.01). After one week of resetting, the telephone follow-up was carried out. The recovery rate of group A and group B were 93% and 74% separately.The recovery rates between group A and B were statistically different( <0.05). In group A, the nystagmus latency at Hallpike was(2.63±2.17) s, and the duration was(17.27±5.94) s. The rate of nystagmus in the upper leaping eye was(16.19±9.54)°/s. The latency of liberation was(2.30±1.41) s and the duration was(11.84±5.98) s. In seconds, the slow phase phasic velocity of the nystagmus was(7.80±4.57)°/s; there was no statistical difference in latency between the detached nystagmus and the Hallpike nystagmus( >0.05), while there was a statistically significant difference between the duration and the nystagmus intensity( <0.01). For PC-BPPV restoration, the presence or absence of nystagmus can be used as a reference to judge whether the restoration succeed or not.The latency of nystagmus at the Hallpike position may be related to the stalactite precipitation rate. The duration and the slow phase angle velocity of the upper hop eye may be related to the otolith quantity.
BibTeX: @article{Zhao2018, author = {Zhao, D and Jiang, Z G}, title = {[Study on the characteristics and clinical significance of relief of nystagmus during the restoration of benign paroxysmal positional vertigo with posterior semicircular canal].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2018}, volume = {32}, issue = {15}, pages = {1134--1138}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2018.15.003}, keywords = {benign paroxysmal positional vertigo; posterior semicircular canal; release nystagmus}, pmid = {30282143} }
Zhang, J.L. and Hui, L.	[Study on the characteristics of benign paroxysmal positional vertigo and the influencing factors of short-term residual symptoms after reposition treatment]. [Abstract] [BibTeX]	2018	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 32(13), pp. 1016-1019	article	DOI
Abstract: The objective of this article is to study the characteristics of benign paroxysmal positional vertigo (BPPV) and the influencing factors of residual symptoms after otolith repositioning therapy, so as to provide references for clinical diagnosis and treatment. From June to November in 2017，568 patients with BPPV were diagnosed and treated in otolaryngology out-patient clinics. All of these patients were followed up after 1 month, and we summarized the amount of residual symptoms.The age,sex,type of disease, etiological factor and the condition of internal medicine were compared between residual symptom ones and no residual symptom ones. All data were statistically analyzed by SPPS 22.0 software. The age range was 12-92 years, and the average age of onset was (54.89±13.06) years. The proportion of men and women was 1.00∶2.74, and the number of middle aged and elderly women at the age of 45-65 was the highest, up to 74.4%. The posterior semicircular canal accounted for about 55.6%, the horizontal semicircular canal accounted for about 22.6%, and the two kinds of semicircular canals were involved in about 21.8%. Primary BPPV accounted for about 90.67% and secondary BPPV accounted for about 9.33%. Secondary BPPV patients had more trauma and middle ear surgery. After reposition, there were 98 remnants of dizziness and balance disorder. There was no significant difference of residual symptoms ( >0.05) between the different sex,the cause and the incidence of the disease. Whether more than 65 years old, whether or not accumulative semicircular canals,whether the combination of related internal medical diseases were compared ( <0.05), and the difference was statistically significant. The residual symptoms such as dizziness and balance disorder were easy to occur after otolith reduction in patients with older, multisemiconventional tube and associated internal medical diseases. Correct guidance and education should be carried out for the patients, and the training of the vestibule rehabilitation should be instructed.
BibTeX: @article{Zhang2018a, author = {Zhang, J L and Hui, L}, title = {[Study on the characteristics of benign paroxysmal positional vertigo and the influencing factors of short-term residual symptoms after reposition treatment].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2018}, volume = {32}, issue = {13}, pages = {1016--1019}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2018.13.014}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, therapy; Child; Dizziness; Female; Humans; Incidence; Male; Middle Aged; Patient Positioning; Semicircular Canals; Young Adult; benign paroxysmal positional vertigo; reduction treatment; residual symptoms}, pmid = {29986567} }
Gu, X., Dong, F.L. and Gu, J.H.	[Study on the serum 25-hydroxyvitamin D levels of benign paroxysmal positional vertigo patients]. [Abstract] [BibTeX]	2017	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 31(12), pp. 924-926	article	DOI
Abstract: To study whether serum 25-hydroxy vitamin D can be used as an independent indicator of prognosis in patients with benign paroxysmal positional vertigo. Two hundred and two patients with BPPV were collected and divided into vitamin D deficiency group and control group according to their serum 25-OHD level. The severity of the symptoms and the recurrence rate were compared between the two groups. Compared with the control group, patients with vitamin D deficiency group showed severer symptoms, either in longer duration of vertigo, lower success rate of repositioning maneuver treatment at the first time, or higher recurrence rate within six months. Serum 25-OHD level was negatively correlated with the severity and prognosis of BPPV, and could be used as an important index to evaluate the prognosis of BPPV.
BibTeX: @article{Gu2017, author = {Gu, X and Dong, F L and Gu, J H}, title = {[Study on the serum 25-hydroxyvitamin D levels of benign paroxysmal positional vertigo patients].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2017}, volume = {31}, issue = {12}, pages = {924--926}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2017.12.007}, keywords = {Benign Paroxysmal Positional Vertigo, blood, complications; Humans; Prognosis; Recurrence; Vitamin D, analogs & derivatives, blood; Vitamin D Deficiency, complications; osteoporosis; otoliths; vertigo; vitamin D deficiency}, pmid = {29798413} }
Craighero, F., Casselman, J.W., Safronova, M.M., De Foer, B., Delanote, J. and Officiers, E.F.	[Sudden onset vertigo: imaging work-up]. [Abstract] [BibTeX]	2011	Journal de radiologie Vol. 92(11), pp. 972-986	article	DOI
Abstract: Vertigo and dysequilibrium are a frequent cause of medical consultation. Clinical evaluation is essential. Some cases of vertigo are diagnosed clinically while others require imaging, sometimes emergently (suspected stroke). MRI is the imaging modality of choice to assess the labyrinth (labyrinthitis? labyrinthine hemorrhage?), internal auditory canal (vestibular schwannoma? other tumor?…) and brain parenchyma including all structures of the auditory pathways: vestibular nuclei, vestibulocerebellar tract, tracts involved with ocular motricity, vestibular cortex… Multiple central etiologies exist: stroke, multiple sclerosis, tumor… However, some etiologies are best depicted with CT, especially lesions of the labyrinth: cholesteatoma, trauma, suspected dehiscence of the superior semicircular canal, suspected labyrinthine fistula… Finally, imaging may be negative (Benign Paroxysmal Positional Vertigo, Meniere's disease, vestibular neuritis, migraine…), merely reducing the differential diagnosis.
BibTeX: @article{Craighero2011, author = {Craighero, F and Casselman, J W and Safronova, M M and De Foer, B and Delanote, J and Officiers, E F}, title = {[Sudden onset vertigo: imaging work-up].}, journal = {Journal de radiologie}, year = {2011}, volume = {92}, issue = {11}, pages = {972--986}, doi = {https://doi.org/10.1016/j.jradio.2011.09.001}, keywords = {Acute Disease; Humans; Magnetic Resonance Imaging; Tomography, X-Ray Computed; Vertigo, diagnosis, etiology}, pmid = {22098646} }
Böhmer, A., Briner, H.R. and Schmid, R.	[Sudden vertigo--differential diagnosis and therapy in peripheral vestibular (inner ear-induced) forms]. [Abstract] [BibTeX]	1996	Praxis Vol. 85(39), pp. 1206-1210	article
Abstract: The most important forms of inner ear disorders manifesting as sudden vertigo may be distinguished by the duration of the vertiginous spells: sudden vertigo, diminishing during days = acute peripheral vestibulopathy, recurrent spells lasting for hours = Ménière's disease, recurrent vertigo lasting for minutes = "vascular', recurrent positioning-induced vertigo lasting for seconds = benign paroxysmal positioning vertigo (BPPV). In the last years, major progress was made in the treatment of BPPV. Based on new ideas on the underlying pathomechanism, this most common form of vestibular vertigo now can be treated definitively in most patients within a few minutes by a simple maneuver (canalith reposition maneuver by Epley/Parnes). This procedure is presented in this paper.
BibTeX: @article{Boehmer1996, author = {Böhmer, A and Briner, H R and Schmid, R}, title = {[Sudden vertigo--differential diagnosis and therapy in peripheral vestibular (inner ear-induced) forms].}, journal = {Praxis}, year = {1996}, volume = {85}, issue = {39}, pages = {1206--1210}, keywords = {Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Calculi, physiopathology; Female; Humans; Male; Meniere Disease, physiopathology; Middle Aged; Nystagmus, Pathologic, physiopathology; Posture, physiology; Semicircular Canals, physiopathology; Vertigo, diagnosis, physiopathology, therapy; Vestibular Diseases, physiopathology}, pmid = {8927905} }
Pérez, N., Pastor, M.J., Zubieta, J.L. and García Tapia, R.	[Surgery of the posterior semicircular duct for the treatment of BPPV]. [Abstract] [BibTeX]	1999	Acta otorrinolaringologica espanola Vol. 50(8), pp. 640-643	article
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo in the otolaryngology clinic. The liberatory maneuvers are the treatment of choice in this entity. In a low percentage of patients, about 5-10%, we found no response to the maneuvers. The occlusion of the posterior semicircular canal is offered for intractable cases. We report a case of woman with an intractable BPPV in which an occlusion of the posterior semicircular was done. We describe the indications, how to perform the surgery and the functional results of this technique.
BibTeX: @article{Perez1999, author = {Pérez, N and Pastor, M J and Zubieta, J L and García Tapia, R}, title = {[Surgery of the posterior semicircular duct for the treatment of BPPV].}, journal = {Acta otorrinolaringologica espanola}, year = {1999}, volume = {50}, issue = {8}, pages = {640--643}, keywords = {Aged; Female; Humans; Semicircular Canals, surgery; Vertigo, surgery}, pmid = {10619901} }
Häusler, R. and Pampurik, J.	[Surgical and physical therapy treatment of benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	1989	Laryngo- rhino- otologie Vol. 68(6), pp. 349-354	article	DOI
Abstract: Two treatments for the benign paroxysmal positional vertigo are presented and evaluated in this article. The first type of treatment is the surgical section of the posterior ampullary nerve according to Gacek and the second is physiotherapeutic by the manoeuvre of Semont. The section of the posterior ampullary nerve has been realised between 1980 and 1986 on 5 patients suffering from persistent and disabling positional vertigo. All 5 patients were relieved from their vertigo immediately after the operation. One patient developed a post-operative hearing loss. The physiotherapeutic manoeuvre of Semont, which has been developed in order to liberate otolithic deposits from the cupula of the posterior semi-circular canal is applied in our clinic since 1985 as treatment of the benign paroxysmal positional vertigo. The efficiency of the manoeuvre was tested at first in a retrospective study on 50 patients. A single manoeuvre cured 20 of these patients and 15 others were cured after a second manoeuvre. Then, a controlled and prospective study was performed: the clinical course of 40 patients without treatment was compared with 37 patients treated with Semont's manoeuvre. In the group of patients without treatment, only 17 were spontaneously cured from their positional vertigo after 18 days of evolution. In the group treated by Semont's manoeuvre 19 patients were completely healed from vertigo and 16 others were greatly improved. On the basis of these favourable results the authors recommend to treat all cases of paroxysmal positional vertigo at first with Semont's manoeuvre. The section of the posterior ampullary nerve should be restricted to the rare cases with persistent and disabling vertigo.(ABSTRACT TRUNCATED AT 250 WORDS)
BibTeX: @article{Haeusler1989, author = {Häusler, R and Pampurik, J}, title = {[Surgical and physical therapy treatment of benign paroxysmal positional vertigo].}, journal = {Laryngo- rhino- otologie}, year = {1989}, volume = {68}, issue = {6}, pages = {349--354}, doi = {https://doi.org/10.1055/s-2007-998351}, keywords = {Follow-Up Studies; Humans; Meniere Disease, rehabilitation, surgery; Physical Therapy Modalities, methods; Posture; Recurrence; Semicircular Canals, innervation; Vestibular Nerve, surgery}, pmid = {2742660} }
Zaugg, Y., Grosjean, P. and Maire, R.	[Surgical treatment of benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2012	Revue medicale suisse Vol. 8(356), pp. 1876, 1878-1876, 1880	article
Abstract: Benign paroxysmal positional vertigo (BPPV) is a common disorder that presents to the general practitioner. This condition represents one of the most common causes of peripheral vertigo. The diagnosis is made on clinical grounds. The treatment relies on repositioning maneuvers with relief of symptoms that occur in a few weeks in the majority of the cases. Rarely, patients are incapacitated by persistent or recurrent BPPV despite multiple repositioning maneuvers. In these cases, surgical therapies are available which provide excellent results.
BibTeX: @article{Zaugg2012, author = {Zaugg, Y and Grosjean, P and Maire, R}, title = {[Surgical treatment of benign paroxysmal positional vertigo].}, journal = {Revue medicale suisse}, year = {2012}, volume = {8}, issue = {356}, pages = {1876, 1878--1876, 1880}, keywords = {Benign Paroxysmal Positional Vertigo; Humans; Models, Biological; Otorhinolaryngologic Surgical Procedures, methods; Patient Positioning, methods; Vertigo, diagnosis, surgery, therapy}, pmid = {23133890} }
Juszczak, M. and Głabiński, A.	[Th17 cells in the pathogenesis of multiple sclerosis]. [Abstract] [BibTeX]	2009	Postepy higieny i medycyny doswiadczalnej (Online) Vol. 63, pp. 492-501	article
Abstract: Th17 cells are a recently described subset of T helper lymphocytes characterized by the production of IL-17 (IL-17A). Since their discovery in 2003, studies on Th17 cells have become increasingly popular among immunologists and they have emerged as key players in the pathogenesis of multiple sclerosis (MS) and other autoimmune disorders traditionally attributed to Th1 cells. Murine Th17 lymphocytes differentiate from naive CD4+ cells in a specific cytokine environment, which includes TGF-b and IL-6 or IL-21, whereas human Th17 cell development requires TGF-beta, IL-1b, and IL-2 in combination with IL-6, IL-21, or IL-23. Th17-related response is additionally enhanced by osteopontin, TNFalpha, and PGE2 and suppressed by IL-25, IL-27, IL-35, and IL-10. Apart from their main cytokine, Th17 cells can also express IL-17F, IL-21,IL-22, TNFalpha, CCL20, and, in humans, IL-26. All of these mediators may contribute to the proinflammatory action of Th17 cells both in the clearance of various pathogens and in autoimmunity. At least some of these functions are exerted through the induction of neutrophil-recruiting chemokines (CXCL1, CXCL2, CXCL8) by IL-17. Accumulating evidence from studies on mice and humans indicates an important role of Th17 cells in mediating autoimmune neuroinflammation. This has led some immunologists to question the previously exhibited importance of Th1 cells in MS pathology. However, more recent data suggest that both these T-cell subsets are capable of inducing and promoting the disease. Further investigation is required to clarify the role of Th17 cells in the pathogenesis of MS since some of the Th17-related molecules appear as attractive targets for future therapeutic strategies.
BibTeX: @article{Juszczak2009, author = {Juszczak, Marek and Głabiński, Andrzej}, title = {[Th17 cells in the pathogenesis of multiple sclerosis].}, journal = {Postepy higieny i medycyny doswiadczalnej (Online)}, year = {2009}, volume = {63}, pages = {492--501}, keywords = {Animals; Autoimmunity, immunology; Humans; Interleukin-17, metabolism; Mice; Multiple Sclerosis, immunology; T-Lymphocytes, Helper-Inducer, immunology}, pmid = {19940328} }
Reiss, M. and Reiss, G.	[The 10-minute consultation. Benign paroxysmal positional vertigo]. [BibTeX]	2006	MMW Fortschritte der Medizin Vol. 148(41), pp. 47-48	article
BibTeX: @article{Reiss2006, author = {Reiss, M and Reiss, G}, title = {[The 10-minute consultation. Benign paroxysmal positional vertigo].}, journal = {MMW Fortschritte der Medizin}, year = {2006}, volume = {148}, issue = {41}, pages = {47--48}, keywords = {Diagnosis, Differential; Female; Humans; Middle Aged; Physical Therapy Modalities; Vertigo, diagnosis, etiology, therapy}, pmid = {17190263} }
Cui, Y., Wang, X., Fu, M., Ge, R., Haung, H., Wu, P. and Chen, S.	[The additional 180° roll test in the determination of affected side of horizontal semicircular canal benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2014	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 28(19), pp. 1492-1494	article
Abstract: To evaluate the significance of additional 180-degree roll test (RT) in the determination of affected side in patients with horizontal semicircular canal benign paroxysmal vertigo (HSC-BPPV). One hundred and six patients with HSC-BPPV were performed the 90 degree RT. patients whose affected side cannot be determined by 90 degree RT were performed 180 degree roll test. The affected side was deter- mined by the 180 degree RT in 10 cases in which the lesion side cannot be determined by the 90-degree RT. The affected side of HSC BPPV was able to be determined by 180 degree RT when it not possible to be determined by 90 degree RT. 180 degree RT is an effective and simple additional method.
BibTeX: @article{Cui2014, author = {Cui, Yong and Wang, Xiaoqian and Fu, Min and Ge, Runmei and Haung, Hongming and Wu, Peina and Chen, Shaohua}, title = {[The additional 180° roll test in the determination of affected side of horizontal semicircular canal benign paroxysmal positional vertigo].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2014}, volume = {28}, issue = {19}, pages = {1492--1494}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis; Head Movements; Humans; Posture; Rotation; Semicircular Canals; Vertigo}, pmid = {25775754} }
Cui, X., Feng, Y., Mei, L., He, C., Lu, X., Zhang, H. and Chen, H.	[The analysis of nystagmus in patients with posterior canal benign paroxysmal positional vertigoin positioning test]. [Abstract] [BibTeX]	2015	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 29(1), pp. 27-30	article
Abstract: To analyze and summarize nystagmus of patients with posterior canal benign paroxysmal positional vertigo (BPPV) in positioning test,and to improve the diagnosis and treatment of posterior canal BPPV (PSC-BPPV). The present study was conducted on 175 patients who had unilateral BPPV of the posterior semicircular canal (PSC). Their positional nystagmus recorded by videnonystagmography in Dix-Hallpike test,roll test and roll over test were analyzed to summarize the characteristics of nystagmus on nystagmograph of PSC-BP-PV. Of the 175 patients, lesion was located in the left PSC in 69 (39.4%) patients,the right PSC in 106 (60. 6%)patients. The nystagmus of patients with PSC-canalithiasis showed upward on the vertical phase of nystagmograph and orientated the different side on horizontal phase in the head hangging position. The horizontal phase pointed to the contralateral side in 47(26. 9%) patients, the ipsilateral contralateral side in 100(57. 1%) patients,no significant reverse ingredients in 28(16.0%) patients. When these patients returned to sit,139(79.4%) patients showed down beating positioning nystagmus, whereas 36 (20. 6%) patients with no nystagmus only had a short vertigo or dizziness. The horizontal phase of the 139 patients pointed to the contralateral side in 40(22. 9%) patients,the ipsilateral contralateral side in 68(38. 9%) patients,no significant reverse ingredients in 31(17. 7%) patients. In roll test,12 patients of the right PSC-BPPV presented an up-beating rotatory nystagmus when the head turned to right,and 5 patients of the left PSC-BPPV presented a down-beating rotatory nystagmus when the head turned to left. When the patients changed body from the left lateral position to the right lateral position in the roll over test, 74(42. 3%) patientsshowed vertical positioning nystagmus. In 30 patients who presented an up-beating nystagmus, there were 25(83. 3%) patientscame from the right PSC-BPPV. In 44 patients who presented a down-beating nystagmus, there were 36(81. 8%) patientscame from the left PSC-BPPV. The direction of the vertical nystagmus was highly correlated with the judgment about the side of the PSC-BPPV in roll over test (P<0. 01). The patient with PSC-canalithiasis showed an uncertain direction in torsional nystagmus in Dix-Hallpike test,the diagnosis was mainly concern with the vertical nystagmus. When we found a rotatory nystagmus with much more up-beating nystagmus in roll test, it might be PSC-BPPV. We also can use the roll over test to diagnose the location of the otolith in which side of the PSC-BPPV.
BibTeX: @article{Cui2015, author = {Cui, Xiangning and Feng, Yong and Mei, Lingyun and He, Chufeng and Lu, Xiaojing and Zhang, Hua and Chen, Hongsheng}, title = {[The analysis of nystagmus in patients with posterior canal benign paroxysmal positional vertigoin positioning test].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2015}, volume = {29}, issue = {1}, pages = {27--30}, keywords = {Benign Paroxysmal Positional Vertigo, complications; Dizziness; Electronystagmography; Face; Head; Humans; Nystagmus, Physiologic; Otolithic Membrane; Patient Positioning; Semicircular Canals; Vertigo; Vestibular Function Tests}, pmid = {25966550} }
Ding, B. and Chen, X.H.	[The analysis of the misdiagnosis big data of the otolaryngology during 2004 to 2013 in China]. [Abstract] [BibTeX]	2016	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 30(15), pp. 1195-1200	article	DOI
Abstract: The aim of this study is to explore the misdiagnosis status of the otolaryngology in China as well as to provide evidence to reduce misdiagnosis and improve the diagnostic level. The retrieval and management system of the misdiagnosed diseases database developed by Chen Xiaohong was used for searching the literature of the misdiagnosis in otolaryngology.The 10 year' smisdiagnosis literature data of the otolaryngology(from 2004 to 2013) were analyzed including the literature sources, sample size, misdiagnosis rate,misdiagnosis consequences and misdiagnosis reasons. A total of 369 articles were found,including 4211 cases.The average misdiagnosis rate was 25.43% in 51 diagnosed diseases.The top misdiagnosed diseases were nasopharyngeal tuberculosis(84.76%),tuberculous otitis media (75%) and congenital laryngeal cyst(75%).The lowest misdiagnosed disease was nasosinusitis(5.92%).The top three misdiagnosed diseases were tuberculosis of otolaryngology(1216 cases),nasosinusitis(710 cases) and BPPV(697 cases).After statistical analysis,we found that 97.22% of the misdiagnosed patients were grade Ⅲ consequences (that is the misdiagnosis and mistreatment does not cause adverse consequences),but there were still 10 cases caused gradeⅠconsequences(death or sequela).The main causes of the misdiagnosis were lack of diagnosis experience, non detailed interrogation and physical examination and non targeted examinations. The big data of the 10 years reflects the misdiagnosis phenomenon in otolaryngology to some extent.Neurologist, stomatologist and ophthalmologist should be familiar to the main points of the differential diagnosis diseases of the otolaryngology and strive to reduce the clinical misdiagnosis and mistreatment.
BibTeX: @article{Ding2016, author = {Ding, B and Chen, X H}, title = {[The analysis of the misdiagnosis big data of the otolaryngology during 2004 to 2013 in China].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2016}, volume = {30}, issue = {15}, pages = {1195--1200}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2016.15.005}, keywords = {China; Diagnosis, Differential; Diagnostic Errors; Humans; Laryngeal Diseases, diagnosis; Otolaryngology, standards; Retrospective Studies; diagnostic errors; ear diseases; laryngeal diseases; nose diseases; pharyngeal diseases}, pmid = {29798328} }
Li, S., Wang, Q., Dong, J. and Zhou, X.	[The assessment of sequential treatment for subjective and objective benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2016	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 30(5), pp. 386-388	article
Abstract: To compare the effectiveness of sequential treatment for subjective and objective benign paroxysmal positional vertigo(BPPV). The efficacy of sequential treatment for nineteen vertical semicircular canal S-BPPV patients(Group A) and forty-five vertical semicircular canal O-BPPV patients(Group B) who were admitted to our hospital between January 2014 and July 2015 was retrospectively analyzed and compared, treatment of five cases with horizontal semicircular canal S-BPPV was reported here as well. The number of repositioning maneuver for Group A was 2 - 6 times (average: 4. 21±1. 18) while 2 - 3 times (average: 2. 29 ± 0. 46) for Group B. There was significant difference between the two groups(P<0. 01). The effective rate of initial treatment for Group A was 78. 9%(15/19) while 82. 2%(37/45)for Group B. After one weeks treatment, the effective rate for Group A changed to be 89. 5% (17/19)while 88. 9% (40/45) for Group B. Non-significant difference was found in the two groups neither in the initial nor one weeks treatment. On three months' follow-up, one in Group A and two in Group B relapsed, and they were cured after treated in the initial treatment. The recurrence for Group A was 5. 3%(1/19) while 4. 4%(2/45) for Group B and there was non-significant difference. The five cases with horizontal semicircular canal S-BPPV were completely free of disease after undergoing treatment. The sequential treatment is effective for both vertical semicircular canal S-BPPV and vertical semicircular canal O-BPPV, but the former needs more repositioning maneuver times. The repositioning maneuver, combined with drug therapy and head-shake-in-supine-position method is recommended for horizontal semicircular canal S-BPPV.
BibTeX: @article{Li2016a, author = {Li, Shuang and Wang, Qing and Dong, Jie and Zhou, Xuhong}, title = {[The assessment of sequential treatment for subjective and objective benign paroxysmal positional vertigo].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2016}, volume = {30}, issue = {5}, pages = {386--388}, keywords = {Benign Paroxysmal Positional Vertigo, therapy; Humans; Patient Positioning; Recurrence; Retrospective Studies; Semicircular Canals, physiopathology; Treatment Outcome}, pmid = {27382683} }
Zhou, R., Liu, B., Zhang, S., Liu, D., Liu, J., Leng, Y. and Kong, W.	[The balance function of the patients with benign paroxysmal positional vertigo during standing]. [Abstract] [BibTeX]	2015	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 29(22), pp. 1966-1969	article
Abstract: The purpose of the study was to investigate the balance function of the patients with benign paroxysmal positional vertigo (BPPV) during standing. In this study 41 patients with posterior semicircular canal BPPV (PC BPPV) and 11 patients with horizontal semicircular canal BPPV (HC BPPV) were recruited. Dynamic balance during standing was measured in Sensory Organization Test (SOT). Static balance during standing was measured in modified Clinical Test of Sensory Interaction and Balance (mCTSIB). Data of BPPV patients were compared to that from 44 normal controls. Scores of the patients with PC BPPV were lower than that of the normal controls in the last three test conditions of SOT. Patients with PC BPPV demonstrated greater sway velocity in stance on foam with eyes open and eyes closed in mCTSIB. No postural deficit was observed in neither SOT nor mCTSIB when the patients with HC BPPV were compared to the normal controls. Disorders of the horizontal semicircular canal do not influence postural control. Both dynamic and static posturography can detect the postural imbalance caused by posterior semicircular canal dysfunction.
BibTeX: @article{Zhou2015, author = {Zhou, Renhong and Liu, Bo and Zhang, Sulin and Liu, Dongdong and Liu, Jingjing and Leng, Yangming and Kong, Weijia}, title = {[The balance function of the patients with benign paroxysmal positional vertigo during standing].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2015}, volume = {29}, issue = {22}, pages = {1966--1969}, keywords = {Benign Paroxysmal Positional Vertigo, physiopathology; Case-Control Studies; Humans; Postural Balance; Semicircular Canals, physiopathology}, pmid = {26911060} }
Ma, X., Zhang, X., Jing, Y. and Yu, L.	[The bithermal test in idiopathic benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2009	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 23(10), pp. 439-442	article
Abstract: Comparison of the bithermal test in benign paroxysmal positional vertigo (BPPV) before and after particle repositioning maneuver (PRM), identify the possible mechanisms of canal paralysis in BPPV. Ninety-six BPPV cases during 2005-2008 were randomly divided into two groups: 52 cases were carried bithermal test before PRM, and the other 44 cases were carried after successful PRM. According to the canal paresis(CP) > or = 20%, subdivided each patients group the normal semicircular canal (SC) function group and the paresis SC function group. Compared the ratio of paresis SC function between the subgroups. Except the ages of the first group were younger than the second group, the gender rate, semicircular canal involved, side involved, course of the disease, recurrent attacks were all equal between the two groups. Using chi square test to compare the ratio of paresis SC between the two groups (t = 0.654, P < 0.05), the differences between the two groups were not statistical. PRM has no influence to the bithermal test in BPPV. The mechanisms of the paresis SC function may be the extensive pathological changes in the vestibular system. The floating otolith has little effect on the dynamic of the endolymph.
BibTeX: @article{Ma2009, author = {Ma, Xin and Zhang, Xiang and Jing, Yuanyuan and Yu, Lisheng}, title = {[The bithermal test in idiopathic benign paroxysmal positional vertigo].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2009}, volume = {23}, issue = {10}, pages = {439--442}, keywords = {Adult; Aged; Aged, 80 and over; Caloric Tests; Female; Humans; Male; Middle Aged; Otolithic Membrane; Paresis, physiopathology; Semicircular Canals, physiopathology; Vertigo, physiopathology; Young Adult}, pmid = {19670623} }
Wang, S.F., Zhang, L., Li, G.H., Zhang, W.W., Wang, Y.P. and Geng, B.	[The change of female progesterone level and blood calcium concentration in perimenopausal women with benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2017	Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery Vol. 52(4), pp. 287-290	article	DOI
Abstract: The estrogen level and blood calcium concentration changes were studied on menopausal women with benign paroxysmal positional vertigo (BPPV). Between January 2015 and January 2016, 70 menopause women with BPPV in outpatient clinics of Department of Otorhinolaryngology, Inner Mongolia Medical University Affiliated Hospital were included in this study as research group, while 30 menopause healthy women who came to hospital for check-up were included as control group. Serum levels of estradiol (E2), follicle stimulating hormone (FSH), luteinizing hormone (LH), progesterone (PRO), testosterone (T), serum prolactin (PRL) and the calcium concentration were analysed and comparied between research group and control group. SPSS17.0 statistical software was used to analyze the data. χ(2) test was used to compare the percentage of decreased serum level of sex hormone, and test was used to compare the serum level of sex hormone and calcium concentration of two groups. In research group, sex hormone decreased proportion of E2 (91%) and PRO (67%) were obviously higher than those in control group (χ(2) value was 8.13, 10.28, respectively, all <0.05). The E2 and PRO in research group were significantly lower than those in control group ((33.18±31.45) pmol/L (64.92 ±31.52) pmol/L, (0.64±0.48) nmol/L (1.02±0.60) nmol/L, value was 6.238, 8.566, respectively, all <0.05). There was no statistically significant difference of the level of LH, PRL, T, FSH and blood calcium concentration in research group compared with control group ((29.81±13.13) U/L (27.21±10.19) U/L, (0.49±0.20) nmol/L (0.49±0.15) nmol/L, (0.56±0.42) nmol/L (0.73±0.62) nmol/L, (64.25±31.44) U/L (60.38±29.97) U/L, (2.28±0.17) mmol/L (2.32±0.21) mmol/L, value was 13.427, 14.876, 7.505, 12.090, 7.532, respectively, all >0.05). The level of E2 and PRO decrease obviously in postmenopausal women with BPPV, which can cause the inner ear microcirculation disorder , may be one of the risk factors of BPPV.
BibTeX: @article{Wang2017, author = {Wang, S F and Zhang, L and Li, G H and Zhang, W W and Wang, Y P and Geng, B}, title = {[The change of female progesterone level and blood calcium concentration in perimenopausal women with benign paroxysmal positional vertigo].}, journal = {Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery}, year = {2017}, volume = {52}, issue = {4}, pages = {287--290}, doi = {https://doi.org/10.3760/cma.j.issn.1673-0860.2017.04.010}, keywords = {Benign Paroxysmal Positional Vertigo, blood; Calcium, blood; China; Estradiol, blood; Estrogens, blood; Female; Follicle Stimulating Hormone, blood; Humans; Luteinizing Hormone, blood; Perimenopause, blood; Progesterone, blood; Testosterone, blood; Benign paroxysmal positional vertigo; Estrogens; Perimenopause; Progestins}, pmid = {28441807} }
Wu, Z.-p., Zhou, B., Chen, H.-b. and Jiang, L.	[The characteristics of benign paroxysmal positional vertigo and application of Epley's maneuver in very old patients]. [Abstract] [BibTeX]	2010	Zhonghua nei ke za zhi Vol. 49(7), pp. 599-601	article
Abstract: To analyze the characteristics of benign paroxysmal positional vertigo (BPPV) and the efficacy and safety of Epley's maneuver in very old patients. A retrospective review of 29 (16.5%) patients with BPPV out of 176 consecutively admitted patients aged 80 and over presented with a complaint of dizziness was performed. In all 29 patients the BPPV origin was attributed to posterior canal involvement; 24 (82.8%) were idiopathic, 4 with a history of Ménière's disease, and 1 secondary to head trauma; 18 (62.1%) were right-side involved; and 25 (86.2%) were diagnosed previously as vertebral-basilar insufficiency. Cardio- and cerebrovascular diseases and the correlative risk factors were common both in patients with BPPV and those with non-BPPV dizziness. Twenty-one patients underwent Epley's maneuver, all were free of vertigo after treatment, 14 of them after a single session and the remaining 2 to 4 sessions. No significant complications were observed except in one who experienced vomiting during the procedure. Patients who received Epley's maneuver had a higher cure rate and short recovery time than those who did not. BPPV is not uncommon in very old patients with dizziness. Clinicians should have the knowledge to diagnose and treat this condition. Epley's maneuver is safe and effective in very old patients with BPPV.
BibTeX: @article{Wu2010a, author = {Wu, Zhi-ping and Zhou, Bo and Chen, Hai-bo and Jiang, Lei}, title = {[The characteristics of benign paroxysmal positional vertigo and application of Epley's maneuver in very old patients].}, journal = {Zhonghua nei ke za zhi}, year = {2010}, volume = {49}, issue = {7}, pages = {599--601}, keywords = {Aged, 80 and over; Female; Humans; Male; Retrospective Studies; Treatment Outcome; Vertigo, etiology, therapy}, pmid = {20979772} }
Zhong, J.W., Ou, Y.K., Huang, Q.H., Chen, L., Tang, X.W. and Zheng, Y.Q.	[The characteristics of the patients with BPPV accompanied byidiopathic sudden sensorineural hearing loss]. [Abstract] [BibTeX]	2016	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 30(14), pp. 1118-1120	article	DOI
Abstract: To investigate the characteristics of the patients with BPPV accompanied by idiopathic sudden sensorineural hearing loss(ISSNHL). Retrospective analysis of 150 cases of patients with ISSNHL.All data of the cases were collected,including history,pure tone audiograms and VNG tests. 16.0% of all patients had BPPV accompanied by ISSNHL.77.8% of these patients had an abnormal caloric test result.73.9% of them had a profound hearing loss.The hearing outcome between those with and without BPPV had no significant difference. Patients with BPPV accompanied by ISSNHL seem to have a more severe damage than those without BPPV,while the hearing outcomes seem no significant difference between them.
BibTeX: @article{Zhong2016, author = {Zhong, J W and Ou, Y K and Huang, Q H and Chen, L and Tang, X W and Zheng, Y Q}, title = {[The characteristics of the patients with BPPV accompanied byidiopathic sudden sensorineural hearing loss].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2016}, volume = {30}, issue = {14}, pages = {1118--1120}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2016.14.006}, keywords = {Benign Paroxysmal Positional Vertigo, complications; Hearing Loss, Sensorineural, complications; Hearing Loss, Sudden, complications; Hearing Tests; Humans; Retrospective Studies; benign paroxysmal positional vertigo; caloric test; idiopathic sudden sensorineural hearing loss; prognosis; type of hearing loss}, pmid = {29798434} }
Zhang, Y., Zhang, J., Zhao, J., Wang, Y., Chen, X., Jia, Z., Ma, X. and Yang, Y.	[The clinical application of vestibular diagnosis and treatment system in benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2015	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 29(14), pp. 1248-1252	article
Abstract: To evaluate the effect of the vestibular diagnosis and treatment system (SRM-IV ) in diagnosis and treatment of patients with benign paroxysmal positional vertigo (BPPV). Patients who were diagnosed as BPPV by SRM-TV in the clinic of our hospital from November 2013 to October 2014 were retrospectively analyzed in this study. Among 425 suspected cases, 230 BPPV-positive patients were diagnosed including 131 cases of posterior SC (57.0%), 95 cases of horizontal SC (41.3%) and 4 cases of more than two SC (1.7%). The cure rate by SRM-V was 94.6% and the effective rate was 100.0%. The relapsed occurred in 10 patients (4.8%), which contained 4 men and 6 women. SRM-V can realize 360° reasonable repositioning procedure while Canalish reposition procedure cannot. SRM-V can improve both the corrective rate of diagnosis and the cure rate, especially for the patients who suffered from complex BPPV.
BibTeX: @article{Zhang2015b, author = {Zhang, Ying and Zhang, Jingqiu and Zhao, Jingcheng and Wang, Yu and Chen, Xinyu and Jia, Zhanhong and Ma, Xin and Yang, Yan}, title = {[The clinical application of vestibular diagnosis and treatment system in benign paroxysmal positional vertigo].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2015}, volume = {29}, issue = {14}, pages = {1248--1252}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis, therapy; Female; Humans; Male; Patient Positioning; Retrospective Studies; Vestibule, Labyrinth, physiopathology}, pmid = {26672235} }
Li, P., Zeng, X.-l., Li, Y.-q., Zhang, G.-h. and Ye, J.	[The clinical characteristics of the benign paroxysmal positional vertigo associated with Meniere's disease]. [Abstract] [BibTeX]	2010	Zhonghua yi xue za zhi Vol. 90(27), pp. 1921-1923	article
Abstract: To explore the clinical characteristics of the benign paroxysmal positional vertigo (BPPV) associated with Meniere's disease (MD) in retrospect in an effort to improve the diagnosis and efficacy of treatment. Fifteen cases (1 male and 14 female, aged 46 to 68 years old) of BPPV associated with MD from July 2007 to June 2009 were retrospectively analyzed. Patient clinically characterized with positional paroxysmal vertigo were diagnosed as MD by ECochG and glycerol test and were confirmed as BPPV associated with MD by Dix Hallpike test or roll test. They were treated with Epley maneuver or Barbecue rol maneuver according to the type of BPPV, and the efficacy was evaluated. (1) Most cases involved female patients in this study; (2) BPPV occurred after MD in al of the cases, of which 13 cases were posterior semicircular canal lithiasis (9 cases in the same ear, 2 in the other and 2 in both) and 2 cases were horizontal semicircular canal lithiasis (cupula lithiasis in the same ear); (3) in this study, 10 patients were cured after 3-4 times of posture treatment (66.7%), 4 patients were cured after 5 times and 1 patient received endolymphatic sac decompression because of recurrent vertigo. (1) BPPV can result from MD, for which a possible mechanism may be the hydrolabyrinth that lead to eardust falling off. (2) Most cases of BPPV occurred in the posterior semicircular canal in the same ear. Most cases in incidence rate have obvious sexual bias in female. (3) Eardust reposition is an effective treatment for BPPV caused by MD; while it is refractory compared to ordinary BPPV and require multiple treatments, which may be related to the recurrence of hydrolabyrinth.
BibTeX: @article{Li2010, author = {Li, Peng and Zeng, Xiang-li and Li, Yong-qi and Zhang, Ge-hua and Ye, Jin}, title = {[The clinical characteristics of the benign paroxysmal positional vertigo associated with Meniere's disease].}, journal = {Zhonghua yi xue za zhi}, year = {2010}, volume = {90}, issue = {27}, pages = {1921--1923}, keywords = {Aged; Female; Humans; Male; Meniere Disease, complications; Middle Aged; Retrospective Studies; Semicircular Canals; Vertigo, diagnosis, etiology}, pmid = {20979913} }
Xiong, B.B., Lin, C.M., Lin, Y.F., Liu, J. and Chen, G.G.	[The clinical characteristics of the evoked nystagmus in the non-affected side during Dix-Hallpike test in the unilateral posterior semicircular canal benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2018	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 32(19), pp. 1451-1454	article	DOI
Abstract: To investigate the clinical characteristics of the evoked nystagmus in the non-affected side during Dix-Hallpike test(D-H test)in unilateral posterior semicircular canal benign paroxysmal positional vertigo(PC-BPPV). Two hundred and thirty-six patients were diagnosed with unilateral PC-BPPV in the Tinnitus and Dizziness clinic.Among them,14 patients exhibited positive nystagmus when the non-affected side was stimulated by D-H test. The clinical data from this subgroup of patients were retrospectively analyzed. The upbeat and torsional nystagmus of 14 patients were all evoked by D-H test in the affected side. 11 cases were right PC-BPPV and 3 cases were left PC-BPPV. Among these 14 patients, 5 patients exhibited the upbeat and torsional nystagmus during D-H test in the non-affected side, which was in the same direction as that evoked in the affected side. Among them, 4 cases were right PC-BPPV and 1 case was left PC-BPPV. However, the downbeat nystagmus of the remaining 9 patients were evoked by D-H test in the non-affected side, in which 7 cases were right PC-BPPV and 2 cases were left PC-BPPV.The nystagmus and vertigo of all patients completely disappeared after performing the Epley or Semont repositioning maneuvers on the affected side. The bilateral positive nystagmus of unilateral PC-BPPV can be evoked by D-H test. The form of nystagmus on the non-affected side is related with the initial position of otoconia in affected semicircular canal and the moving direction of otoconia during the positional test. It is effective to perform Epley or Semont repositioning maneuvers on the affected side. Meanwhile, both the effect of maneuvers and the type of nystagmus evoked by D-H test can verify which side is affected.
BibTeX: @article{Xiong2018, author = {Xiong, B B and Lin, C M and Lin, Y F and Liu, J and Chen, G G}, title = {[The clinical characteristics of the evoked nystagmus in the non-affected side during Dix-Hallpike test in the unilateral posterior semicircular canal benign paroxysmal positional vertigo].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2018}, volume = {32}, issue = {19}, pages = {1451--1454}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2018.19.002}, keywords = {Dix-Hallpike; positive nystagmus; vertigo}, pmid = {30550185} }
Zhang, M.X., Zhang, J., Su, J., Xu, Y. and Zhou, H.F.	[The clinical values of oVEMP in the repositioning of otoconia of benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2016	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 30(21), pp. 1706-1709	article	DOI
Abstract: To evaluate whether oVEMP amplitudes increase after successful repositioning of otoconia in patients diagnosed as benign paroxysmal positioning vertigo(BPPV). Fifty-three cases of unilateral pcBPPV were prospectively examined with air-conducted oVEMP at two time points: before, and 1 week after reposition. A commercially available software package SPSS 20.0 was used for statistical analysis. Prevalence was 84.9% before treatment, and it changed to 88.7% 1 week after reposition. During one week follow-up, 28 out of 45 cases were asymptomatic(healing group); vertigo could still be induced in the other 17(effective group) cases. In healing group the mean N1 amplitude on the affected side increased from(3.16±0.64)μV at baseline (before the treatment) to(3.99±0.67)μV at 1 week after treatment; the mean N1-P1 amplitudes on the affected side increased from(3.08±1.14)μV at baseline(before the treatment) to (4.22±0.87)μV at 1 week after treatment, and this increase was significant ( < 0.05). However there is no significantly statistical difference on the no affected side in the healing group( >0.05). And no significantly statistical difference was found in the effective group( >0.05). A repositioning of otoconia to the utricle may occur during the repositioning maneuver in BPPV, an increasing oVEMP amplitudes was found after the repositioning maneuver, oVEMP examinations could be useful to evaluate the the effect of repositioning in BPPV.
BibTeX: @article{Zhang2016, author = {Zhang, M X and Zhang, J and Su, J and Xu, Y and Zhou, H F}, title = {[The clinical values of oVEMP in the repositioning of otoconia of benign paroxysmal positional vertigo].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2016}, volume = {30}, issue = {21}, pages = {1706--1709}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2016.21.010}, keywords = {benign paroxysmal positional vertigo; ocular vestibular evoked myogenic potentials; repositioning of otoconia}, pmid = {29871179} }
Matsnev, E.I. and Sigaleva, E.E.	[The complete elimination of the episodes of benign positional paroxysmal vertigo in a patient with the involvement of the posterior semicircular canal following the eccentric rotation test]. [Abstract] [BibTeX]	2015	Vestnik otorinolaringologii Vol. 80(3), pp. 50-53	article	DOI
Abstract: The objective of the present study was the clinical and neurophysiological analysis of the observations of a 42 year-old female patient suffering from benign paroxysmalpositional dizziness (BPPD) associated with the lesion of the posterior semicircular canal. The dynamic evaluation of the utricular function was performed during eccentric rotation of the patient in the vestibulometric chair at a speed of 300 degrees. The chair together with the patients was atomatically displaced during the rotation 3.5--4.0 cm to the right or left off the vertical axis, and the error in subjective perception of the deviation from the vertical was estimated. The saccular function was evaluated by recording cervical vestibular evoked myogenic potentials. The symptoms of BPPD were found to completely disappear after the eccentric rotation. Not a single spell of benign paroxysmalpositional dizziness was documented within 6 months after the eccentric rotation. The mechanisms underlying the elimination of these symptoms as a result of eccentric rotation are discussed.
BibTeX: @article{Matsnev2015, author = {Matsnev, E I and Sigaleva, E E}, title = {[The complete elimination of the episodes of benign positional paroxysmal vertigo in a patient with the involvement of the posterior semicircular canal following the eccentric rotation test].}, journal = {Vestnik otorinolaringologii}, year = {2015}, volume = {80}, issue = {3}, pages = {50--53}, doi = {https://doi.org/10.17116/otorino201580350-53}, keywords = {Adult; Benign Paroxysmal Positional Vertigo, diagnosis, physiopathology; Female; Humans; Recovery of Function; Rotation; Semicircular Canals, pathology, physiopathology; Vestibular Evoked Myogenic Potentials; Vestibular Function Tests, methods}, pmid = {26288211} }
Fan, H.R., Wang, B.Q., Yu, W.Y., Chen, G.G. and Zheng, Z.Y.	[The diagnosis and treatment analysis of compound-benign paroxysmal positional vertigo in 38 cases]. [BibTeX]	2016	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 30(23), pp. 1899-1902	article	DOI
BibTeX: @article{Fan2016, author = {Fan, H R and Wang, B Q and Yu, W Y and Chen, G G and Zheng, Z Y}, title = {[The diagnosis and treatment analysis of compound-benign paroxysmal positional vertigo in 38 cases].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2016}, volume = {30}, issue = {23}, pages = {1899--1902}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2016.23.016}, keywords = {joint canalith repositioning procedure; positioning test; vertigo}, pmid = {29798023} }
Lu, B., Yu, W., Wu, Z., Lian, R., Lu, Z. and Yang, J.	[The diagnosis applying effects of ocular vestibular evoked myogenic potentials in BBPV disease]. [Abstract] [BibTeX]	2015	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 29(14), pp. 1256-1259	article
Abstract: To investigate the diagnosis applying effects of ocular vestibular evoked myogenic potentials(oVEMP) in peripheral BPPV disease. During September 2012 to January 2015, we selected 80 healthy people in our hospital medical center as the control group, choose the same period of primary benign paroxysmal positional vertigo as the observation group of 80 patients. Two groups were carried out fully functional auditory evoked potential analysis, determination of oVEMP and cervical vestibular evoked myogenic potentials (cVEMP) anomaly amplitude threshold, P1 latencies, N1 incubation period. The cVEMP abnormal rate in the observation group was 28.8%, the oVEMP abnormal rate was 38.8%, while cVEMP and oVEMP abnormal rates in the control group was 1.3% and 2.5% respectively that compared to significant differences between the two groups (P < 0.05). The oVEMP test amplitude in the observation group was (5.98 ± 2.15) µv, the N1 incubation period was (10.03 ± 0.76)ms, while the control group were (4.09 ± 2.11)µv and (11.67 ± 0.78) ms that compared difference were statistically significant (P < 0.05). The cVEMP test amplitude in the observation group was (154.8 ± 43.9)2 µv, while the control group was (180.49 ± 45.34)µv, compared the difference was statistically significant (P < 0.05). Paroxysmal positional vertigo patients ocular vestibular evoked myogenic potentials abnormal rate is relatively high, the utricle dysfunction for more severe than the balloon can be the subject of an objective function of the ear stone judgment, judgment in favor of the disease.
BibTeX: @article{Lu2015, author = {Lu, Baocai and Yu, Wenfu and Wu, Zhiyan and Lian, Rong and Lu, Zhenmin and Yang, Jianbin}, title = {[The diagnosis applying effects of ocular vestibular evoked myogenic potentials in BBPV disease].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2015}, volume = {29}, issue = {14}, pages = {1256--1259}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis; Case-Control Studies; Humans; Saccule and Utricle, physiopathology; Vestibular Evoked Myogenic Potentials}, pmid = {26672237} }
Kudriavtseva, A.S., Amelin, A.V., Lilenko, S.V. and Skoromets, A.A.	[The differential diagnosis of recurrent episodes of vertigo]. [Abstract] [BibTeX]	2016	Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova Vol. 116(4), pp. 4-9	article	DOI
Abstract: Recurrent episodes of vertigo are one of the most frequent reasons of referrals for medical help. In the Russian medicine, the development of vertigo is traditionally associated with a cerebral vascular pathology. It is suggested that correctly planned clinical neurovestibular study may identify the signs of a balance disorder of peripheral and central genesis. To increase the effectiveness of the differential diagnosis of peripheral and central vertigo in patients with recurrent episodes of balance disorders using the protocol of neurovestibular examination ALGORITM. The study included 120 outpatients with preliminary diagnoses of cerebral ischemia and autonomic vascular dystonia. Signs of lesion of peripheral and central regions of the vestibular system were found in 43.5 and 17.5% patients, respectively. Benign positional vertigo was the most frequent cause of vertigo while chronic cerebral ischemia was identified in 16.5% of the patients. Neurovestibularexamnation using the protocol ALGORITM is important for assessment of the level of vestibular system lesion. Iitis necessary to use it in complex examination of patients with complaints of vertigo.
BibTeX: @article{Kudriavtseva2016, author = {Kudriavtseva, A S and Amelin, A V and Lilenko, S V and Skoromets, A A}, title = {[The differential diagnosis of recurrent episodes of vertigo].}, journal = {Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova}, year = {2016}, volume = {116}, issue = {4}, pages = {4--9}, doi = {https://doi.org/10.17116/jnevro2016116414-9}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, diagnosis, etiology; Brain Ischemia, complications; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Russia; Vestibule, Labyrinth, physiopathology; Young Adult}, pmid = {27240041} }
Koehler, P.J.	[The Dutch College of General Practitioners' practice guideline "Dizziness"; reaction from a neurologic perspective]. [Abstract] [BibTeX]	2003	Nederlands tijdschrift voor geneeskunde Vol. 147(8), pp. 325-327	article
Abstract: When a patient complains of dizziness, the term may cover several types of sensations. When the physician carefully takes the history, he or she will most often be able to differentiate between vertigo and other types of dizziness, including a feeling of lightness or fainting. Based on this differentiation, the Dutch College of General Practitioners (NHG) designed a practice guideline for its members. The most important causes of vertigo are paroxysmal benign positional vertigo, vestibular neuritis, Ménière's disease and TIA or stroke in the vertebrobasilar system. Differentiation between vestibular neuritis and stroke may be difficult, in particular at the onset of the complaints and therefore consultation of a neurologist will often be necessary. Fortunately, special drugs for dizziness are not recommended, as their effectiveness has not been proven. Among the causes of non-vertigo dizziness complaints, hyperventilation, often in the context of anxiety disorder, is a major cause. In general, the NHG succeeded in compiling a practical guideline.
BibTeX: @article{Koehler2003, author = {Koehler, P J}, title = {[The Dutch College of General Practitioners' practice guideline "Dizziness"; reaction from a neurologic perspective].}, journal = {Nederlands tijdschrift voor geneeskunde}, year = {2003}, volume = {147}, issue = {8}, pages = {325--327}, keywords = {Diagnosis, Differential; Diagnostic Techniques, Neurological; Dizziness, diagnosis; Humans; Netherlands; Neurologic Examination; Practice Guidelines as Topic; Practice Patterns, Physicians'; Vertigo, diagnosis}, pmid = {12661115} }
Akoğlu, E., Okuyucu, S., Okuyucu, E., Melek, I.M., Duman, T. and Dağli, A.S.	[The effectiveness of the Epley maneuver for the treatment of BPPV and the role of nystagmus direction as an early indicator of successful treatment]. [Abstract] [BibTeX]	2007	Kulak burun bogaz ihtisas dergisi : KBB = Journal of ear, nose, and throat Vol. 17(4), pp. 212-216	article
Abstract: We investigated the role of the direction of nystagmus that might occur during the Epley maneuver as an early indicator for treatment success in benign paroxysmal positional vertigo (BPPV). The study included 47 patients (24 males, 23 females; mean age 46+/-12 years; range 29 to 70 years) who underwent the Epley maneuver for BPPV. The occurrence and the direction of nystagmus were observed. Nystagmus occurred in 16 patients during the maneuver, being ipsilateral in nine patients and contralateral in seven patients. The treatment was successful in seven patients (77.8%) with ipsilateral nystagmus, whereas none of the patients with contralateral nystagmus benefited from the maneuver. While there was no significant relationship between ipsilateral nystagmus and the success of the treatment (p=0.625), a significant correlation was found between contralateral nystagmus and treatment failure (p=0.000). The occurrence of contralateral nystagmus during the Epley maneuver may be a sign of an unsuccessful result.
BibTeX: @article{Akoglu2007, author = {Akoğlu, Ertap and Okuyucu, Semsettin and Okuyucu, Esra and Melek, Ismet Murat and Duman, Taşkin and Dağli, Ali Safak}, title = {[The effectiveness of the Epley maneuver for the treatment of BPPV and the role of nystagmus direction as an early indicator of successful treatment].}, journal = {Kulak burun bogaz ihtisas dergisi : KBB = Journal of ear, nose, and throat}, year = {2007}, volume = {17}, issue = {4}, pages = {212--216}, keywords = {Adult; Aged; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, physiopathology; Physical Therapy Modalities; Treatment Outcome; Vertigo, physiopathology, therapy; Vestibular Function Tests}, pmid = {18187973} }
Kunel'skaya, N.L., Guseva, A.L., Baibakova, E.V., Chistov, S.D. and Chugunova, M.A.	[The efficacious algorithm for the diagnostics and treatment of benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2015	Vestnik otorinolaringologii Vol. 80(5), pp. 19-22	article	DOI
Abstract: The objective of the present study was to elucidate the prevalence of various forms of benign paroxysmal positional vertigo (BPPV) among the patients with the complaints of dizziness who had applied for the medical aid. The secondary objective was to evaluate the effectiveness of the newly developed algorithm for the diagnostics and treatment of various forms of the disease. A total of 195 patients with the verified BPPD diagnosis were available for the examination. The fraction of the patients visiting the otoneurologist's office with complaints of this conditions is estimated at 17.8%. It was shown that the women suffer from benign paroxysmal positional vertigo 1.8 times more frequently than the men. The mean age of the patients of either sex experiencing this problem is above 50 years. Most of them have idiopathic pathology. The relationship between benign paroxysmal positional vertigo and vascular neurological disorders or inner and middle ear diseases remains to be elucidated. The present study also included the assessment of the effectiveness of the combination of various repositioning maneuvers, self-assisted vestibular gymnastics in the domestic environment, and training in long lying on the unaffected side.
BibTeX: @article{Kunelskaya2015, author = {Kunel'skaya, N L and Guseva, A L and Baibakova, E V and Chistov, S D and Chugunova, M A}, title = {[The efficacious algorithm for the diagnostics and treatment of benign paroxysmal positional vertigo].}, journal = {Vestnik otorinolaringologii}, year = {2015}, volume = {80}, issue = {5}, pages = {19--22}, doi = {https://doi.org/10.17116/otorino201580519-22}, keywords = {Aged; Algorithms; Benign Paroxysmal Positional Vertigo, diagnosis, therapy; Female; Humans; Male; Middle Aged}, pmid = {26525466} }
Zhou, X., Yu, Y., Zhao, Y., Wang, Y., Liu, Z. and Liu, Q.	[The efficacy of intratympanic dexamethasone injection for the moderate and severe sudden deafness with BPPV]. [Abstract] [BibTeX]	2015	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 29(10), pp. 934-936	article
Abstract: To evaluate the efficacy of intratympanic dexamethasone injection for the moderate and severe sudden deafness with BPPV. A total of 63 patients diagnosed with sudden sensorineural hearing loss with BPPV were treated through OPD. Patients were divided into three groups: 20 cases in intratympanic dexamethasone injection as initial treatment (group A); 18 cases in systemic hormone therapy group (group B); 25 cases in intratympanic dexamethasone injection as salvage treatment (group C). In addition, routine drugs were used to all patients. The overall effective rate of group A, B and C in hearing recovery was 60.0%, 38.9% and 48.0%, respectively: (1) No significant difference of hearing recovery was observed among three groups (P > 0.05); (2) A significant difference of hearing recovery was evidenced between group A and C (P < 0.05); (3) A significant difference of hearing recovery was evidenced between group A and C (P < 0.05); (4) No statistically significant difference was found in the hearing recovery between group B and C (P > 0.05). Our data showed that intratympanic dexamethasone should be used as initial therapy for treating the moderate and severe sudden deafness with BPPV.
BibTeX: @article{Zhou2015c, author = {Zhou, Xiaowei and Yu, Youjun and Zhao, Yuanxin and Wang, Yuejian and Liu, Zhen and Liu, Qiuling}, title = {[The efficacy of intratympanic dexamethasone injection for the moderate and severe sudden deafness with BPPV].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2015}, volume = {29}, issue = {10}, pages = {934--936}, keywords = {Benign Paroxysmal Positional Vertigo, complications; Dexamethasone, administration & dosage, therapeutic use; Hearing Loss, Sensorineural, complications, drug therapy; Hearing Loss, Sudden, complications, drug therapy; Hearing Tests; Humans; Injection, Intratympanic; Salvage Therapy; Treatment Outcome}, pmid = {26596013} }
Kunelskaya, N.L., Melnikov, O.A., Guseva, A.L. and Baybakova, E.V.	[The etioiogy, pathophysiology and differential diagnosis of benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2016	Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova Vol. 116(4), pp. 79-84	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder. The confirmation of BPPV is easy and based on a set of positioning tests. The authors present the recent data concerning the-etiology, pathophysiology a:nd the most effective positioning tests for the posterior, horizontal and anterior semicircular canals. The differential diagnosis of BPPV from other diseases, manifesting with positional vertigo, is discussed as well.
BibTeX: @article{Kunelskaya2016, author = {Kunelskaya, N L and Melnikov, O A and Guseva, A L and Baybakova, E V}, title = {[The etioiogy, pathophysiology and differential diagnosis of benign paroxysmal positional vertigo].}, journal = {Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova}, year = {2016}, volume = {116}, issue = {4}, pages = {79--84}, doi = {https://doi.org/10.17116/jnevro20161164179-84}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis, epidemiology, etiology, physiopathology; Diagnosis, Differential; Female; Humans; Male; Patient Positioning, methods; Semicircular Canals, physiopathology}, pmid = {27386590} }
Ji, R., Chen, T.S., Wang, W., Xu, K.X., Li, S.S., Wen, C., Liu, Q. and Lin, P.	[The exploration on optimization of two alternatives between roll test and Dix-Hallpike test in benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2017	Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery Vol. 52(6), pp. 440-445	article	DOI
Abstract: To analyze the objective characteristics of roll test and Dix-Hallpike test in benign paroxysmal positional vertigo(BPPV)patients, discussing the premier solution of positional test. A total of 230 patients with BPPV, whereas 170 posterior semicircular canal canalithiasis (PSC-Can) BPPV and 60 horizontal semicircular canal canalithiasis (HSC-Can) BPPV were involved respectively. The induced nystagmus in roll test and Dix-Hallpike test was recorded by video nystagmuo graph (VNG), and the direction, intensity and time characteristics of nystagmus were compared in various BPPV.SPSS19.0 software was used for statistical analysis. Vertically upward nystagmus was induced by hanging in 170 PSC-Can Dix-Hallpike test, and the nystagmus reversed and turned weaker when the subjects came to sit. The intensity of nystagmus at turning to lesion side by hanging and sitting were (30.3±14.1)°/s and (12.6±7.5)°/s respectively, the difference was statistically significant ( =20.153, <0.05). However, no nystagmus was induced in PSC-Can roll test. Horizontal nystagmus in the same direction with turning was induced in 60 HSC-Can roll test. The intensity of nystagmus at turning to lesion side and normal side was (42.0±18.0)°/s and (20.3±8.7)°/s respectively, the difference was statistically significant ( =12.731, <0.05). Furthermore, horizontal nystagmus in the same direction with turning was induced in 57 HSC-Can Dix-Hallpike. The coherence was 95% with the results of roll test. Dix-Hallpike test can not only be used to diagnose PSC-Can, but also induce nystagmus in HSC-Can effectively. Whereas the roll test only show significance in diagnosing HSC-Can. To avoid uncomfortable stimulation to patients as much as possible, we suggest to use Dix-Hallpike test at first, and to judge whether using roll test based on the result of the horizontal nystagmus.
BibTeX: @article{Ji2017, author = {Ji, R and Chen, T S and Wang, W and Xu, K X and Li, S S and Wen, C and Liu, Q and Lin, P}, title = {[The exploration on optimization of two alternatives between roll test and Dix-Hallpike test in benign paroxysmal positional vertigo].}, journal = {Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery}, year = {2017}, volume = {52}, issue = {6}, pages = {440--445}, doi = {https://doi.org/10.3760/cma.j.issn.1673-0860.2017.06.009}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis, etiology; Female; Humans; Male; Nystagmus, Pathologic, etiology; Otolithic Membrane; Semicircular Canals; Semicircular Ducts; Vestibular Function Tests, methods; Nystagmus, pathologic; Vertigo; Vestibular function tests}, pmid = {28635217} }
Ma, X., Si, F., Liu, Y., Han, L., Jing, Y. and Yu, L.	[The false-negative reasons of positioning test in benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2016	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 30(1), pp. 19-21	article
Abstract: To analyze the false-negative proportion and reasons of positioning test in benign paroxysmal positional vertigo (BPPV). Sixty-eight cases were reviewed and analyzed during February to April 2009. All patients had typical clinical history of BPPV and diagnosed by positioning test,and all were treated with PRM successfully. If positioning test at the first time were negative, examinations repeated after either head shaking or return visits. Thirteen patients (19.12%) appeared false-negative in positoning test, and 11 cases showed typical nystagmus after head shaking,while 2 cases were diagnosed by return visitis the next day. There were no statistically difference between false-negative group and positive group in age (P > 0.05), gender (P > 0.05), course of disease (P > 0.05) and types of semi-circular canal (P > 0.05). Re-examinations after head shaking or return visits are useful for the diagnosis in the suspected BPPV patients who have negative positioning test.
BibTeX: @article{Ma2016, author = {Ma, Xin and Si, Fengzhi and Liu, Yan and Han, Lin and Jing, Yuanyuan and Yu, Lisheng}, title = {[The false-negative reasons of positioning test in benign paroxysmal positional vertigo].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2016}, volume = {30}, issue = {1}, pages = {19--21}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis, therapy; False Negative Reactions; Humans; Patient Positioning}, pmid = {27197448} }
Xu, Z., Zhao, P., Yang, X., Liu, X., Chen, X., Zhang, S. and Wu, Z.	[The hearing and vestibular evoked myogenic potentials test in patients with primary benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2015	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 29(1), pp. 20-23	article
Abstract: To investigate the result of vestibular evoked myogenic potentials (VEMP) of primary benign paroxysmal positional vertigo(BPPV)and to identify the characteristics in VEMP examination of the primary BPPV and to observe the relevance of patients with primary BPPV and abnormal VEMP with hearing loss. Patients with primary BPPV were tested with pure tone audiometry, videonystagmograph and VEMPs test. We analyzed the difference in the two groups with normal hearing and hearing loss, discussed the etiology and pathogenesis. Primary BPPV comprised 23.0% with hearing lost, 77.0% hearing normal. The results of oVEMP were abnormal in 79. 7% (59/74) of the cases; and the results of cVEMP were abnormal in 66. 2% (49/74) of the cases; oVEMP and cVEMP differences to the diagnosis of primary BPPV (P<0. 05); oVEMP and cVEMP differences to the diagnosis primary BPPV with hearing lost (P<0. 05). oVEMP detection positive rate of primary BPPV is higher than cVEMP,which may be due to otolithic particles falling from the utricle; positive rate of cVEMP in primary BPPV with hearing loss is higher than that of oVEMP, which may related to the cochlear and sacculus occured in the same embryonic tissue structure.
BibTeX: @article{Xu2015, author = {Xu, Zhiwei and Zhao, Peng and Yang, Xu and Liu, Xingjian and Chen, Xianbing and Zhang, Suzhen and Wu, Ziming}, title = {[The hearing and vestibular evoked myogenic potentials test in patients with primary benign paroxysmal positional vertigo].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2015}, volume = {29}, issue = {1}, pages = {20--23}, keywords = {Audiometry, Pure-Tone; Benign Paroxysmal Positional Vertigo, physiopathology; Cochlea; Hearing Loss, etiology; Hearing Tests; Humans; Otolithic Membrane; Saccule and Utricle; Vestibular Evoked Myogenic Potentials}, pmid = {25966548} }
Kunel'skaya, N.L., Baybakova, E.V., Guseva, A.L., Chugunova, M.A. and Manaenkova, E.A.	[The importance of vestibular evoked myogenic potentials for the assessment of the otolith function in the patients presenting with benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2017	Vestnik otorinolaringologii Vol. 82(4), pp. 5-8	article	DOI
Abstract: The objective of the present study was to evaluate the otolith function in the patients presenting with idiopathic benign paroxysmal positional vertigo (pBPPV) attributable to the occlusion of the posterior semicircular canal (PSCC) of the inner ear with the use of vestibular evoked myogenic potentials (VEMP). Cervical (cVEMP) and ocular VEMP (oVEMP) were measured in 34 patients with idiopathic pBPPV before and 7 days after the treatment by means of reposition maneuvers. The results of the repeated Dix-Hallpike test performed 7 days after the repositioning maneuver were negative in 27 patients and positive in 7 patients. There was no statistically significant difference in the amplitude of cervical VEMP between the healthy and affected ears either before or after the repositioning treatment. The measurement of oVEMP revealed a reduction of the response amplitude on the affected side. The average values of the plnl on the healthy side were 12.84±1.09 and those on the affected side 4.62±0.69 (p<0,05). The successful repositioning treatment resulted in a significant increase of the oVEMP amplitude on the affected side (p<0,05). In the patients presenting with the persistent symptoms of pBPPV, the repositioning maneuvers did not cause an appreciable increase in the amplitude of oVEMP on the affected side (p<0.05). The results of the present study give evidence that pBPPV of the posterior semicircular canal is associated with the impairment of the function of the receptor structures of the utriculus and the preserved function of the succulus as suggested by the reduction of the oVEMP amplitude and clinically significant asymmetry of ocular VEMP on the affected side with intact cervical VEMP on both sides. The successful treatment of pBPPV of PSCC with the use of the liberatory maneuver results in the increase of the oVEMP amplitude on the affected side increases while the response asymmetry between both sides significantly decreases which indicates the repair of the utriculus otolith function.
BibTeX: @article{Kunelskaya2017, author = {Kunel'skaya, N L and Baybakova, E V and Guseva, A L and Chugunova, M A and Manaenkova, E A}, title = {[The importance of vestibular evoked myogenic potentials for the assessment of the otolith function in the patients presenting with benign paroxysmal positional vertigo].}, journal = {Vestnik otorinolaringologii}, year = {2017}, volume = {82}, issue = {4}, pages = {5--8}, doi = {https://doi.org/10.17116/otorino20178245-8}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis, etiology, physiopathology; Female; Humans; Male; Middle Aged; Otolithic Membrane, pathology, physiopathology; Patient Outcome Assessment; Patient Positioning, methods; Recovery of Function; Reproducibility of Results; Semicircular Canals, pathology, physiopathology; Vestibular Evoked Myogenic Potentials, physiology; Vestibular Function Tests, methods; benign paroxysmal positional vertigo; cervical VEMP; ocular VEMP; otolith function}, pmid = {28980586} }
Strupp, M., Glaser, M., Karch, C., Rettinger, N., Dieterich, M. and Brandt, T.	[The most common form of dizziness in middle age: phobic postural vertigo]. [Abstract] [BibTeX]	2003	Der Nervenarzt Vol. 74(10), pp. 911-914	article	DOI
Abstract: Up to now, there have been only a few valid epidemiological investigations of dizziness or vertigo as key symptoms. According to an analysis of 4,214 patients examined between 1989 and 2002 in an outpatient dizziness unit, benign peripheral paroxysmal positional vertigo (BPPV) and phobic postural vertigo (PPV) constitute the two most frequent syndromes. In this study, the relative age and sex distribution of both disorders was analysed. In the age group from 20 to 50 years, PPV was comparatively the most frequent form of dizziness, with a share of 22% to 26%. When left untreated, PPV becomes chronic in most cases and leads to considerable impairments, also at work. However, when diagnosed correctly, it can be treated successfully in more than 70% of cases. Thus, it takes on considerable medical and socioeconomic significance and should be part of the diagnostic repertoire of every doctor.
BibTeX: @article{Strupp2003, author = {Strupp, M and Glaser, M and Karch, C and Rettinger, N and Dieterich, M and Brandt, T}, title = {[The most common form of dizziness in middle age: phobic postural vertigo].}, journal = {Der Nervenarzt}, year = {2003}, volume = {74}, issue = {10}, pages = {911--914}, doi = {https://doi.org/10.1007/s00115-003-1567-5}, keywords = {Adult; Age Factors; Aged; Aged, 80 and over; Ambulatory Care, statistics & numerical data; Cross-Sectional Studies; Diagnosis, Differential; Dizziness, diagnosis, epidemiology; Female; Germany, epidemiology; Humans; Incidence; Male; Middle Aged; Phobic Disorders, diagnosis, epidemiology; Retrospective Studies; Vertigo, diagnosis, epidemiology}, pmid = {14551699} }
Jia, J., Chang, D., Dai, S., Sang, Y., Tai, X., Sun, X., Hou, Y. and Zhang, W.	[The necessity of post-maneuver postural restriction in treating benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2013	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 27(16), pp. 910-912	article
Abstract: To evaluate the necessity of postural restrictions after repositioning maneuvers in posterior canal benign paroxysmal positional vertigo (BPPV). Sixty-eight consecutive patients diagnosed of posterior canal BPPV with a positive Dix-Hallpike test. Thirty-two patients were instructed to follow postural restrictions after repositioning maneuvers, and 36 patients did not receive any postural restriction after treatment. All the patients were reevaluated at 1 week and 3 months later respectively. There was no statistical difference in number of maneuvers needed to resolve symptoms between two groups. Epley maneuver is effective to treat patients with posterior canal BPPV, and postural restrictions does not improved the efficacy. Above all, we do not recommend any postural restrictions to patients with posterior canal BPPV.
BibTeX: @article{Jia2013, author = {Jia, Jianping and Chang, Delong and Dai, Song and Sang, Yuehong and Tai, Xuhui and Sun, Xiaohui and Hou, Yue and Zhang, Wei}, title = {[The necessity of post-maneuver postural restriction in treating benign paroxysmal positional vertigo].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2013}, volume = {27}, issue = {16}, pages = {910--912}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Female; Humans; Male; Middle Aged; Patient Positioning; Treatment Outcome; Vertigo, therapy}, pmid = {24260872} }
Wen, C., Wang, W., Xu, K.X., Liu, Q., Li, S.S., Han, X., Chen, T.S. and Lin, P.	[The nystagmus characteristics of two positions of the horizontal semicircular canal cupulolithiasis]. [Abstract] [BibTeX]	2018	Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery Vol. 53(12), pp. 888-892	article	DOI
Abstract: To analyze the characteristics of nystagmus of horizontal semicircular canal cupulolithiasis(HSC-Cup) in Roll test and Dix-Hallpike test. Between December 2016 and December 2017, a total of 164 patients with BPPV from Tianjin First Center Hospital, 124 HSC-Can BPPV and 40 HSC-Cup BPPV, were involved.The induced nystagmus in Roll test and Dix-Hallpike test were recorded by video-nystagmograph(VNG), whose direction and intensity characteristics were compared in various BPPV. HSC-Can patients were induced a horizontal nystagmus with Roll test, the nystagmus intensity of the disease and healthy side were (41.3±20.1)°/s (mean standard deviation)and(21.9±9.4)°/s respectively, the difference was statistically significant ( =6.709, <0.05). HSC-Cup patients were induced a horizontal nystagmus that was opposite to the direction of the Roll test, the nystagmus intensity of the disease and the healthy side were (12.9±6.4)°/s and(29.1±9.3)°/s respectively, with significant difference ( =9.066, <0.05). Among 124 cases of HSC-Can patients, 120 cases of horizontal nystagmus were recorded in the left and right sides of the Dix-Hallpike test in the same direction as the turning direction, the horizontal nystagmus intensity of the disease and the healthy sides were (15.1±10.0)°/s and(9.4±7.4)°/s respectively, the difference was statistically significant ( =2.365, <0.05). And 40 cases of HSC-Cup patients were recorded at the head of the Dix-Hallpike test in the opposite direction to the horizontal eye earthquake.The horizontal nystagmus intensity of the disease and the healthy side were (5.3±2.8)°/s and(13.9±4.4)°/s respectively, the difference was statistically significant ( =10.579, <0.05). Characteristic horizontal nystagmus can be induced by HSC-Cup in both roll test and Dix-Hallpike test. Preliminary localization of Dix-Hallpike Test can also be used for HSC-Cup.
BibTeX: @article{Wen2018, author = {Wen, C and Wang, W and Xu, K X and Liu, Q and Li, S S and Han, X and Chen, T S and Lin, P}, title = {[The nystagmus characteristics of two positions of the horizontal semicircular canal cupulolithiasis].}, journal = {Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery}, year = {2018}, volume = {53}, issue = {12}, pages = {888--892}, doi = {https://doi.org/10.3760/cma.j.issn.1673-0860.2018.12.003}, keywords = {BPPV; Nystagmus, physiologic; Vertigo; Vestibular function tests}, pmid = {30584998} }
Pal'chun, V.T., Mel'nikov, O.A., Levina, Y.V. and Guseva, A.L.	[The peculiar features of the clinical course of Meniere's disease associated with benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2018	Vestnik otorinolaringologii Vol. 83(1), pp. 32-35	article	DOI
Abstract: The objective of the present study was to evaluate the frequency of occurrence and clinical features of vertigo spells in the patients presenting with Ménière's disease (MD) associated with benign paroxysmal positional vertigo (BPPV). A total of 104 patients with MD were available for the observation. All of them underwent the comprehensive examination that included the audiological study and vestibular tests, such as the Dix-Hallpike test and the roll-test for BPPV diagnostics. A structured questionnaire was used to calculate the average number of vertigo spells per month during the period of 6 months and the mean duration of the vertigo spells; the presence or the absence of changes in hearing ability during the spells as well as the severity of vertigo were determined with the use of the 10-point visual analogue scale. The patients suffering from BPPV associated with Meniere's disease presented with the following clinical features which distinguished them from the patients with idiopathic BPPV (p<0.05): (1) a higher percentage of female patients; (2) a longer duration of clinical symptoms; (3) the frequent involvement of the horizontal semicircular canal; (4) a greater incidence of canal paresis; (5) more therapeutic sessions needed for the recovery in conjunction with a higher rate of recurrence. The frequency of association of MD and BPPV was estimated at 14.4%. Such association of MD was more frequently observed in the elderly patients (older than 60 years) (p<0.05). The clinical manifestations of the vertigo spells in the patients having MD associated with BPPV occurred with an enhanced frequency; their mean duration was relatively short due to the presence of both long and short positional vertigo attacks characterized by the absence of hearing changes during the spells and the equal severity of vertigo (p < 0,05).
BibTeX: @article{Palchun2018, author = {Pal'chun, V T and Mel'nikov, O A and Levina, Yu V and Guseva, A L}, title = {[The peculiar features of the clinical course of Meniere's disease associated with benign paroxysmal positional vertigo].}, journal = {Vestnik otorinolaringologii}, year = {2018}, volume = {83}, issue = {1}, pages = {32--35}, doi = {https://doi.org/10.17116/otorino201883132-35}, keywords = {Adult; Age Factors; Aged; Audiometry, methods; Benign Paroxysmal Positional Vertigo, complications, diagnosis, physiopathology; Female; Humans; Incidence; Male; Meniere Disease, complications, diagnosis, physiopathology; Middle Aged; Recurrence; Retrospective Studies; Risk Factors; Russia; Semicircular Canals, pathology, physiopathology; Ménière's disease; benign paroxysmal positional vertigo; vertigo; vestibular disorders}, pmid = {29488493} }
Zamergrad, M.V., Parfenov, V.A., Morozova, S.V., Mel'nikov, O.A. and Antonenko, L.M.	[The peripheral vestibular disorders encountered in the routine out-patient practical work]. [Abstract] [BibTeX]	2017	Vestnik otorinolaringologii Vol. 82(1), pp. 30-33	article	DOI
Abstract: The objective of the present study was to elucidate the frequency of causes underlying the development of dizziness and vertigo in the patients seeking advice and care at an outpatient healthcare facility. A total of 590 patients with complaints of dizziness and vertigo were examined. It was found out that the peripheral disorders of the vestibular analyzer were the most frequent causes of dizziness and vertigo in the majority of the examined patients. These conditions were documented to occur in more than 65% of the patients. The most common forms of peripheral vestibular disorders were benign paroxysmal positional vertigo, Meniere's disease, and vestibular neuronitis. The central vestibular disorders occurred considerably less frequently than peripheral ones and were diagnosed only in 10.9% of the patients. The results of the study provided a basis for the development of the algorithm forthe bedside examination of the patients presenting with vertigo and dizziness associated with peripheral vestibular disorders. It is emphasized that such examination should include, besides the standard neurological studies, the neuro-otological tests making it possible to detect the most common forms of peripheral vestibular disorders.
BibTeX: @article{Zamergrad2017, author = {Zamergrad, M V and Parfenov, V A and Morozova, S V and Mel'nikov, O A and Antonenko, L M}, title = {[The peripheral vestibular disorders encountered in the routine out-patient practical work].}, journal = {Vestnik otorinolaringologii}, year = {2017}, volume = {82}, issue = {1}, pages = {30--33}, doi = {https://doi.org/10.17116/otorino201782130-33}, keywords = {Ambulatory Care, statistics & numerical data; Dizziness, diagnosis; Humans; Vestibular Diseases, diagnosis}, pmid = {28252586} }
Zhou, X., Yu, Y., Zhao, Y., Wang, Y., Liu, Z. and Liu, Q.	[The preliminary research of progress on sudden deafness with benign paroxysmal positional vertigo patients]. [Abstract] [BibTeX]	2014	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 28(16), pp. 1219-1221	article
Abstract: To investigate the prognosis of sudden deafness patients with benign paroxysmal positional vertigo (BPPV). The clinical data of 24 sudden deafness patients with BPPV was analyzed. The outcome of 125 sudden deafness patients without BPPV at the same time was compared. Hearing improvement after three months treatment was 41.67% and 72.80% in sudden deafness patients with BPPV and sudden deafness patients without BPPV, respectively. The difference was statistically significant (P<0.05). The prognosis of hearing in sudden deafness patients with BPPV is worse than that in sudden deafness patients without BPPV. BPPV may predict a poor hearing outcome in sudden deafness.
BibTeX: @article{Zhou2014, author = {Zhou, Xiaowei and Yu, Youjin and Zhao, Yuanxin and Wang, Yuejian and Liu, Zhen and Liu, Qiuling}, title = {[The preliminary research of progress on sudden deafness with benign paroxysmal positional vertigo patients].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2014}, volume = {28}, issue = {16}, pages = {1219--1221}, keywords = {Adolescent; Adult; Aged; Benign Paroxysmal Positional Vertigo, complications, diagnosis; Female; Hearing Loss, Sudden, complications, diagnosis; Humans; Male; Middle Aged; Prognosis; Retrospective Studies; Young Adult}, pmid = {25464561} }
Zhang, Y.M., Yang, Z.D., Li, W.X., Shi, C. and Yu, Y.F.	[The relationship between the recurrence of benign paroxysmal positional vertigo and the level of bone mineral as well as estrogen in postmenopausal women]. [Abstract] [BibTeX]	2017	Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery Vol. 52(12), pp. 881-884	article	DOI
Abstract: To investigate the relationship between the recurrence of benign paroxysmal positional vertigo(BPPV) and the levels of bone mineral density(BMD) and estrogen in postmenopausal women. A total of 38 postmenopausal women with recurrent BPPV were recruited as study group, in the First Affiliated Hospital of Soochow University from December 2013 to June 2017. Meanwhile, 49 normal menopausal women were included as control. All patients were natural menopausal for over one year.The patients were diagnosed as BPPV based on results of Dix-Hallpike test and Roll-test, with at least two episodes of recurrent onset. In the subjects, BMD was measured by dual X-ray absorptiometry of lumbar vertebrae. Estrogen levels were obtained by testing serum estradiol (E2) levels in early morning fasting venous blood. In the present study, we compared the level of E2 and the value of BMD in two groups by SPSS 21.0. In the study group, patients with decreased BMD were divided into two groups: treatment and untreated group. The recurrence rate of BPPV was compared between the two groups within 12 months. ①The averagel levels of E2 and BMD in the study group were (16.21±11.00)ng/L and -1.68±0.98) respectively, which were significantly lower than those in the control group ( value was 7.03 and 8.05 respectively, both <0.05). The averagel levels of E2 and BMD incontrol group were(28.52±6.34)ng/L and -0.18±0.77 respectively. ②The number of patients with decreased BMD in the study group (30 cases) was more than that in control group (6 cases), and the difference was statistically significant ( <0.05). ③ The recurrence rate of BPPV in treatment group [17.6%(3/17)] was significantly lower than that of untreated group [61.5%(8/13)], and the difference was statistically significant ( <0.05). Recurrent BPPV in postmenopausal women usually accompany with low levels of estrogen and BMD. Active treatment is helpful for their recurrence of BPPV.
BibTeX: @article{Zhang2017, author = {Zhang, Y M and Yang, Z D and Li, W X and Shi, C and Yu, Y F}, title = {[The relationship between the recurrence of benign paroxysmal positional vertigo and the level of bone mineral as well as estrogen in postmenopausal women].}, journal = {Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery}, year = {2017}, volume = {52}, issue = {12}, pages = {881--884}, doi = {https://doi.org/10.3760/cma.j.issn.1673-0860.2017.12.001}, keywords = {Absorptiometry, Photon; Benign Paroxysmal Positional Vertigo, blood, physiopathology; Bone Density; Case-Control Studies; Estrogens, blood; Female; Humans; Lumbar Vertebrae, physiology; Menopause, blood, physiology; Postmenopause, blood, physiology; Recurrence; Bone density; Estrogens; Postmenopause; Vertigo}, pmid = {29262443} }
Chen, X., Li, P., Gu, X., Lin, S. and Zhang, R.	[The relevance of high stimulus rate ABR and recurrent vertigo and its clinical significance]. [Abstract] [BibTeX]	2011	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 25(7), pp. 289-291	article
Abstract: To study the relevance of the high stimulus rate auditory brainstem response(auditory brainstem response, ABR) test in recurrent vertigo, investigate the cause of recurrent vertigo, and provide important help for the clinical treatment. One hundred and one cases with recurrent vertigo were retrospectively analyzed, and high stimulus rate ABR were tested and compared in attack episodes and intermittent episodes. The abnormal difference between ABR I and V latency was selected as parameters. The abnormal rate of high stimulation ABR was 56.4% in patients with recurrent episodes of vertigo many times (2 and above), of which the highest rate was 71.9% in MV patients, and the second one was BPPV. The abnormal rate of high stimulation ABR was 14.9% in patients during medication or intermittent episodes. The abnormal rate in all groups decreased obviously as compared to attack episodes. Abnormal rate of high stimulus rate ABR correlates well with recurrent vertigo significantly. The inner ear microcirculation may result in the attack of recurrent vertigo.
BibTeX: @article{Chen2011, author = {Chen, Xi and Li, Ping and Gu, Xi and Lin, Shaolian and Zhang, Rong}, title = {[The relevance of high stimulus rate ABR and recurrent vertigo and its clinical significance].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2011}, volume = {25}, issue = {7}, pages = {289--291}, keywords = {Adolescent; Adult; Aged; Benign Paroxysmal Positional Vertigo; Evoked Potentials, Auditory, Brain Stem; Female; Humans; Male; Middle Aged; Retrospective Studies; Vertigo, etiology; Young Adult}, pmid = {21710712} }
Zhang, Y.M., Yang, Z.D. and Yu, Y.F.	[The role of video nystagmography in the diagnosis and treatment of multiple benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2016	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 30(18), pp. 1435-1437;1443	article	DOI
Abstract: To explore the role of video nystagmography in the diagnosis and treatment of multiple benign paroxysmal positional vertigo. Eleven patients of 313 patients with benign paroxysmal positional vertigo had been diagnosed as multiple benign paroxysmal positional vertigo.They were post and horizontal semicircular canal ipsilaterally, bilateral post semicircular canal, superior and horizontal semicircular canal ipsilaterally, and bilateral superior semicircular canal benign paroxysmal positional vertigo. The patients were performed Dix-Hallpike test and Roll test under VNG, combined with track record by video nystagmography to confirm the affected sites. Six cases were post and horizontal semicircular canal benign paroxysmal positional vertigo ipsilaterally. Three cases were bilateral posterior semicircular canal benign paroxysmal positional vertigo, one case of superior semicircular canal and horizontal semicircular canal benign paroxysmal positional vertigo ipsilaterally, and one case of bilateral superior semicircular canal benign paroxysmal positional vertigo. The symptom of patients got relief after repositioning sequentially. We repositioned the affected canal with strong nystagmus and vertigo at the first time. Multiple benign paroxysmal positional vertigo was rare and easily misdiagnosed because of complex nystagmus. We can confirm the affected canal and intensity by video nystagmography and get good prognosis after repositioning sequentially.
BibTeX: @article{Zhang2016a, author = {Zhang, Y M and Yang, Z D and Yu, Y F}, title = {[The role of video nystagmography in the diagnosis and treatment of multiple benign paroxysmal positional vertigo].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2016}, volume = {30}, issue = {18}, pages = {1435--1437;1443}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2016.18.003}, keywords = {benign paroxysmal positional vertigo; video nystagmography}, pmid = {29871111} }
Zhou, X., Yu, Y., Wu, Z., Liu, X. and Chen, X.	[The roles of otolith organs in the recurrence primary benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2015	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 29(18), pp. 1641-1644	article
Abstract: To explore the roles of otolith organs in the occurrence and recurrence of primary benign paroxysmal positional vertigo (BPPV) by vestibular evoked myogenic potential (VEMP) test. We enrolled 17 recurrent primary BPPV patients and 42 non-recurrent primary BPPV patients between September 2014 and November 2014. All patients underwent VEMP tests, including cervical vestibular evoked myogenic potential (cVEMP and ocular vestibular evoked myogenic potential (oVEMP) tests. The abnormal case was defined as non-elicitation or asymmetry rate between bilateral sides is larger than 29%. Significant difference was found in abnormal rate between cVEMP and oVEMP (P < 0.05 ) in BPPV patients. The abnormal rate of oVEMP was higher than that of cVEMP. Significant difference was found in abnormal rate in oVEMP test between recurrent and non-recurrent groups (P < 0.01) but not in cVEMP( P > 0.05). No significant difference was found in sex and age between recurrent and non-recurrent groups (P > 0.05). The impairment of otolith organs, especially the utricle, is related to primary BPPV. Dysfunction of utricle may play a role in recurrence of BPPV. Recurrence of BPPV is not correlated with sex and age.
BibTeX: @article{Zhou2015a, author = {Zhou, Xiaowei and Yu, Youjun and Wu, Ziming and Liu, Xinjian and Chen, Xianbing}, title = {[The roles of otolith organs in the recurrence primary benign paroxysmal positional vertigo].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2015}, volume = {29}, issue = {18}, pages = {1641--1644}, keywords = {Benign Paroxysmal Positional Vertigo, physiopathology; Humans; Otolithic Membrane, physiopathology; Recurrence; Saccule and Utricle, physiopathology; Vestibular Evoked Myogenic Potentials}, pmid = {26790267} }
Pal'chun, V.T., Guseva, A.L., Levina, Y.V. and Chistov, S.D.	[The specific clinical features of acute sensorineural loss of hearing associated with vertigo]. [Abstract] [BibTeX]	2016	Vestnik otorinolaringologii Vol. 81(1), pp. 8-12	article	DOI
Abstract: The objective of the present study was to estimate the prevalence of vertigo and to determine the type of the lesion of the vestibular analyzer in the patients presenting with acute sensorineural loss of hearing (ASNLH). The secondary objective was to evaluate the possibility of the restoration of the auditory thresholds. The results of the examination and treatment of 94 patients suffering from ASNLH are presented. It was shown that the development of acute sensorineural loss of hearing was accompanied by unilateral peripheral vestibulopathy in 22.3% of the patients. In 5.3% of these cases, dizziness could be attributed to benign paroxysmal positional vertigo and canalolythias is of the posterior semicircular canal on the side of hearing impairment. It is concluded that the presence of the clinical signs of lesions of the vestibular analyzer and peripheral vestibular dysfunction in the form of latent spontaneous nystagmus without gaze fixation and/or asymmetric nystagmus with unilateral weakness in the caloric test is a negative prognostic factor for the restoration of the auditory thresholds in the patients presenting with acute sensorineural loss of hearing.
BibTeX: @article{Palchun2016, author = {Pal'chun, V T and Guseva, A L and Levina, Yu V and Chistov, S D}, title = {[The specific clinical features of acute sensorineural loss of hearing associated with vertigo].}, journal = {Vestnik otorinolaringologii}, year = {2016}, volume = {81}, issue = {1}, pages = {8--12}, doi = {https://doi.org/10.17116/otorino20168118-12}, keywords = {Adolescent; Adult; Aged; Benign Paroxysmal Positional Vertigo, diagnosis, physiopathology; Dizziness, diagnosis, physiopathology; Female; Hearing Loss, Sensorineural, diagnosis, physiopathology; Humans; Male; Middle Aged; Vestibular Function Tests; Young Adult}, pmid = {26977560} }
López-Escámez, J.A., López-Nevot, A. and Salinero, J.	[The treatment of benign paroxysmal positional vertigo of the lateral semicircular canal by positional manipulation]. [Abstract] [BibTeX]	1999	Acta otorrinolaringologica espanola Vol. 50(6), pp. 473-475	article
Abstract: A case of left horizontal-canal benign paroxysmal positional vertigo (HC-BPPV) in a woman with a 7-year history of episodic vertigo when turning over in bed is reported. The diagnosis was established with the patient lying down with her head raised 30 degrees with respect to the horizontal plane. Treatment with positional maneuvers (270 degrees contralateral head rotation in 3 steps) resolved the attacks. Positional testing failed to elicit symptoms 7 days, 14 days, 1 month, and 2 months after treatment. Four months after treatment, the patient remains asymptomatic. Published cases of HC-BPPV are discussed, as well as the differential diagnosis with posterior semicircular canal BPPV.
BibTeX: @article{Lopez-Escamez1999, author = {López-Escámez, J A and López-Nevot, A and Salinero, J}, title = {[The treatment of benign paroxysmal positional vertigo of the lateral semicircular canal by positional manipulation].}, journal = {Acta otorrinolaringologica espanola}, year = {1999}, volume = {50}, issue = {6}, pages = {473--475}, keywords = {Adult; Chronic Disease; Diagnosis, Differential; Female; Humans; Posture; Recurrence; Semicircular Canals; Vertigo, diagnosis, therapy}, pmid = {10502701} }
Frade González, C., Martín Martín, C. and Proupin Vázquez, N.	[The treatment of benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	1994	Acta otorrinolaringologica espanola Vol. 45(6), pp. 421-423	article
Abstract: Medical treatment of the benign paroxysmal positional vertigo has achieved a high relevance in the last fifteen years because this is one of the most frequent types of vertigo. However, at the present time it is not possible to reject the surgical treatment yet. A review of 116 cases with benign paroxysmal positional vertigo has been made. Patients were included in three groups of therapy: pharmacological treatment, postural manoeuvres and a combination of both. Results were categorized in different groups according to the time (1 month, 3 months, 6 months and 1 year) that symptoms took to wear off. The most efficient treatment has been the BRANDT and DAROFF'S manoeuvres in association with vestibular sedatives.
BibTeX: @article{FradeGonzalez1994, author = {Frade González, C and Martín Martín, C and Proupin Vázquez, N}, title = {[The treatment of benign paroxysmal positional vertigo].}, journal = {Acta otorrinolaringologica espanola}, year = {1994}, volume = {45}, issue = {6}, pages = {421--423}, keywords = {Adult; Combined Modality Therapy; Exercise; Female; Humans; Hypnotics and Sedatives, therapeutic use; Male; Middle Aged; Posture; Treatment Outcome; Vasodilator Agents, therapeutic use; Vertigo, diagnosis, drug therapy, therapy}, pmid = {7873231} }
Wang, T., An, F., Xie, C., Chen, J., Zhu, C. and Wang, Y.	[The treatment of benign positional paroxysmal vertigo of posterior semicircular canal by Epley maneuver combined with Semont maneuver]. [Abstract] [BibTeX]	2014	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 28(19), pp. 1469-1471	article
Abstract: To investigate the treatment of benign positional paroxysmal vertigo of posterior semi-circular canal by Epley maneuver combined with Semont maneuver. One hundred and fifty patients with benign positional paroxysmal vertigo of posterior semicircular canal were randomly divided into three groups: group A, B and C. Patients in group A were treated by Epley maneuver and patients in group B were treated by Semont maneuver. Patients in group C were received the treatment of Epley maneuver combined with Semont ma- neuver. We recorded the times of treatments in different groups respectively. Statistics of treatment effects and follow-up studies with 3 months after the recovery were assessed. The cure rate of the canalith repositioning on the primary, secondary and tertiary treatment in group A was respective 72% (38/53) and 81% (43/53) and 85% (45/53), in group B was 68% (30/44) and 80% (35/44) and 84% (37/44), in group C was 89% (47/53) and 94% (50/53) and 98% (52/53). The cure rate in group C is significantly higher than group A and group B (χ2 = 6.777, P < 0.05; χ2 = 6.647, P < 0.05). 3 months after recovery 6 patients in group A, 5 patients in group B and 1 patient in group C were relapsed. By the use of Epley maneuver combined with Semont maneuver in the treatment of benign positional paroxysmal vertigo of posterior semicircular canal, the primary cure rate was increased and the numbers of treatments were reduced and the relapse was decreased. It is suitable to use Epley maneuver combined with Semont maneuver in the clinic.
BibTeX: @article{Wang2014, author = {Wang, Tan and An, Fengwei and Xie, Cuili and Chen, Jianqiu and Zhu, Chunsheng and Wang, Ying}, title = {[The treatment of benign positional paroxysmal vertigo of posterior semicircular canal by Epley maneuver combined with Semont maneuver].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2014}, volume = {28}, issue = {19}, pages = {1469--1471}, keywords = {Benign Paroxysmal Positional Vertigo, therapy; Follow-Up Studies; Humans; Patient Positioning; Physical Therapy Modalities; Posture; Recurrence; Semicircular Canals; Vertigo}, pmid = {25775747} }
Zhuang, J., Huang, J., Zhao, Z., Zhao, Y., Zhou, H., Wang, W. and Tian, G.	[The treatment of Semont maneuver for 40 patients with posterior semicircular canal benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2005	Lin chuang er bi yan hou ke za zhi = Journal of clinical otorhinolaryngology Vol. 19(7), pp. 300-1, 304	article
Abstract: To evaluate the effectiveness of Semont maneuver for posterior semicircular canal benign paroxysmal positional vertigo (PC-BPPV). Forty patients with PC-BPPV were treated with Semont maneuver from January to August in 2004. After a single treatment session of Semont maneuver,the symptoms disappeared completely in 32 patients, the first success rate was 80%. Among 19 patients who had only 1 week duration of PC-BPPU, the symptoms disappeared in 16 patients after a single treatment. The symptoms disappeared in 3 patients after twice, 2 patients after 3 times and 1 patient after 4 times of Semont maneuver sessions, the total success rate was 95%. No effectiveness was found 2 patients; PC-BPPU recurred in 5 patients during follow-up and the recurrent rate was 12.5%. it was still effective for another Semont maneuver therapy session. The Semont maneuver therapy is safe and effective for PC-BPPV. Repeated Semont maneuver therapy is still effective for them.
BibTeX: @article{Zhuang2005, author = {Zhuang, Jianhua and Huang, Jian and Zhao, Zhongxin and Zhao, Ying and Zhou, Hui and Wang, Wenzhao and Tian, Guohong}, title = {[The treatment of Semont maneuver for 40 patients with posterior semicircular canal benign paroxysmal positional vertigo].}, journal = {Lin chuang er bi yan hou ke za zhi = Journal of clinical otorhinolaryngology}, year = {2005}, volume = {19}, issue = {7}, pages = {300--1, 304}, keywords = {Adult; Aged; Female; Humans; Male; Middle Aged; Physical Therapy Modalities; Posture, physiology; Semicircular Canals, pathology; Treatment Outcome; Vertigo, etiology, therapy}, pmid = {16001895} }
Pollak, L.	[The variety of symptoms in patients with benign paroxysmal positional vertigo--revision]. [Abstract] [BibTeX]	2013	Harefuah Vol. 152(2), pp. 73-5, 124	article
Abstract: Despite its frequent occurrence and effective treatment options, benign paroxysmal positional vertigo (BPPV) still remains underestimated in the community. Acquaintance of the physician with the various presentation symptoms assists in recognition of the entity. We report the complaints and subjective outcome in our cohort of BPPV patients and discuss the possible origin of the atypical, but common, symptoms.
BibTeX: @article{Pollak2013, author = {Pollak, Lea}, title = {[The variety of symptoms in patients with benign paroxysmal positional vertigo--revision].}, journal = {Harefuah}, year = {2013}, volume = {152}, issue = {2}, pages = {73--5, 124}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Female; Humans; Male; Middle Aged; Vertigo, diagnosis, physiopathology, therapy; Young Adult}, pmid = {23513495} }
Mierzwiński, J., Pawlak-Osińska, K., Kaźmierczak, H., Korbal, P., Muller, M., Piziewicz, A., Wesołowska, M. and Masztalerz, A.	[The vestibular system and migraine in children]. [Abstract] [BibTeX]	2000	Otolaryngologia polska = The Polish otolaryngology Vol. 54(5), pp. 537-540	article
Abstract: Migraine in childhood is relatively common disease. Although clinical practice and scientific publications recognize frequent association of migraine and vestibular disorders, relationships have yet to be well defined. In present study the vestibular function was extensively tested in 20 children suffering from migraine. All the patients underwent complete neurootological examination including tonal threshold audiometry, testing of vestibulo-spinal reflexes--Romberg and Unterberger-Fukuda tests, Dix-Halpike test for BPPV, videonystagmography. On videonystagmography each patient was evaluated regarding: calibration, spontaneous nystagmus, gaze nystagmus, eye tracking test, optokinetic and positional nystagmus, and caloric testing. The same procedure have been performed regarding control group comprised of 15 healthy. All the patients with migraine presented abnormalities in vestibular testing. Analysis of the results showed that: functional state of structures forming both visuo-ocular and vestibulo-ocular structures was altered in all the migraine patients evaluated in the study, pathological findings suggest mainly central localisation of vestibular dysfunction in children suffering from migraine, the number of pathological VNG findings seems not to be correlated with the type of migraine.
BibTeX: @article{Mierzwinski2000, author = {Mierzwiński, J and Pawlak-Osińska, K and Kaźmierczak, H and Korbal, P and Muller, M and Piziewicz, A and Wesołowska, M and Masztalerz, A}, title = {[The vestibular system and migraine in children].}, journal = {Otolaryngologia polska = The Polish otolaryngology}, year = {2000}, volume = {54}, issue = {5}, pages = {537--540}, keywords = {Adolescent; Child; Child, Preschool; Female; Humans; Male; Migraine Disorders, classification, etiology, physiopathology; Nystagmus, Pathologic, complications, diagnosis; Vestibular Diseases, complications, diagnosis; Vestibule, Labyrinth, physiopathology}, pmid = {11202339} }
Wang, X., Tian, Y.J. and Shan, J.	[Therapeutic effects of psychological intervention combined with manual reduction on benign paroxysmal positional vertigo in the elderly]. [Abstract] [BibTeX]	2018	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 32(4), pp. 264-269	article	DOI
Abstract: To explore the best treatment for elderly patients with benign paroxysmal positional vertigo (BPPV). Sixty-eight BPPV patients aged 60-85 years were randomly divided into two groups. The control group was treated by simple manipulation. The study group was treated by manual reduction combined with psychological intervention. The curative effect was compared. The cure rates of the control group and the study group were 44.4% and 43.8% respectively, with no significant difference ( >0.05); the effective rates were 52.78% and 87.50% respectively, with significant difference ( <0.05). The recurrence rates of control group and study group were 8.3% and 3.1% after 2 weeks of treatment, respectively, with no significant difference ( >0.05). The recurrence rates at 3 months were 5.6% and 0 respectively, with no significant difference ( >0.05). The difference of SAS and SDS between the two groups after treatment was statistically significant ( <0.05). There was no significant difference in the residual symptoms between the two groups at the first follow-up ( >0.05), and at 1 week and 4 weeks ( <0.05). The residual symptoms of the patients after reoperation were relieved compared with those of the control group. The DHI scores of the study group between 60-70 years old and 71-85 years old group for the first time, after 1 week and 4 weeks were statistically significant ( <0.05), and the residual symptoms in the 60-70 years group were reduced compare to the 71-85-year-old group. Elderly people with BPPV are susceptible to anxiety and depression. Manipulation combined with psychological intervention can promote the curative effect well, but personalized treatment plan should be developed.
BibTeX: @article{Wang2018f, author = {Wang, X and Tian, Y J and Shan, J}, title = {[Therapeutic effects of psychological intervention combined with manual reduction on benign paroxysmal positional vertigo in the elderly].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2018}, volume = {32}, issue = {4}, pages = {264--269}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2018.04.006}, keywords = {Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, psychology, therapy; Humans; Middle Aged; Patient Positioning; Psychotherapy; Recurrence; Retrospective Studies; aged; psychological intervention; vertigo}, pmid = {29798502} }
Hamann, K.F.	[Therapy of benign paroxysmal positional vertigo]. [BibTeX]	2000	Laryngo- rhino- otologie Vol. 79(11), pp. 625-626	article	DOI
BibTeX: @article{Hamann2000, author = {Hamann, K F}, title = {[Therapy of benign paroxysmal positional vertigo].}, journal = {Laryngo- rhino- otologie}, year = {2000}, volume = {79}, issue = {11}, pages = {625--626}, doi = {https://doi.org/10.1055/s-2000-8283}, keywords = {Humans; Meniere Disease, etiology, physiopathology, therapy; Otolithic Membrane, physiopathology; Physical Therapy Modalities}, pmid = {11138490} }
Guo, P., Li, J. and Zhang, H.	[Three cases of benign positional paroxysmal vertigo in pregnant women]. [Abstract] [BibTeX]	2015	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 29(22), pp. 2012-2013	article
Abstract: BPPV is the most common cause of dizziness in adults, and the symptoms, causes, behavior of adult patients are clearly defined. Pregnant woman may also suffer from BPPV. To our knowledge, there are few reports on BPPV in pregnant women. In this paper, the clinical characteristics and results of 3 pregnant women with BPPV are reported.
BibTeX: @article{Guo2015, author = {Guo, Pengfei and Li, Jinrang and Zhang, Hao}, title = {[Three cases of benign positional paroxysmal vertigo in pregnant women].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2015}, volume = {29}, issue = {22}, pages = {2012--2013}, keywords = {Adult; Benign Paroxysmal Positional Vertigo, diagnosis; Dizziness; Female; Humans; Pregnancy; Pregnancy Complications, diagnosis}, pmid = {26911074} }
Shan, X.-z., Sun, Q., Long, S.-b. and Ma, L.-t.	[Three-axis otoconia maneuver treatment in benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2008	Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery Vol. 43(10), pp. 786-788	article
Abstract: To evaluate three-axis otoconia maneuver (TOM) for benign paroxysmal positional vertigo (BPPV). The data from twenty BPPV patients who received three-axis otoconia maneuver treatment and 20 BPPV patients who received canalith repositioning (CRP) maneuver treatment were analyzed retrospectively. There were 17 patients received 1 TOM session and 3 patients received 2 TOM sessions while 16 patients received 1 CRP session and 4 patients received 2 CRP sessions. The chi-square (X2) test was used in evaluating the association between two independent samples in a contingency table. Both methods had no statistically significant. The significance level for statistical tests was 5% (alpha = 0.05). Three-axis otoconia maneuver could be effective used in benign paroxysmal positional vertigo with the advantage of repeatedly practicable and instrumental.
BibTeX: @article{Shan2008, author = {Shan, Xi-zheng and Sun, Qing and Long, Shun-bo and Ma, Li-tao}, title = {[Three-axis otoconia maneuver treatment in benign paroxysmal positional vertigo].}, journal = {Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery}, year = {2008}, volume = {43}, issue = {10}, pages = {786--788}, keywords = {Adolescent; Adult; Female; Humans; Male; Middle Aged; Retrospective Studies; Semicircular Canals; Treatment Outcome; Vertigo, therapy; Young Adult}, pmid = {19119678} }
Zhang, N., Chen, T., Dong, H., Lin, P. and Liu, R.	[To analyze the etiology of benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2011	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 25(7), pp. 307-311	article
Abstract: To analyze the occurrence and probable etiological factors of benign paroxysmal positional vertigo (BPPV). one hundred and twenty four BPPV cases were inquired histories, classified into different groups and analyzed relevant diseases. All patients were taken Caloric tests before Canal repositioning procedure, and compared the differences of unilateral weakness (UW) and semicircular canal involved between BPPV patients with and without relevant diseases. There were 97 (78.2%) patients with relevant diseases while 27 (21.8%) without. Ninety-two (74.2%) patients with abnormal UW. To compare the normal and abnormal UW, posterior canal and lateral canal with abnormal UW values, unilateral or bilateral of abnormal UW values, consistency of abnormal UW side and BPPV side between BPPV patients with and without relevant diseases, there were no significant differences (Chi-square values were 0.000, 0.000, 0.306, 0.027, P>0.05). BPPV patients with relevant diseases are common, which mainly occurs in middle-aged or aged people and female. Otolith ecclesiis and dysfunction of semicircular canal may have the same etiological factors. Caloric tests may do help to analyze the BPPV etiological factors.
BibTeX: @article{Zhang2011, author = {Zhang, Na and Chen, Taisheng and Dong, Hong and Lin, Peng and Liu, Ranran}, title = {[To analyze the etiology of benign paroxysmal positional vertigo].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2011}, volume = {25}, issue = {7}, pages = {307--311}, keywords = {Adolescent; Adult; Aged; Benign Paroxysmal Positional Vertigo; Caloric Tests; Female; Humans; Male; Middle Aged; Vertigo, diagnosis, etiology, pathology; Young Adult}, pmid = {21710718} }
Jiang, Z.D.	[To standardize the clinical diagnosis and treatment of benign paroxysmal positional vertigo]. [BibTeX]	2018	Zhonghua yi xue za zhi Vol. 98(16), pp. 1201-1203	article	DOI
BibTeX: @article{Jiang2018, author = {Jiang, Z D}, title = {[To standardize the clinical diagnosis and treatment of benign paroxysmal positional vertigo].}, journal = {Zhonghua yi xue za zhi}, year = {2018}, volume = {98}, issue = {16}, pages = {1201--1203}, doi = {https://doi.org/10.3760/cma.j.issn.0376-2491.2018.16.001}, pmid = {29747302} }
Gordon, C.R., Joffe, V., Levite, R. and Gadoth, N.	[Traumatic benign paroxysmal positional vertigo: diagnosis and treatment]. [Abstract] [BibTeX]	2002	Harefuah Vol. 141(11), pp. 944-7, 1012, 1011	article
Abstract: Although head trauma is the cause of Benign Paroxysmal Positional Vertigo (BPPV) in about 15% of cases, the clinical features and response to treatment in this particular group of patients was not previously evaluated. We present 20 cases of traumatic BPPV: 12 cases identified from 150 consecutive BPPV patients diagnosed in our Dizziness Clinic; and 8 cases diagnosed from 75 consecutive head trauma patients seen in the Emergency Room. In all patients the clinical diagnosis was confirmed by the Dix-Hallpike maneuver and all were treated by the Epley procedure. Treatment results were compared to those of 40 consecutive patients with idiopathic BPPV. There was a wide spectrum and severity of head trauma including road accident (7), different falls (5), blow to the head (5) and miscellaneous (3). Two patients experienced brief loss of consciousness. Only two patients were diagnosed as BPPV before referral to our clinic. When presented to our Dizziness Clinic the patients were diagnosed as follows: unspecified dizziness (7), cervical vertigo (4) and transient ischemic attack (1). Five patients (25%) had bilateral BPPV. Eight patients (40%) had complete resolution of symptoms and signs following a single treatment while 12 patients (60%) required additional physical treatments until complete resolution of BPPV was achieved. During follow-up, 11 patients (55%) had recurrent attacks of BPPV. Thirty-four patients with idiopathic BPPV (85%) had a single successful treatment session while the others required repeated physical treatments until complete resolution of BPPV. We conclude that traumatic BPPV is probably under-recognized or misdiagnosed in clinical practice. Response to a single physical treatment seems to be less favorable than in idiopathic BPPV. The Dix-Hallpike maneuver is mandatory in all patients with dizziness and vertigo following head trauma.
BibTeX: @article{Gordon2002, author = {Gordon, Carlos R and Joffe, Vitaly and Levite, Ronen and Gadoth, Natan}, title = {[Traumatic benign paroxysmal positional vertigo: diagnosis and treatment].}, journal = {Harefuah}, year = {2002}, volume = {141}, issue = {11}, pages = {944--7, 1012, 1011}, keywords = {Accidental Falls; Accidents, Traffic; Adult; Aged; Craniocerebral Trauma, complications; Female; Humans; Ischemic Attack, Transient; Male; Middle Aged; Posture; Treatment Outcome; Vertigo, diagnosis, etiology, therapy}, pmid = {12476625} }
Pérez Vázquez, P., Manrique Estrada, C., Muñoz Pinto, C., Baragaño Río, L., Bernardo Corte, M.J. and Suárez Nieto, C.	[Treating benign paroxysmal positional vertigo with the canalith repositioning maneuver of Epley. Our experience]. [Abstract] [BibTeX]	2001	Acta otorrinolaringologica espanola Vol. 52(3), pp. 193-198	article
Abstract: Benign Paroxysmal Positional Vertigo (BPPV) is one of the most common peripheral vestibular disorders. Particle repositioning maneuvers are simple and effective treatments for patients with BPPV. This study included 37 consecutive cases of BPPV treated with the particle repositioning maneuver of Epley. 97% of patients improved and the maneuver was well tolerated. We conclude that Epley Maneuver is safe and effective in the treatment of BPPV.
BibTeX: @article{PerezVazquez2001, author = {Pérez Vázquez, P and Manrique Estrada, C and Muñoz Pinto, C and Baragaño Río, L and Bernardo Corte, M J and Suárez Nieto, C}, title = {[Treating benign paroxysmal positional vertigo with the canalith repositioning maneuver of Epley. Our experience].}, journal = {Acta otorrinolaringologica espanola}, year = {2001}, volume = {52}, issue = {3}, pages = {193--198}, keywords = {Humans; Posture; Retrospective Studies; Vertigo, therapy}, pmid = {11526863} }
Ferri, E., Armato, E. and Ianniello, F.	[Treatment approaches to benign paroxysmal positional vertigo. Clinical features in 228 cases of posterior and lateral canalolithiasis]. [Abstract] [BibTeX]	1999	Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale Vol. 19(1), pp. 12-20	article
Abstract: After having discussed the etiopathogenesis, epidemiology and physiopathology of Benign Paroxysmal Positional Vertigo (BPPV), the authors present their case study covering audiovestibology out-patients treated in the last two years: 228 cases of canalotithiasis-derived BPPV, both posterior (186 cases) and lateral (42 cases). These patients were diagnosed and treated between July 1996 and July 1998 and account for 15% of the 1550 patients complaining of balance and postural disorders seen during that period. Analysis of the results shows BPPV epidemiological data that are practically the same those reported in the literature: greater incidence in females, predominance of posterior canalolithiasis and optimal use of the canalith repositioning techniques. The authors reconfirm the effectiveness of the Semont maneuver and its variations in the treatment of those forms involving the posterior semicircular canal (97% healing). As regards BPPV due to lateral canalolithiasis. The authors feel the vestibular "barbecue" rehabilitation techniques suggested by Lempert--i.e. a 270 degrees rotation starting from the decubitus position on the pathological side, rather than Baloh's traditional 360 degrees rotation--is most suitable for the treatment of BPPV stemming from lateral canalolithiasis. The Lempert technique provided satisfactory results (76% healing) and a reduction in the number of failures (24%).
BibTeX: @article{Ferri1999, author = {Ferri, E and Armato, E and Ianniello, F}, title = {[Treatment approaches to benign paroxysmal positional vertigo. Clinical features in 228 cases of posterior and lateral canalolithiasis].}, journal = {Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale}, year = {1999}, volume = {19}, issue = {1}, pages = {12--20}, keywords = {Adult; Ear Canal, pathology; Ear Diseases, epidemiology, pathology, therapy; Female; Humans; Lithiasis, epidemiology, pathology, therapy; Male; Middle Aged; Posture; Prevalence; Retrospective Studies; Vertigo, therapy}, pmid = {10418187} }
Vaz Garcia, F.	[Treatment failures in benign paroxysmal positional vertigo. Role of vestibular rehabilitation]. [Abstract] [BibTeX]	2005	Revue de laryngologie - otologie - rhinologie Vol. 126(4), pp. 271-274	article
Abstract: The objective of this study is to evaluate the efficacy of therapeutic maneuvers performed for BPPV patients. The study will also evaluate the efficacy of complementary exercises for vestibular rehabilitation (VR) in BPPV, presenting with persistent vertigo or disequilibrium after performing therapeutic maneuvers. 175 patients from both sexes, were included in this analysis. All suffered from BPPV and were treated with therapeutic maneuvers, preferably that described by Semont (SM). One week after SM, 79% of patients were cured; 13% complained of disequilibrium or vertigo without BPPV, 3%, presented with a persistent positional vertigo without nystagmus during the Hallpike manoeuvre and 5% of the patients still complained from BPPV which in some cases got worse. For patients still complaining of imbalance or non-positional vertigo, customized VR programs were applied (optokinetic stimulations, rotatory chair, proprioceptive training and/or platform). The final results, evaluated by posturography and by DHI, were good. VR exercises can achieve improvement or cure in 16% of these patients.
BibTeX: @article{VazGarcia2005, author = {Vaz Garcia, F}, title = {[Treatment failures in benign paroxysmal positional vertigo. Role of vestibular rehabilitation].}, journal = {Revue de laryngologie - otologie - rhinologie}, year = {2005}, volume = {126}, issue = {4}, pages = {271--274}, keywords = {Electromyography; Evaluation Studies as Topic; Female; Humans; Male; Middle Aged; Physical Therapy Modalities; Retreatment; Treatment Failure; Vertigo, etiology, physiopathology, rehabilitation; Vestibule, Labyrinth, physiopathology}, pmid = {16496557} }
Chen, D., Xiong, S. and Cui, Y.	[Treatment of anterior canal benign paroxysmal positional vertigo by Yacovino repositioning maneuver]. [Abstract] [BibTeX]	2015	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 29(1), pp. 17-19	article
Abstract: To evaluate the efficacy of Yacovino repositioning maneuver in patients with anterior semicircular canal benign paroxysmal positional vertigo (ASC-BPPV). Nine patients were diagnosed as ASC-BPPV from January 2013 to October 2014. All the patients were performed with Yacovino repositioning maneuver and the effective rate were evaluated by Dix-Hallpike tests. Among the nine ASC-BPPV patients, 2 cases were successfully controlled by the first maneuver, 2 cases by the second time, and the nystagmus of 1 case was disappeared after 1 months' follow-up. The remaining 3 cases were respectively followed up till 7,8, 12 months with consistent positional downbeat nystagmus. Being a relative low incidence disease, of ASC-BPPV also has low effective rate after Yacovino repositioning maneuver.
BibTeX: @article{Chen2015a, author = {Chen, Danping and Xiong, Shanshan and Cui, Yong}, title = {[Treatment of anterior canal benign paroxysmal positional vertigo by Yacovino repositioning maneuver].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2015}, volume = {29}, issue = {1}, pages = {17--19}, keywords = {Benign Paroxysmal Positional Vertigo, therapy; Humans; Patient Positioning; Semicircular Canals; Vertigo}, pmid = {25966547} }
Kunelskaya, N.L., Guseva, A.L. and Baybakova, E.V.	[Treatment of benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2016	Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova Vol. 116(6), pp. 98-103	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder. BPPV is easily diagnosed by positioning tests and effectively treated by repositioning maneuvers. The authors focus on the treatment of BPPV, when different canals are affected, including canalo- and cupulolithiasias. Complications of BPPV and surgery of cases, resistant to conservative treatment, are also discussed.
BibTeX: @article{Kunelskaya2016a, author = {Kunelskaya, N L and Guseva, A L and Baybakova, E V}, title = {[Treatment of benign paroxysmal positional vertigo].}, journal = {Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova}, year = {2016}, volume = {116}, issue = {6}, pages = {98--103}, doi = {https://doi.org/10.17116/jnevro20161166198-103}, keywords = {Benign Paroxysmal Positional Vertigo, therapy; Humans; Patient Positioning; benign paroxysmal positional vertigo; canalithiasis; cupulolithiasis; repostioning maneuver}, pmid = {28635797} }
Tommerup, B.E. and Felding, C.A.	[Treatment of benign paroxysmal postural vertigo in a department of otorhinolaryngology]. [Abstract] [BibTeX]	1998	Ugeskrift for laeger Vol. 160(43), pp. 6204-6206	article
Abstract: Benign paroxysmal positional vertigo can be succesfully treated by means of the Epley manoeuvre and vibration. This is a simple, non-invasive and economic procedure for this group of patients, who are greatly affected by vertigo in their daily life and therefore have many sick days.
BibTeX: @article{Tommerup1998, author = {Tommerup, B E and Felding, C A}, title = {[Treatment of benign paroxysmal postural vertigo in a department of otorhinolaryngology].}, journal = {Ugeskrift for laeger}, year = {1998}, volume = {160}, issue = {43}, pages = {6204--6206}, keywords = {Adult; Aged; Female; Head; Head-Down Tilt; Humans; Male; Middle Aged; Posture; Prospective Studies; Rotation; Semicircular Canals, physiology; Vertigo, diagnosis, physiopathology, therapy; Vibration}, pmid = {9803869} }
Liu, Y., Zou, S.Z. and Tian, S.Y.	[Treatment of patients with probable benign paroxysmal positional vertigot]. [Abstract] [BibTeX]	2018	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 32(13), pp. 1023-1026	article	DOI
Abstract: To study the treatment and outcome of the patients with probable BPPV who lacked typical nystagmus. Nine hundred and twenty-two patients with posterior canal BPPV or lateral canal BPPV were selected from the database of our department. There were 801 patients with typical nystagmus during positional testing and 121 patients lacked of typical nystagmus. Manual reposition (Eply,modified Semount,Barbecue and Li manuve) were used and the follow-up was（3.7±2.5）days. In the patients with probable BPPV,there were 44 patients affected by posterior canal and 77 patients had been affected by lateral canal.In the patients with definite BPPV,there were 489 patients affected by posterior canal and 312 by horizontal canal.There was no statistic difference in the result of the treatment (cure,relief and no response) between the probable BPPV and definite BPPV ( >0.05).However,the rate of 'cure' and 'relief' in the probable BPPV was higher than the definite BPPV in lateral canal ( =0.023). A few patients with probable BPPV may develop to definite BPPV or other disease with dizziness.Maneuver of reposition is meaningful for probable BPPV,especially for patients with lateral canal probable BPPV.
BibTeX: @article{Liu2018a, author = {Liu, Y and Zou, S Z and Tian, S Y}, title = {[Treatment of patients with probable benign paroxysmal positional vertigot].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2018}, volume = {32}, issue = {13}, pages = {1023--1026}, doi = {https://doi.org/10.13201/j.issn.1001-1781.2018.13.016}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis, etiology, therapy; Dizziness; Humans; Nystagmus, Pathologic; Patient Positioning; Semicircular Canals; benign paroxysmal positional vertigo; reposition; semi-circular canal}, pmid = {29986569} }
Pino Rivero, V., Pantoja Hernández, C.G., González Palomino, A., Mora Santos, M.E., Marcos García, M., Montero García, C. and Blasco Huelva, A.	[Treatment of the benign paroxysmal positional vertigo (BPPV) by Epley maneuver]. [Abstract] [BibTeX]	2007	Anales otorrinolaringologicos ibero-americanos Vol. 34(1), pp. 67-73	article
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most common of the peripheral vertigo. We report the case of a 45 years old female with that pathology suspected by the symptoms which the patient related to head changes of positions and movements. Her diagnosis was confirmed by the maneuver of Dix-Hallpike, that was positive, and the treatment consisted in a maneuver of canalicular reposition according to Epley's technique. Such maneuver was successful and actually the patient is without symptoms after more than 2 years since the first episode. Finally we have performed a bibliographic review to verify the effectiveness of that treatment.
BibTeX: @article{PinoRivero2007a, author = {Pino Rivero, V and Pantoja Hernández, C G and González Palomino, A and Mora Santos, M E and Marcos García, M and Montero García, C and Blasco Huelva, A}, title = {[Treatment of the benign paroxysmal positional vertigo (BPPV) by Epley maneuver].}, journal = {Anales otorrinolaringologicos ibero-americanos}, year = {2007}, volume = {34}, issue = {1}, pages = {67--73}, keywords = {Female; Follow-Up Studies; Humans; Middle Aged; Physical Therapy Modalities; Posture; Semicircular Canals; Time Factors; Treatment Outcome; Vertigo, diagnosis, therapy}, pmid = {17405460} }
Zhang, H., Zhang, Q., Xu, D. and Xu, M.	[Treatment outcome of patients with idiopathic sudden sensorineural hearing loss and concomitant benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2014	Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery Vol. 28(16), pp. 1212-1214	article
Abstract: To evaluate the treatment outcome of patients with idiopathic sudden sensorineural hearing loss (ISSHL) with concomitant benign paroxysmal positional vertigo (BPPV). Out of 252 ISSHL patients, 96 patients were diagnosed with complicating vertigo and examined using electronystagmography. All patients were divided into three groups, namely, ISSHL without vertigo group (n=156), ISSHL with non-BPPV vertigo group (n=70) and ISSHL with BPPV group (n=26). All patients received daily intravenous infusion of 200,000 U urokinase for 3 consecutive days and 100,000 U for 3 additional days. Concomitant medications included intravenous Ginkgo biloba leave compound and vitamin B6 and intramuscular vitamins B1 and B12 for 2 weeks. Twenty-six patients diagnosed with BPPV on electronystagmography positioning test also received canalith repositioning maneuver. Vertigo-associated symptoms completely resolved after canalith repositioning maneuver in ISSHL patients with complicating BPPV. With respect to post-treatment hearing, ISSHL patients without vertigo exhibited a similar improvement as compared to those with BPPV, while those with non-BPPV vertigo had a significantly less improvement than those without vertigo and with BPPV. ISSHL patients with complicating BPPV exhibit a relatively favorable outcome with respect to hearing and vertigo-associated symptoms after medical and repositioning treatment.
BibTeX: @article{Zhang2014, author = {Zhang, Haixiong and Zhang, Qing and Xu, Dadao and Xu, Min}, title = {[Treatment outcome of patients with idiopathic sudden sensorineural hearing loss and concomitant benign paroxysmal positional vertigo].}, journal = {Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery}, year = {2014}, volume = {28}, issue = {16}, pages = {1212--1214}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, complications, therapy; Female; Hearing Loss, Sudden, complications, therapy; Humans; Male; Middle Aged; Prognosis}, pmid = {25464559} }
Migueis, A.C., Sémont, A., Stapleton Garcia, C. and Paço, J.	[Up-to-date on the BPPV: Semont maneuver for the posterior canal]. [BibTeX]	2005	Revue de laryngologie - otologie - rhinologie Vol. 126(1), pp. 57-63	article
BibTeX: @article{Migueis2005a, author = {Migueis, Antonio Carlos and Sémont, Alain and Stapleton Garcia, Carlos and Paço, Joao}, title = {[Up-to-date on the BPPV: Semont maneuver for the posterior canal].}, journal = {Revue de laryngologie - otologie - rhinologie}, year = {2005}, volume = {126}, issue = {1}, pages = {57--63}, keywords = {Humans; Physical Therapy Modalities; Posture, physiology; Semicircular Canals, physiopathology; Vertigo, physiopathology, therapy}, pmid = {16080651} }
Ou, Y., Liang, X., Zheng, Y., Yang, H., Chen, S., Liu, X., Liu, W. and Xu, Y.	[Value of the different positioning tests in diagnosis of benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2005	Lin chuang er bi yan hou ke za zhi = Journal of clinical otorhinolaryngology Vol. 19(22), pp. 1032-1034	article
Abstract: To ascertain the value of different positioning tests in diagnosis of benign paroxysmal positional vertigo (BPPV). Seventy-two patients who had determined the diagnosis of the posterior semicircular canal BPPV (PC-BPPV) in our department from Feb. 2000 to Apr. 2004 was tested with different positioning maneuvers. All cases were randomly divided into 2 groups with cross-over design. Group A with 36 subjects was tested with the Dix-Hallpike maneuver followed up by side-lying maneuver; Group B was tested in reverse order. Then, the Roll test was performed. The results had association (P > 0.01) between the Dix-Hallpike maneuver and side-lying maneuver, and the positive rate had no significant difference (P < 0.01). The features of vertigo and nystagmus provoked by the tests were the same. One patient was found combining with BPPV of horizontal semicircular canal (HC-BPPV) by the Roll test. As the Dix-Hallpike maneuver, the side-lying test has the same diagnostic value in determine the PC-BPPV. Because it is safer and easier to perform in the condition of range-of-motion limitations such as spondylosis, it can alter the Dix-Hallpike maneuver. If the horizontal nystagmus provoked in above tests, the Roll test should be perform also to determine whether combining with HC- BPPV or not.
BibTeX: @article{Ou2005, author = {Ou, Yongkang and Liang, Xiangfeng and Zheng, Yiqing and Yang, Haidi and Chen, Suijun and Liu, Xiang and Liu, Wei and Xu, Yaodong}, title = {[Value of the different positioning tests in diagnosis of benign paroxysmal positional vertigo].}, journal = {Lin chuang er bi yan hou ke za zhi = Journal of clinical otorhinolaryngology}, year = {2005}, volume = {19}, issue = {22}, pages = {1032--1034}, keywords = {Adult; Aged; Cross-Over Studies; Female; Humans; Male; Middle Aged; Posture; Semicircular Canals; Vertigo, diagnosis, etiology; Vestibular Diseases, diagnosis; Vestibular Function Tests, methods; Young Adult}, pmid = {16463767} }
Kato, H., Nagata, K., Kawamura, S., Suzuki, A., Sato, M., Mito, Y., Maruya, H., Hatazawa, J., Watahiki, Y., Sato, Y., Hirata, Y. and Utumi, H.	[Vascular and metabolic reserve in a case of hypoplasia of bilateral internal carotid arteries]. [Abstract] [BibTeX]	2000	Rinsho shinkeigaku = Clinical neurology Vol. 40(11), pp. 1096-1100	article
Abstract: We report a 64-year-old right-handed man who presented with a hypoplasia of bilateral internal carotid arteries (ICAs). The patient complained of a vertigo and was diagnosed as having a benign paroxysmal positional vertigo. Upon neurological examination, he was completely free from neurological deficits. MR angiogram revealed an occlusion of both ICAs. On conventional angiogram, the right ICA was occluded about 3 cm distal from its origin, and the left ICA was occluded at the precavernous portion. There was an abundant collateral blood flow to the frontal, temporal and parietal lobes through the posterior communicating arteries. Both carotid canals were hypoplastic on 3D-CT. The patient was then diagnosed as having a hypoplasia of both ICAs. Using a positron emission tomography (PET), cerebral blood flow (CBF), cerebral metabolic rate for oxygen (CMRO2), oxygen extraction fraction (OEF), and vascular transit time (VTT) were measured during resting state, and the vascular reactivities to carbon dioxide inhalation (VRCO2), and to the intravenous administration of Acetazolamide (VRACZ) were also evaluated. There was no global or focal reduction in CBF and VTT was within normal limit, whereas a global reduction of CMRO2 caused mild decrease in OEF. Moreover, VRACZ was significantly decreased and an intracerebral steal phenomenon was observed in the parietal cortical areas, whereas VRCO2 was preserved. The discrepancy between VRACZ and VRCO2 observed could be related to the differences in the mechanisms underlying the vasodilating effects of carbon dioxide and ACZ.
BibTeX: @article{Kato2000, author = {Kato, H and Nagata, K and Kawamura, S and Suzuki, A and Sato, M and Mito, Y and Maruya, H and Hatazawa, J and Watahiki, Y and Sato, Y and Hirata, Y and Utumi, H}, title = {[Vascular and metabolic reserve in a case of hypoplasia of bilateral internal carotid arteries].}, journal = {Rinsho shinkeigaku = Clinical neurology}, year = {2000}, volume = {40}, issue = {11}, pages = {1096--1100}, keywords = {Arterial Occlusive Diseases, diagnosis, physiopathology; Brain, metabolism; Carotid Artery Diseases, diagnosis, physiopathology; Carotid Artery, Internal, abnormalities; Cerebrovascular Circulation; Humans; Male; Middle Aged; Tomography, Emission-Computed}, pmid = {11332189} }
Zwergal, A., Möhwald, K. and Dieterich, M.	[Vertigo and dizziness in the emergency room]. [Abstract] [BibTeX]	2017	Der Nervenarzt Vol. 88(6), pp. 587-596	article	DOI
Abstract: Vertigo and dizziness are among the most common chief complaints in the emergency department. Etiologies can be categorized into three subgroups: neurootological (vestibular), medical (especially cardiovascular, metabolic), and psychiatric disorders. The diagnostic approach in the emergency department is based on a systematic analysis of case history (type, time course of symptoms, modulating factors, associated symptoms), clinical examination of the vestibular, ocular motor, and cerebellar systems (head impulse test, nystagmus, skew deviation, positioning maneuver, test of gait and stance), as well as a basal monitoring (vital signs, 12-lead ECG, blood tests). For differentiation of peripheral and central etiologies in acute vestibular syndrome, the HINTS exam (head impulse test, nystagmus, test of skew) and examination of smooth pursuit and saccades should be applied. Nonselective use of neuroimaging is not indicated due to a low diagnostic yield. Cranial imaging should be done in the following constellations: (1) detection of focal neurological or central ocular motor and vestibular signs on clinical exam, (2) acute abasia with only minor ocular motor signs, (3) presence of various cardiovascular risk factors, (4) headache of unknown quality as an accompanying symptom. Besides the symptomatic therapy of vertigo and dizziness with antiemetics or analgesics, further diagnostic differentiation is urgent to guide proper treatment. Examples are the acute therapy in cerebral ischemia, the execution of positioning maneuvers in benign paroxysmal positional vertigo, the use of corticosteroids in acute unilateral vestibulopathy, as well as the readjustment of metabolic homeostasis in medical disorders.
BibTeX: @article{Zwergal2017, author = {Zwergal, A and Möhwald, K and Dieterich, M}, title = {[Vertigo and dizziness in the emergency room].}, journal = {Der Nervenarzt}, year = {2017}, volume = {88}, issue = {6}, pages = {587--596}, doi = {https://doi.org/10.1007/s00115-017-0342-y}, keywords = {Cardiovascular Diseases, complications, diagnosis, therapy; Diagnosis, Differential; Dizziness, diagnosis, etiology, therapy; Emergency Medical Services, methods; Emergency Service, Hospital, organization & administration; Evidence-Based Medicine; Germany; Humans; Mental Disorders, complications, diagnosis, therapy; Metabolic Diseases, complications, diagnosis, therapy; Treatment Outcome; Vertigo, diagnosis, etiology, therapy; Vestibular Diseases, complications, diagnosis, therapy; Acute vestibular syndrome; Benign paroxysmal positional vertigo; Cerebral ischemia; Unilateral vestibulopathy; Vestibular pseudoneuritis}, pmid = {28484820} }
Strupp, M.	[Vertigo and dizziness: the neurologist's perspective]. [Abstract] [BibTeX]	2013	Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft Vol. 110(1), pp. 7-15	article	DOI
Abstract: The spectrum of diagnoses of patients with dizziness as the leading symptom who consult a neurologist does not differ greatly from the spectrum of those who consult ear nose and throat (ENT) specialists or general practitioners (GP). The most frequent forms are benign paroxysmal positioning vertigo (BPPV), phobic postural vertigo, central vertigo disorders, Menière's disease, vestibular neuritis and bilateral vestibulopathy. However, the first and most important question that is posed to neurologists is whether it is a central or peripheral syndrome. In more than 90 % of cases this differentiation is possible by taking the patient history (asking about the type of vertigo, the duration, triggers and accompanying symptoms) and conducting a physical examination of the patient. In the case of acute vertigo disorders in particular, a five-step procedure has proved to be helpful: the cover test to look for skew deviation as the central sign and component of the ocular tilt reaction, an examination with and without Frenzel's goggles to differentiate between peripheral vestibular spontaneous nystagmus and central fixation nystagmus, an examination of smooth pursuit and gaze-holding function and finally the head-impulse test to look for a deficit in the vestibulo-ocular reflex (VOR). Considerable advances have been made in the treatment of vertigo disorders in the last 10 years, e.g., cortisone for the treatment of acute vestibular neuritis, betahistine as a high-dosage, long-term treatment for Menière's disease, carbamazepine to treat vestibular paroxysmia and aminopyridine for downbeat nystagmus and episodic ataxia type 2.
BibTeX: @article{Strupp2013a, author = {Strupp, M}, title = {[Vertigo and dizziness: the neurologist's perspective].}, journal = {Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft}, year = {2013}, volume = {110}, issue = {1}, pages = {7--15}, doi = {https://doi.org/10.1007/s00347-012-2573-4}, keywords = {Diagnostic Techniques, Neurological; Dizziness, diagnosis, therapy; Humans; Medical History Taking; Ocular Motility Disorders, diagnosis, therapy; Vertigo, diagnosis, therapy}, pmid = {23288313} }
Dodt, C. and Zelihic, E.	[Vertigo and dizziness. Diagnostic algorithm from the perspective of emergency medicine]. [Abstract] [BibTeX]	2013	Medizinische Klinik, Intensivmedizin und Notfallmedizin Vol. 108(1), pp. 41-46	article	DOI
Abstract: Vertigo and dizziness are common symptoms in the acute care setting and have a wide diagnostic range. The most deleterious diagnosis is vertebrobasilar disease with brain infarction in the posterior fossa. Therefore, every patient with acute vestibular syndrome needs to be evaluated by a structured interview and a systematic physical examination for red flag symptoms which indicate vertebrobasilar infarction. Routinely, the physical examination should cover the head impulse (Halmagyi) test, test for nystagmus as well as the test of skew and in cases of benign paroxysmal positional vertigo, by the Dix-Hallpike maneuver. The suspicion of a central cause of vertigo is ideally confirmed by a magnetic resonance imaging (MRI) scan. Most patients with a peripheral cause of vertigo can be discharged under symptomatic therapy with the advice to consult an ear nose and throat physician while patients with a central cause of vertigo are admitted for further neurological treatment.
BibTeX: @article{Dodt2013, author = {Dodt, C and Zelihic, E}, title = {[Vertigo and dizziness. Diagnostic algorithm from the perspective of emergency medicine].}, journal = {Medizinische Klinik, Intensivmedizin und Notfallmedizin}, year = {2013}, volume = {108}, issue = {1}, pages = {41--46}, doi = {https://doi.org/10.1007/s00063-012-0173-3}, keywords = {Algorithms; Brain Ischemia, diagnosis, therapy; Cerebral Infarction, diagnosis, therapy; Critical Pathways; Diagnosis, Differential; Dizziness, etiology, therapy; Emergency Service, Hospital; Humans; Magnetic Resonance Imaging; Meniere Disease, diagnosis, therapy; Migraine Disorders, diagnosis, therapy; Patient Admission; Vertebrobasilar Insufficiency, diagnosis, therapy; Vertigo, etiology, therapy; Vestibular Function Tests}, pmid = {23377286} }
Zeng, X.-l., Li, P., Kong, Q.-c., Li, Y.-q., Li, Z.-c., Cen, J.-t., Wang, S.-f., Liu, X. and Zhang, G.-h.	[Vertigo due to enlarged vestibule with lateral semicircular canal dysplasia: an analysis of clinical characteristics]. [Abstract] [BibTeX]	2011	Zhonghua yi xue za zhi Vol. 91(46), pp. 3250-3253	article
Abstract: To explore the clinical characteristics and possible pathological mechanisms of vertigo due to enlarged vestibule with lateral semicircular canal dysplasia. A retrospective review was conducted for 5 cases of peripheral vertigo due to enlarged vestibule with lateral semicircular canal dysplasia. Their characteristics of medical history, precipitating factors, course of vertigo, auditory tests, vestibular tests and imaging examine results were analyzed. The clinical characteristics were as follows. (1) Specifics of medical history: 4 cases suffered delays in gross motor development and potential equilibrium dysfunctions. One case failed to recount an earlier medical history, but could maintain normal hearing and vestibular functions for a long time in adulthood. (2) Most cases could identify the precipitating factors of initial attacks, such as head-bumping, nose-blowing and constipation, etc. resulting in sudden rises of intracranial or abdominal pressures. (3) Paroxysmal vertigo and progressive hearing loss were mimicking Meniere disease or large vestibular aqueduct syndrome. But its course of vertigo was different from those of Meniere disease and large vestibular aqueduct syndrome with regards to hearing levels and audiograms. (4) Some cases had positional vertigo. But the results of Dix-Hallpike and Roll tests were different from benign paroxysmal positioning vertigo (BPPV). (5) The inner ear imaging showed enlarged vestibule with lateral semicircular canal dysplasia. The enlarged vestibule with lateral semicircular canal dysplasia is a rare etiology of peripheral vertigo. The history of delays in gross motor development and potential equilibrium dysfunctions in childhood may offer important diagnostic clues. And audiological and vestibular tests, high-resolution computed tomography and magnetic resonance may help to ascertain the diagnosis.
BibTeX: @article{Zeng2011, author = {Zeng, Xiang-li and Li, Peng and Kong, Qing-cong and Li, Yong-qi and Li, Zhi-cheng and Cen, Jin-tian and Wang, Shu-fang and Liu, Xian and Zhang, Ge-hua}, title = {[Vertigo due to enlarged vestibule with lateral semicircular canal dysplasia: an analysis of clinical characteristics].}, journal = {Zhonghua yi xue za zhi}, year = {2011}, volume = {91}, issue = {46}, pages = {3250--3253}, keywords = {Adult; Benign Paroxysmal Positional Vertigo; Female; Humans; Male; Middle Aged; Retrospective Studies; Semicircular Canals, abnormalities; Vertigo, etiology; Vestibular Aqueduct, abnormalities; Vestibule, Labyrinth, abnormalities; Young Adult}, pmid = {22333143} }
Langhagen, T., Lehnen, N., Krause, E. and Jahn, K.	[Vertigo in children and adolescents. Part 1: Epidemiology and diagnosis of peripheral vestibular disorders]. [Abstract] [BibTeX]	2013	HNO Vol. 61(9), pp. 791-802; quiz 803-4	article	DOI
Abstract: Migraine equivalents are the most common cause of vertigo in children and adolescents. Vertigo and balance disorders occur frequently in children during the course of otitis media, middle ear effusion and viral infections. If otitis media is associated with reduced hearing and vertigo, labyrinthitis must be considered. Craniocerebral injury is another important cause of vertigo in children. In contrast, spontaneous benign paroxysmal positional vertigo is rare among children. The isolated cases of endolymphatic hydrops that occur in children are usually secondary. Perilymph fistula can have congenital, infectious or trauma-related causes. The following characteristics are useful for differentiating between different vertiginous syndromes: type and duration of vertigo, triggering/aggravating/alleviating factors and accompanying symptoms. A neuro-ophthalmologic examination is essential to rule out central vestibular disorders.
BibTeX: @article{Langhagen2013, author = {Langhagen, T and Lehnen, N and Krause, E and Jahn, K}, title = {[Vertigo in children and adolescents. Part 1: Epidemiology and diagnosis of peripheral vestibular disorders].}, journal = {HNO}, year = {2013}, volume = {61}, issue = {9}, pages = {791--802; quiz 803-4}, doi = {https://doi.org/10.1007/s00106-013-2705-4}, keywords = {Craniocerebral Trauma, complications, diagnosis; Diagnosis, Differential; Diagnostic Techniques, Neurological; Endolymphatic Hydrops, complications, diagnosis; Humans; Otitis, complications, diagnosis; Syndrome; Vertigo, diagnosis, etiology; Vestibular Function Tests, methods}, pmid = {23963261} }
Toupet, M. and Toupet, F.	[Vertigo in children]. [Abstract] [BibTeX]	1994	La Revue du praticien Vol. 44(3), pp. 343-349	article
Abstract: Oto-neurologic investigation in the child with vertigo is fundamentally important. In 3% of cases, it reveals the presence of a cerebral tumour. Technical difficulties in examining a child under 5 years of age stem from their fear of the dark, insecurity in a medical setting and a labile attention span. Major causes are migraine (in 28% of cases) and childhood idiopathic paroxysmal vertigo, and recurring vestibular disorders (13% of cases). Classic disorders such as Ménière's disease are rare in the child (3% of cases), as are benign paroxysmal positional vertigo and cupulolithiasis (only 5% of children with vertigo).
BibTeX: @article{Toupet1994, author = {Toupet, M and Toupet, F}, title = {[Vertigo in children].}, journal = {La Revue du praticien}, year = {1994}, volume = {44}, issue = {3}, pages = {343--349}, keywords = {Adolescent; Adult; Age Factors; Child; Child, Preschool; Diagnosis, Differential; Humans; Nystagmus, Pathologic, diagnosis; Vertigo, diagnosis, etiology}, pmid = {8178100} }
Tilikete, C. and Vighetto, A.	[Vertigo treatment according to their mechanisms]. [Abstract] [BibTeX]	2009	Neuro-Chirurgie Vol. 55(2), pp. 259-267	article	DOI
Abstract: Vertigo is an illusion of rotatory or linear movement that demonstrates a functional or lesional disturbance of the vestibular system, from periphery to central connections. According to the ANAES report (1997), benign paroxysmal positional vertical vertigo, vestibular neuronitis and Ménière's disease account for 40-50% of all mixed vertigo etiologies. Central etiologies may account for 20-40% of causes and 10-40% remain more difficult to classify, and are usually classified under the term of "peripheral vestibulopathy." These include vertigo due to neurovascular compression syndrome of the VIIIth nerve. Clinical manifestations, differential diagnosis, and treatment of the main etiologies of vertigo will be developed in this chapter. A specific section will discuss the subject of neurovascular compression syndrome of the VIIIth nerve. Even though some publications should be challenged, it appears that neurovascular compression syndrome of the VIIIth nerve might explain some cases of vertigo or chronic instability, with or without cochlear signs. The diagnosis is difficult and must be established on multiple clinical, electrophysiological and radiological arguments. A therapeutic test with antiepileptic drugs is helpful. The treatment includes these drugs as a first option but may require a neurosurgical approach if medical treatment fails.
BibTeX: @article{Tilikete2009, author = {Tilikete, C and Vighetto, A}, title = {[Vertigo treatment according to their mechanisms].}, journal = {Neuro-Chirurgie}, year = {2009}, volume = {55}, issue = {2}, pages = {259--267}, doi = {https://doi.org/10.1016/j.neuchi.2009.01.011}, keywords = {Chronic Disease; Diagnosis, Differential; Humans; Recurrence; Vertigo, diagnosis, etiology, surgery, therapy; Vestibular Diseases, diagnosis, etiology, surgery; Vestibular Neuronitis, complications, diagnosis; Vestibulocochlear Nerve, pathology, surgery}, pmid = {19303115} }
Imbaud Genieys, S.	[Vertigo, dizziness and falls in the elderly]. [Abstract] [BibTeX]	2007	Annales d'oto-laryngologie et de chirurgie cervico faciale : bulletin de la Societe d'oto-laryngologie des hopitaux de Paris Vol. 124(4), pp. 189-196	article	DOI
Abstract: The purpose of this study was to find cause of dizziness, vertigo and falls in old age and to propose treatment. The study was conducted from October 2003 to March 2004 with 100 patients over the age of 75 years: 72 women and 28 men. They complained of unsteadiness, vertigo, or falls. In this group of patients, 68% were found to have benign paroxysmal positional vertigo, 9% neurologic problems, 5% Meniere disease, 4% vestibular areflexia, 8% a rare cause such as a psychiatric or vascular disorder, and no cause was found in 6%. The diagnosis of Benign Paroxysmal Positional Vertigo is difficult in the elderly because vertigo is often missing and unsteadiness or falls only feeled. Our study showed that dizziness or unsteadiness in the elderly must be explored by a complete vestibular examination and treated to improve the well-being of these patients.
BibTeX: @article{ImbaudGenieys2007, author = {Imbaud Genieys, S}, title = {[Vertigo, dizziness and falls in the elderly].}, journal = {Annales d'oto-laryngologie et de chirurgie cervico faciale : bulletin de la Societe d'oto-laryngologie des hopitaux de Paris}, year = {2007}, volume = {124}, issue = {4}, pages = {189--196}, doi = {https://doi.org/10.1016/j.aorl.2007.04.003}, keywords = {Accidental Falls, statistics & numerical data; Aged; Dizziness, epidemiology, etiology; Female; Humans; Male; Meniere Disease, complications, epidemiology; Prevalence; Reflex, Abnormal; Reflex, Vestibulo-Ocular; Risk Factors; Vertigo, epidemiology, etiology}, pmid = {17761136} }
Uemura, K. and Nozue, M.	[Vertigo--their typical clinical pictures from neurosurgical standpoints]. [Abstract] [BibTeX]	1983	No shinkei geka. Neurological surgery Vol. 11(3), pp. 229-242	article
Abstract: Although vertigo is commonly encountered in many clinical disciplines, meticulous analysis of the onset and nature of the vertigo is essential not to overlook the vertigo of brainstem or cerebral origin without any other neurological signs and symptoms. Three central vestibular projection pathways and their possible functional roles in relation to vertigo were briefly discussed. To illustrate the characteristic clinical features of vertigo of various origins, 16 typical cases were presented and discussed. Their etiology include Ménière's disease, vertigo of neurovascular compression, sudden deafness, acoustic neurinoma, Rumsay-Hunt's syndrome, BPPN (benign paroxysmal positioning nystagmus), vestibular neuronitis, brainstem infarct, MPPN (malignant persistent positional nystagmus) with brainstem midline hemorrhage, cerebellar hemorrhage followed by orthostatic hypotension, vertiginous epilepsy, TIA from MCA stenosis, intracerebral hemorrhage from a mycotic aneurysm, falx meningioma, subclavian steal phenomenon, and cervical spondylosis. It is wrong and quite dangerous to believe that vertigo of CNS origin should be associated with some definite neurological signs and symptoms and to diagnose the vertigo to be of peripheral origin merely based on normal findings of CT scan and angiography. Recently advanced detailed neurootological investigations are quite helpful in differentiating vertigo of various origins, but may totally overlook the vertigo of serious CNS pathology. For "solo vertigo," the key point is first differentiate BPPN and vertibular neuronitis from others after which careful neurosurgical and neurootological evaluation should be pursued regardless of presence or absence of concomitant neurological findings.
BibTeX: @article{Uemura1983, author = {Uemura, K and Nozue, M}, title = {[Vertigo--their typical clinical pictures from neurosurgical standpoints].}, journal = {No shinkei geka. Neurological surgery}, year = {1983}, volume = {11}, issue = {3}, pages = {229--242}, keywords = {Adult; Aged; Cerebral Cortex, physiopathology; Cerebral Hemorrhage, diagnosis; Diagnosis, Differential; Female; Humans; Male; Meniere Disease, diagnosis; Middle Aged; Neural Pathways; Vertigo, diagnosis, physiopathology; Vestibular Nuclei, physiopathology}, pmid = {6856035} }
Boleas-Aguirre, M., Sánchez-Ferrándiz, N., Artieda, J. and Pérez, N.	[Vestibular evoked myogenic potentials and benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2007	Acta otorrinolaringologica espanola Vol. 58(5), pp. 173-177	article
Abstract: Benign paroxysmal positional vertigo (BPPV) seems to occur because of otoconia migration into the semicircular canals or their adherence to the cupula. Although the origin of these otoconia lies in the macula of the utricle, vestibular evoked myogenic potentials (VEMPs) can be used assess saccular function. The aim of this study is to assess the saccular function in patients diagnosed with BPPV. Nineteen patients diagnosed with BPPV of the posterior semicircular canal were included in this study. Their auditory function and their caloric, rotatory chair, and VEMP responses were tested. Ipsilateral and contralateral VEMP thresholds, ipsilateral and contralateral p13 and n23 latencies at 100 dB, inter-peak amplitude and the interaural amplitude difference were determined. We found a lack of VEMP response in 52 % of the ears with BPPV. When adjusted for bilateral absence, VEMP response was absent in 20.3 % of ears. Some patients with idiopathic BPPV show a degree of saccular dysfunction.
BibTeX: @article{Boleas-Aguirre2007b, author = {Boleas-Aguirre, Marisol and Sánchez-Ferrándiz, Noelia and Artieda, Julio and Pérez, Nicolás}, title = {[Vestibular evoked myogenic potentials and benign paroxysmal positional vertigo].}, journal = {Acta otorrinolaringologica espanola}, year = {2007}, volume = {58}, issue = {5}, pages = {173--177}, keywords = {Adult; Aged; Aged, 80 and over; Evoked Potentials, physiology; Female; Humans; Male; Middle Aged; Prospective Studies; Vertigo, diagnosis, physiopathology, therapy; Vestibular Function Tests; Vestibule, Labyrinth, physiopathology}, pmid = {17498466} }
Ruiz-Allec, L.D., Peñaloza-López, Y.R., Ocaña-Plante, N.D.R., Valdivia-Muñoz, M.B. and Martínez-Castro, F.	[Vestibular findings in patients with Vogt-Koyanagi-Harada syndrome]. [Abstract] [BibTeX]	2009	Acta otorrinolaringologica espanola Vol. 60(5), pp. 305-310	article	DOI
Abstract: To identify and describe vestibular abnormalities in patients with Vogt-Koyanagi-Harada syndrome (VKH). Prospective, cross-sectional, observational and descriptive study. Patients with VKH referred by an ophthalmological center, were interrogated and physically examined in search of signs of vestibular abnormalities, and if positive, they underwent videonystagmography, computerized dynamic posturography, tonal audiometry and tympanometry. Out of 21 patients with VKH, only 10 were included in the study due to presenting data of vestibular abnormalities (10/10 with vestibular symptoms and 9/10 with abnormalities in the physical exploration). The age average was 37.8 years. The videonystagmography was mainly abnormal in ocular saccades test (10/10). The posturography showed a higher alteration of the visual (4/10) and vestibular (4/10) afferents. A diagnosis of benign paroxysmal positional vertigo was mostly concluded (6/10). None presented abnormalities of the middle ear nor data of central pathology, 6/10 presented abnormalities in tonal audiometry. Peripheral vestibular disorder is often present in the population with VKH.
BibTeX: @article{Ruiz-Allec2009, author = {Ruiz-Allec, Laura Daniela and Peñaloza-López, Yolanda Rebeca and Ocaña-Plante, Nieves Del Rosario and Valdivia-Muñoz, Martha Beatriz and Martínez-Castro, Francisco}, title = {[Vestibular findings in patients with Vogt-Koyanagi-Harada syndrome].}, journal = {Acta otorrinolaringologica espanola}, year = {2009}, volume = {60}, issue = {5}, pages = {305--310}, doi = {https://doi.org/10.1016/j.otorri.2009.05.004}, keywords = {Adult; Cross-Sectional Studies; Female; Humans; Male; Prospective Studies; Uveomeningoencephalitic Syndrome, physiopathology; Vestibule, Labyrinth, physiopathology}, pmid = {19814981} }
Zur, O., Carmeli, E., Himellfarb, M. and Berner, Y.N.	[Vestibular function, falls and hip fracture in elderly--a relationship study]. [Abstract] [BibTeX]	2004	Harefuah Vol. 143(3), pp. 197-202, 246	article
Abstract: Falling is the main reason for which people over 70 arrive at emergency rooms. Over 90% of hip fractures occur as a direct result of falling. To examine the relationship between the function of the vestibular system and hip fractures following falls in elderly. The research group (n = 84) undergone hip surgery as a result of a fall and were then hospitalized in a rehabilitative geriatric care unit at the Meir Hospital in Kfar Sava. The control group (n = 85)--without any history of a hip fracture and living in a retirement home. Four clinical tests were given to each examinee in order to locate any impairment of the vestibular system. Three of the clinical examinations concentrated on testing the VOR while the fourth test was especially used to locate BPPV (Benign Paroxysmal Positional Vertigo). Sociodemographic status and medical history were taken. A significant difference was found between the two groups (those with a hip fracture and those without any hip fracture) with regard to the functioning of the VOR, age, endocrine disease and medications for treating diabetic. However, there was no significant difference found in the appearance of the BPPV. It is important to locate the elderly who are at risk of falling in nursing homes and the community at large by performing the four simple clinical tests. Correct diagnosis and early treatment of the vestibular impairment in elderly patient can prevent the next fall.
BibTeX: @article{Zur2004, author = {Zur, Oz and Carmeli, Eli and Himellfarb, Mordechi and Berner, Yitshal N}, title = {[Vestibular function, falls and hip fracture in elderly--a relationship study].}, journal = {Harefuah}, year = {2004}, volume = {143}, issue = {3}, pages = {197--202, 246}, keywords = {Accidental Falls; Aged; Hip Fractures, physiopathology, rehabilitation; Homes for the Aged; Humans; Nursing Homes; Retirement; Retrospective Studies; Vertigo, diagnosis, etiology; Vestibular Function Tests}, pmid = {15065358} }
López-Escámez, J.A.	[Vestibular myogenic evoked potentials in patients with benign paroxysmal positional vertigo]. [BibTeX]	2007	Acta otorrinolaringologica espanola Vol. 58(10), pp. 495	article
BibTeX: @article{Lopez-Escamez2007, author = {López-Escámez, José Antonio}, title = {[Vestibular myogenic evoked potentials in patients with benign paroxysmal positional vertigo].}, journal = {Acta otorrinolaringologica espanola}, year = {2007}, volume = {58}, issue = {10}, pages = {495}, keywords = {Evoked Potentials, physiology; Humans; Muscle, Skeletal, physiology; Vertigo, diagnosis, physiopathology; Vestibule, Labyrinth, physiopathology}, pmid = {18082083} }
Reinhard, A. and Maire, R.	[Vestibular neuritis: treatment and prognosis]. [Abstract] [BibTeX]	2013	Revue medicale suisse Vol. 9(400), pp. 1775-1779	article
Abstract: Vestibular neuritis is a sudden unilateral peripheral vestibular deficit of unknown origin without associated hearing loss. It is the second cause of peripheral vertigo after Benign Paroxysmal Positional Vertigo (BPPV). The etiology remains unclear and some treatments are still controversial. The prognosis is good. The differential diagnosis of the disease mainly includes an acute vertigo of central origin. This article summarizes the management and prognosis of vestibular neuritis.
BibTeX: @article{Reinhard2013, author = {Reinhard, A and Maire, R}, title = {[Vestibular neuritis: treatment and prognosis].}, journal = {Revue medicale suisse}, year = {2013}, volume = {9}, issue = {400}, pages = {1775--1779}, keywords = {Diagnosis, Differential; Disease Progression; Humans; Prognosis; Vestibular Neuronitis, diagnosis, epidemiology, etiology, therapy}, pmid = {24187751} }
Xu, J., Huang, W.-N., Gao, B. and Zhou, J.-M.	[Vestibular pathology associated with noise-induced inner ear impairment]. [Abstract] [BibTeX]	2008	Zhongguo yi xue ke xue yuan xue bao. Acta Academiae Medicinae Sinicae Vol. 30(6), pp. 639-642	article
Abstract: To evaluate the pathological status of the vestibular system associated with noise-induced inner ear impairment. Totally 68 patients with noise-induced hearing loss (NIHL) who presented with vestibular symptoms including vertigo, dizziness, and chronic disequilibrium were screened. All patients underwent a series of conventional vestibular function tests and vestibular autorotation test and the results were retrospectively reviewed and evaluated. Sixty-eight (14.5%) patients with NIHL were identified among 469 patients with vertigo, dizziness, or imbalance. A pure tone hearing threshold of patients with vertigo and NIHL at 4000 Hz were between 30 dB HL and 80 dB HL with an average threshold of (46.7 +/- 17.6) dB HL in left ear and (37.3 +/- 16.7) dB HL in right ear. Patients with symmetrical hearing loss at 4000 Hz accounted for 41.7% and those with asymmetrical loss accounted for 58.3%. Vestibular pathologies included benign positional paroxysmal vertigo (45.7%), unilateral decreased caloric responses (20.0%), bilateral decreased caloric responses (26.7%), abnormal vestibulo-spinal reflex function (28.6%), vestibular function response hyperactivity (3.0%), and abnormal vestibulo-ocular reflex presentation at high frequencies (97.0%). Loud acoustic stimulation not only damages the cochlea but also causes clear functional impairment to the vestibular end organs. Although the vestibular pathology is not correlated with the severity of the hearing loss, it correlates with the subjective symptoms of the vestibular system.
BibTeX: @article{Xu2008, author = {Xu, Jin and Huang, Wei-Ning and Gao, Bo and Zhou, Jin-Mei}, title = {[Vestibular pathology associated with noise-induced inner ear impairment].}, journal = {Zhongguo yi xue ke xue yuan xue bao. Acta Academiae Medicinae Sinicae}, year = {2008}, volume = {30}, issue = {6}, pages = {639--642}, keywords = {Adult; Aged; Aged, 80 and over; Female; Hearing Loss, Noise-Induced, pathology, physiopathology; Humans; Male; Middle Aged; Noise; Retrospective Studies; Vestibular Function Tests; Vestibule, Labyrinth, pathology, physiopathology; Young Adult}, pmid = {19180906} }
Boleas-Aguirre, M., Migliaccio, A.A. and Carey, J.P.	[Vestibulo-oculomotor reflex recording using the scleral search coil technique. Review of peripheral vestibular disorders]. [Abstract] [BibTeX]	2007	Acta otorrinolaringologica espanola Vol. 58(7), pp. 321-326	article
Abstract: Our goal is to review vestibulo-oculomotor reflex (VOR) studies on several peripheral vestibular disorders (Ménière's disease, vestibular neuritis, benign paroxysmal positional vertigo, superior canal dehiscence syndrome, and vestibular neuroma), using the scleral search coil (SSC) technique. Head movements are detected by vestibular receptors and the elicited VOR is responsible for compensatory 3 dimensional eye movements. Therefore, to study the VOR it is necessary to assess the direction and velocity of 3 dimensional head and eye movements. This can be achieved using the SCC technique. Interaction between a scleral search coil and an alternating magnetic field generates an electrical signal that is proportional to eye position. Ideally, eye rotation axis is aligned with head rotation axis and VOR gain (eye velocity/head velocity) for horizontal and vertical head rotations is almost 1. The VOR gain, however, for torsional head rotations is smaller and about 0.7.
BibTeX: @article{Boleas-Aguirre2007, author = {Boleas-Aguirre, Marisol and Migliaccio, Amerio A and Carey, John P}, title = {[Vestibulo-oculomotor reflex recording using the scleral search coil technique. Review of peripheral vestibular disorders].}, journal = {Acta otorrinolaringologica espanola}, year = {2007}, volume = {58}, issue = {7}, pages = {321--326}, keywords = {Humans; Meniere Disease, diagnosis, epidemiology, physiopathology; Otolaryngology, instrumentation; Reflex, Vestibulo-Ocular, physiology; Semicircular Canals, physiopathology; Vertigo, diagnosis, epidemiology, physiopathology; Vestibular Diseases, diagnosis, physiopathology; Vestibular Neuronitis, diagnosis, physiopathology}, pmid = {17683700} }
Guan, Q., Zhang, L., Hong, W., Yang, Y., Chen, Z., Zhang, D. and Hu, X.	[Video head impulse test for evaluation of vestibular function in patients with vestibular neuritis and benign paroxysmal positional vertigo]. [Abstract] [BibTeX]	2017	Zhejiang da xue xue bao. Yi xue ban = Journal of Zhejiang University. Medical sciences Vol. 46(1), pp. 52-58	article
Abstract: To assess the clinical application of video head impulse test (vHIT) for vestibular function in vestibular neuritis (VN) and benign paroxysmal positional vertigo (BPPV) patients. Thirty-three patients with VN and 43 patients with BPPV were enrolled from Sir Run Run Shaw Hospital and Ningbo Second Hospital from March 15 to September 10, 2015; and 50 healthy controls were also enrolled in the study. vHIT was used to quantitatively test the vestibulo-ocular reflex (VOR) gains of a pair of horizontal semicircular canals. VOR gains two pairs of vertical semicircular canals, and the corresponding asymmetrical value of three VOR gains. The saccades information was also recorded. Compared with the healthy control group and BPPV patients, the affected horizontal and vertical VOR gains were declined and the corresponding asymmetries were increased in VN patients (all <0.01). BPPV group also showed higher vertical VOR gain asymmetries compared with the healthy control group (all <0.01), but no significant difference was observed in VOR gains and horizontal VOR gain asymmetry (all >0.05). The sensibility of vHIT in diagnosis of VN was 87.9%. Among 33 VN patients, 22 were diagnosed with superior vestibular nerve dysfunction, 7 were found with inferior vestibular nerve dysfunction and 3 were with both dysfunction; and 1 case was not distinguished. Video head impulse test can quantitatively evaluate the vestibular dysfunction of VN and can help early diagnosis of VN, which may be widely used in clinic.
BibTeX: @article{Guan2017, author = {Guan, Qiongfeng and Zhang, Lisan and Hong, Wenke and Yang, Yi and Chen, Zhaoying and Zhang, Dan and Hu, Xingyue}, title = {[Video head impulse test for evaluation of vestibular function in patients with vestibular neuritis and benign paroxysmal positional vertigo].}, journal = {Zhejiang da xue xue bao. Yi xue ban = Journal of Zhejiang University. Medical sciences}, year = {2017}, volume = {46}, issue = {1}, pages = {52--58}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis; Head Impulse Test; Humans; Reflex, Vestibulo-Ocular, physiology; Saccades, physiology; Semicircular Canals, innervation, physiopathology; Sensitivity and Specificity; Vestibular Diseases, classification, diagnosis; Vestibular Nerve, pathology; Vestibular Neuronitis, classification, diagnosis}, pmid = {28436631} }
Olusesi, A.D. and Abubakar, J.	10 years of Vertigo Clinic at National Hospital Abuja, Nigeria: what have we learned? [Abstract] [BibTeX]	2016	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 273(11), pp. 3567-3572	article	DOI
Abstract: The clinician's major role in management of the dizzy patient involves determining what dizziness is vertigo, and what vertigo is of central or peripheral origin. These demand attention to details of history, otolaryngological workup including vestibular assessment, and often use of diagnostic and management algorithms. There is paucity of published reports of the management outcomes of peripheral vestibular diseases from Africa. Two tertiary care otologist-led dedicated vertigo clinics are located in Abuja, Nigeria. A prospective, non-randomized study of patients presenting with features of peripheral vestibular diseases attending the National Hospital Abuja Nigeria (between May 2005 and April 2014) and CSR Otologics Specialist Clinics (May 2010 to April 2014) was carried out. Both institutions adopted the same diagnostic and management protocols. Data extracted from anonymized databases created for this study include age, sex, vertigo duration (acute <12 weeks, chronic >12 weeks), dizziness handicap inventory score at presentation and at subsequent visits, otological and vestibular findings, ice-water caloric testing results, other investigation outcomes, treatments offered and outcomes. 561/575 (97.5 %) of the cases recorded had peripheral vestibular disease. The male-to-female ratio was 290:271. The mean age of the subjects was 44.7 years. Duration of vertigo at presentation was acute in 278 subjects and chronic in 283 subjects. Identifiable clinical diagnostic groups include BPPV (n = 200), Meniere's disease (n = 189), cervicogenic vertigo (n = 35), labyrinthitis (n = 32), Migraine-associated vertigo (MAV) (n = 32), cholesteatoma/perilymph Fistula (n = 10), climacteric vertigo (n = 8) and unclassified vertigo (n = 55). Migraine-associated vertigo recorded the highest DHI score (95 % CI 75 ± 4.3), followed by cholesteatoma/perilymph fistula (95 % CI 72 ± 6.1) and labyrinthitis (95 % CI 62 ± 1.9). Pure tone audiometry (95 % CI 67.3 ± 3.43), followed by thyroid function tests (95 % CI 66.7 ± 23.55) and ice-water caloric testing (95 % CI 59.7 ± 2.69) were investigations with the highest yields. 86.5 % of cases were treated by either vestibular suppressant medications alone (n = 285) and/or particle repositioning maneuver (n = 200) with improvement in vertigo control (95 % CI 63.63 to 74.37 % and 62.59 to 75.41 %, respectively). Peripheral vestibular diseases constitute majority of cases of self-reported vertigo seen in our setting. Migraine-associated vertigo seen in our setting all have peripheral vestibular signs. Dedicated vertigo clinics could significantly improve the diagnostic and treatment yield in a resource-constrained setting like ours. Most cases can be managed using non-operative measures.
BibTeX: @article{Olusesi2016, author = {Olusesi, Abiodun D and Abubakar, J}, title = {10 years of Vertigo Clinic at National Hospital Abuja, Nigeria: what have we learned?}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2016}, volume = {273}, issue = {11}, pages = {3567--3572}, doi = {https://doi.org/10.1007/s00405-016-3969-6}, keywords = {Adult; Cholesteatoma, Middle Ear, complications, diagnosis; Female; Humans; Labyrinthitis, complications, diagnosis; Male; Meniere Disease, complications, diagnosis; Middle Aged; Migraine Disorders, complications, diagnosis; Nigeria; Outpatient Clinics, Hospital; Prospective Studies; Vertigo, diagnosis, etiology, therapy; Vestibular Diseases, complications, diagnosis; Africa; BPPV; Diagnostic outcomes; Meniere’s disease; Migraine-associated vertigo; Peripheral vestibular disease; Treatment outcomes; Vertigo}, pmid = {26961517} }
Maslovara, S., Butkovic Soldo, S., Sestak, A., Milinkovic, K., Rogic-Namacinski, J. and Soldo, A.	25 (OH) D3 levels, incidence and recurrence of different clinical forms of benig paroxysmal positional vertigo. [Abstract] [BibTeX]	2018	Brazilian journal of otorhinolaryngology Vol. 84(4), pp. 453-459	article	DOI
Abstract: Benign paroxysmal positional vertigo is the most common cause of dizziness in the general population. It is a condition with potential impact of reduced levels of vitamin D on its recurrent attacks. The aim of this study was to measure the serum levels of 25-hydroxyvitamin D3 (25-OH D3) in patients with benign paroxysmal positional vertigo and determine whether there is a difference in the serum levels of vitamin D3 between patients with and without recurrence, as well as between the different clinical forms of benign paroxysmal positional vertigo. The study included 40 patients who came to the regular medical examination, diagnosed with posterior canal-benign paroxysmal positional vertigo based on the positive Dix-Hallpike's test. All patients underwent Epley manoeuvre after the diagnosis. Patients were classified according to current guidelines for levels of vitamin D3 in the serum in three groups: the deficiency, insufficiency and adequate level. The average serum level of 25-OH D3 among respondents was 20.78ng/mL, indicating a lack or insufficiency of the aforementioned 25-OH D3. According to the levels of 25-OH D3, most patients suffer from deficiency (47.5%). 7 (17.5%) respondents had adequate blood level of 25-OH D3, and 14 (35%) respondents suffer from insufficiency. A significant difference was not found in the serum level of 25-OH D3 between patients with and without benign paroxysmal positional vertigo recurrence. There was a significant difference in the serum levels of 25-OH D3 in comparison to the clinical form of the disease. Lower 25-OH D3 values were found in patients with canalithiasis compared to those with cupulolithiasis. There were no significant differences in the vitamin D3 serum level in patients with and without recurrence. The study showed a low level of serum vitamin D3 in most patients, indicating the need for supplemental therapy.
BibTeX: @article{Maslovara2018, author = {Maslovara, Sinisa and Butkovic Soldo, Silva and Sestak, Anamarija and Milinkovic, Katarina and Rogic-Namacinski, Jasna and Soldo, Anamarija}, title = {25 (OH) D3 levels, incidence and recurrence of different clinical forms of benig paroxysmal positional vertigo.}, journal = {Brazilian journal of otorhinolaryngology}, year = {2018}, volume = {84}, issue = {4}, pages = {453--459}, doi = {https://doi.org/10.1016/j.bjorl.2017.05.007}, keywords = {Aged; Benign Paroxysmal Positional Vertigo, blood, pathology; Calcifediol, blood; Calcium, blood; Cholecalciferol, blood; Female; Humans; Male; Middle Aged; Recurrence; Reference Values; Statistics, Nonparametric; Vitamin D Deficiency, blood; Benign paroxysmal positional vertigo; Clinical forms; Formas clínicas; Insuficiência da vitamina D3; Recorrência; Recurrence; Vertigem posicional paroxística benigna; Vitamin D3 insufficiency}, pmid = {28655524} }
Dannenbaum, E., Rappaport, J.M., Paquet, N., Visintin, M., Fung, J. and Watt, D.	2-year review of a novel vestibular rehabilitation program in Montreal and Laval, Quebec. [Abstract] [BibTeX]	2004	The Journal of otolaryngology Vol. 33(1), pp. 5-9	article
Abstract: To evaluate the benefits of a vestibular rehabilitation program (VRP) in the Montreal-Laval area. The VRP was conceptualized by a panel of experts including otolaryngologists, physiotherapists, and researchers from McGill University and its teaching hospitals. From February 1999 to December 2001, 117 patients were seen, and 88 of them completed the VRP. The VRP has been established at the Jewish Rehabilitation Hospital in Laval, PQ, to provide specialized rehabilitation to clients suffering from vertigo, dizziness, and/or impaired balance owing to lesions or disorders of the vestibular system. Presence or absence of nystagmus or vertigo during the Dix-Hallpike test, Dizziness Handicap Inventory (DHI), and Dynamic Gait Index (DGI). Thirty-five patients with benign paroxysmal positional vertigo of the posterior canal were treated with canalith repositioning manoeuvres. All of the patients (100%) had absence of nystagmus or vertigo after one to four treatment sessions. Forty-six patients with vestibular deficits or dizziness-disequilibrium completed the VRP, which consisted mainly of individualized eye-head and balance home exercise programs. At the end of the VRP, there was a significant decrease in DHI score (31 vs 57; p < .01) and a significant increase in DGI score (18.4 vs 22.6; p < .01). A range of modest to major improvements was shown by comparing initial and discharge scores of patients who had completed vestibular rehabilitation. The VRP appears to be beneficial for patients with a variety of vestibular disorders. Further research is needed to continue optimizing vestibular rehabilitation.
BibTeX: @article{Dannenbaum2004, author = {Dannenbaum, Elizabeth and Rappaport, Jamie M and Paquet, Nicole and Visintin, Martha and Fung, Joyce and Watt, Douglas}, title = {2-year review of a novel vestibular rehabilitation program in Montreal and Laval, Quebec.}, journal = {The Journal of otolaryngology}, year = {2004}, volume = {33}, issue = {1}, pages = {5--9}, keywords = {Female; Humans; Male; Outcome Assessment (Health Care); Program Evaluation; Quebec; Vestibular Diseases, rehabilitation}, pmid = {15291269} }
Imai, T., Takeda, N., Ito, M., Sekine, K., Sato, G., Midoh, Y., Nakamae, K. and Kubo, T.	3D analysis of benign positional nystagmus due to cupulolithiasis in posterior semicircular canal. [Abstract] [BibTeX]	2009	Acta oto-laryngologica Vol. 129(10), pp. 1044-1049	article	DOI
Abstract: The characteristic of both the vertical-torsional positional nystagmus with long time constant and its disappearance at the neutral head position could diagnose cupulolithiasis in posterior semicircular canal (PSCC) in the eight patients with the PSCC type of benign paroxysmal positional vertigo (P-BPPV). The aim of the study was to diagnose cupulolithiasis in patients with P-BPPV. We used three-dimensional rotation axis analysis of nystagmus of the vertical-torsional positional nystagmus in 111 patients with P-BPPV and evaluated its time constant. We then examined whether the vertical-torsional positional nystagmus with long time constant disappeared at the neutral head position where the axis of the heavy cupula of the affected PSCC is aligned with gravity. The first parameter showed a wide variation that could be divided into two groups: one lasting more than 40 s in 8 patients and another below 20 s in 103 patients. Since the time constant of the positional nystagmus induced by cupulolithiasis was much longer than that induced by canalolithiasis, this finding suggests that cupulolithiasis in the PSCC induced the vertical-torsional positional nystagmus with a long time constant in the group of eight patients. The vertical-torsional positional nystagmus disappeared in these patients at the neutral head position, where the axis of the cupula of affected PSCC aligned with gravity.
BibTeX: @article{Imai2009, author = {Imai, Takao and Takeda, Noriaki and Ito, Mahito and Sekine, Kazunori and Sato, Go and Midoh, Yoshihiro and Nakamae, Koji and Kubo, Takeshi}, title = {3D analysis of benign positional nystagmus due to cupulolithiasis in posterior semicircular canal.}, journal = {Acta oto-laryngologica}, year = {2009}, volume = {129}, issue = {10}, pages = {1044--1049}, doi = {https://doi.org/10.1080/00016480802566303}, keywords = {Adult; Aged; Aged, 80 and over; Female; Humans; Imaging, Three-Dimensional; Labyrinth Diseases, diagnosis; Lithiasis, diagnosis; Male; Middle Aged; Nystagmus, Physiologic; Young Adult}, pmid = {19058052} }
Teixido, M., Woods, O., Kung, B. and Seyyedi, M.	A 3D benign paroxysmal positional vertigo model for study of otolith disease. [Abstract] [BibTeX]	2016	World journal of otorhinolaryngology - head and neck surgery Vol. 2(1), pp. 1-6	article	DOI
Abstract: To develop a three-dimensional study tool of the membranous labyrinth in order to study the pathophysiology, diagnostic workup and treatment of benign paroxysmal positional vertigo (BPPV). BPPV is the most common cause of peripheral vertigo. Its diagnosis and treatment depend on an understanding of the anatomy of the vestibular labyrinth and its position relative to the head. To date, many illustrations have been made to explain principals of diagnosis and treatment of BPPV, but few have been based on anatomical studies of the membranous labyrinth. A cadaveric human membranous labyrinth was axially sectioned at 20 μm resolution, stained and segmented to create a high-resolution digital model. The model was cloned to create an enantiomeric pair of labyrinths. These were associated a 3D model of a human skull, segmented from MRI data, and were oriented according to established anatomic norms. Canal markers representing otoliths were created to mark canalith position during movement of the model within the 3D environment. The model allows visualization of true membranous labyrinth anatomy in both ears simultaneously. The dependent portion of each semicircular duct and of the utricle can easily be visualized in any head position. Moveable markers can mark the expected progress of otolith debris with changes in head position and images can be captured to document simulations. The model can be used to simulate pathology as well as diagnostic maneuvers and treatment procedures used for BPPV. The model has great potential as a teaching tool. A simple model based on human anatomy has been created to allow careful study of BPPV pathophysiology and treatment. Going forward, this tool could offer insights that may lead to more accurate diagnosis and treatment of BPPV.
BibTeX: @article{Teixido2016, author = {Teixido, Michael and Woods, Owen and Kung, Brian and Seyyedi, Mohammad}, title = {A 3D benign paroxysmal positional vertigo model for study of otolith disease.}, journal = {World journal of otorhinolaryngology - head and neck surgery}, year = {2016}, volume = {2}, issue = {1}, pages = {1--6}, doi = {https://doi.org/10.1016/j.wjorl.2016.02.002}, keywords = {3D; Anatomy; Benign paroxysmal positional vertigo; Histology; Model; Modeling}, pmid = {29204541} }
Riska, K.M., Akin, F.W., Williams, L., Rouse, S.B. and Murnane, O.D.	A Benign Paroxysmal Positional Vertigo Triage Clinic. [Abstract] [BibTeX]	2017	American journal of audiology Vol. 26(4), pp. 481-485	article	DOI
Abstract: The purpose of this study was to evaluate the effectiveness of triaging patients with motion-provoked dizziness into a benign paroxysmal positional vertigo (BPPV) clinic. A retrospective chart review was performed of veterans who were tested and treated for BPPV in a triaged BPPV clinic and veterans who were tested and treated for BPPV in a traditional vestibular clinic. The BPPV triage clinic had a hit rate of 39%. On average, the triaged BPPV clinic reduced patient wait times by 23 days relative to the wait times for the traditional vestibular clinic while also reducing patient costs. Triaging patients with BPPV is one method to improve access to evaluation and treatment and a mechanism for the effective use of clinic time and resources.
BibTeX: @article{Riska2017, author = {Riska, Kristal M and Akin, Faith W and Williams, Laura and Rouse, Stephanie B and Murnane, Owen D}, title = {A Benign Paroxysmal Positional Vertigo Triage Clinic.}, journal = {American journal of audiology}, year = {2017}, volume = {26}, issue = {4}, pages = {481--485}, doi = {https://doi.org/10.1044/2017_AJA-16-0119}, keywords = {Ambulatory Care, economics, organization & administration; Ambulatory Care Facilities; Benign Paroxysmal Positional Vertigo, diagnosis, therapy; Case-Control Studies; Cost-Benefit Analysis; Delivery of Health Care, economics, methods; Health Services Accessibility; Humans; Retrospective Studies; Time Factors; Triage, economics, methods; Vestibular Diseases; Veterans}, pmid = {28975255} }
Shim, D.B., Song, C.E., Baek, S.J. and Song, M.H.	A case of isolated cerebellar hemorrhage presenting as vestibular neuritis combined with contralateral benign paroxysmal positional vertigo. [BibTeX]	2012	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 146(5), pp. 865-867	article	DOI
BibTeX: @article{Shim2012a, author = {Shim, Dae Bo and Song, Chang Eun and Baek, Seung Jae and Song, Mee Hyun}, title = {A case of isolated cerebellar hemorrhage presenting as vestibular neuritis combined with contralateral benign paroxysmal positional vertigo.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2012}, volume = {146}, issue = {5}, pages = {865--867}, doi = {https://doi.org/10.1177/0194599811425475}, keywords = {Benign Paroxysmal Positional Vertigo; Cerebellar Diseases, complications, diagnosis; Cerebral Hemorrhage, complications, diagnosis; Diagnosis, Differential; Female; Humans; Magnetic Resonance Imaging; Middle Aged; Vertigo, diagnosis, etiology; Vestibular Neuronitis, diagnosis}, pmid = {21987651} }
Shim, D.B., Ko, K.M., Song, M.H. and Song, C.E.	A case of labyrinthine fistula by cholesteatoma mimicking lateral canal benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2014	Korean journal of audiology Vol. 18(3), pp. 153-157	article	DOI
Abstract: Acute peripheral vestibulopathy, of which the chief complaint is positional vertigo, comprises benign paroxysmal positional vertigo (BPPV), labyrinthitis, labyrinthine fistula, and cerebellopontine angle tumors. Since the typical presentation of labyrinthine fistulas may be sensorineural hearing loss, positional vertigo, or disequilibrium, it is often difficult to distinguish from BPPV or Meniere's disease. Herein we report a 61-year-old female patient with typical symptoms and signs attributable to geotropic type variant of the lateral semicircular canal BPPV on the left side, who eventually was confirmed as having a labyrinthine fistula from chronic otitis media with cholesteatoma on the left side. This is another case where, even in the presence of isolated vertigo showing typical findings of acute peripheral vestibulopathy, other otologic symptoms and signs must not be overlooked.
BibTeX: @article{Shim2014, author = {Shim, Dae Bo and Ko, Kyung Min and Song, Mee Hyun and Song, Chang Eun}, title = {A case of labyrinthine fistula by cholesteatoma mimicking lateral canal benign paroxysmal positional vertigo.}, journal = {Korean journal of audiology}, year = {2014}, volume = {18}, issue = {3}, pages = {153--157}, doi = {https://doi.org/10.7874/kja.2014.18.3.153}, keywords = {Benign paroxysmal positional vertigo; Cholesteatoma; Labyrinthine fistula}, pmid = {25558413} }
Schubert, M.C., Dunlap, P.M. and Whitney, S.L.	A Case Study of High-Velocity, Persistent Geotropic Nystagmus: Is This BPPV? [Abstract] [BibTeX]	2017	Journal of neurologic physical therapy : JNPT Vol. 41(3), pp. 182-186	article	DOI
Abstract: Deciphering the cause for a persistent, direction-changing geotropic nystagmus can be difficult. Migraine and light cupula are two possible causes, though can be confused with benign paroxysmal positional vertigo (BPPV) affecting the horizontal semicircular canal. In migraine, the persistent geotropic nystagmus tends to be slow; in light cupula, the nystagmus has been illustrated to beat in the direction opposite that of prone positioning. Here we describe a patient with initial occurrence then recurrence of a high velocity (≥30 deg/sec), persistent direction-changing geotropic nystagmus and vertigo with an intensity variable based on head position, which was difficult to manage. This patient did not have migraine. The case presented uniquely as it was unlikely due to canalithiasis of the horizontal semicircular canal yet the presentation was not clearly related to the light cupula phenomena either. In this case, the physical therapist attempted to use the barbeque roll canalith repositioning maneuver (CRM) even though the direction-changing geotropic nystagmus was persistent. The nystagmus did not resolve during the clinic visit. The persistent, high velocity geotropic nystagmus resolved within 1 week, however, this resolution was likely spontaneous and not due to the CRM intervention. Our case suggests that physical therapists assessing persistent geotropic nystagmus should wait long enough for the nystagmus to stop (∼2 minutes), test for fatigue by repeating the positional nystagmus tests, incorporate a head flexion component as part of the positional testing, and attempt to identify a null point.Video Abstract available for additional insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A178).
BibTeX: @article{Schubert2017, author = {Schubert, Michael C and Dunlap, Pamela M and Whitney, Susan L}, title = {A Case Study of High-Velocity, Persistent Geotropic Nystagmus: Is This BPPV?}, journal = {Journal of neurologic physical therapy : JNPT}, year = {2017}, volume = {41}, issue = {3}, pages = {182--186}, doi = {https://doi.org/10.1097/NPT.0000000000000191}, keywords = {Aged; Benign Paroxysmal Positional Vertigo, complications, diagnosis, physiopathology; Humans; Male; Nystagmus, Pathologic, complications, diagnosis, physiopathology; Semicircular Canals; Vestibular Function Tests}, pmid = {28628552} }
Zhang, Y., Chen, X., Wang, X., Cao, L., Dong, Z., Zhen, J., Li, G. and Zhao, Z.	A clinical epidemiological study in 187 patients with vertigo. [Abstract] [BibTeX]	2011	Cell biochemistry and biophysics Vol. 59(2), pp. 109-112	article	DOI
Abstract: A retrospective study to investigate the clinical epidemiological characteristics of vertigo was carried out on 187 patients with vertigo. A clinical history for each patient was recorded precisely about the attack, frequency, and development of vertigo, its duration, intensity, and the accompanied symptoms including the risk factors for cerebrovascular disease, etc. All the patients were subjected to physical examination with special attention to neurologic systems and Dix-Hallpike maneuver, computed tomography/computed tomography-angiography (CT/CTA) and MRI scan were performed when necessary. Majority of the patients in this study suffered with posterior circulation ischemia (59.89%) and benign paroxysmal positional vertigo (16.04%). Other ailments that affected these patients included migraine, Meniere's disease (1.6%), sudden hearing loss (1.07%), vestibular neuronitis, multiple sclerosis, acute viral encephalitis, meningioma, neurosis, posttraumatic vertigo, acute myocardial infarction (0.53%), and neurosis (14.97%). It appeared that in comparison to younger patients the elderly population is likely to be more susceptible to vertigo. Vertigo attacks patients with various diseases, which pre-dispose the patients to this disease. Presentation of vertigo can be clinically diagnosed in most cases of patients suffering from posterior circulation ischemia.
BibTeX: @article{Zhang2011a, author = {Zhang, Yan and Chen, Xu and Wang, Xiaoting and Cao, Limei and Dong, Zhiqiang and Zhen, Jia and Li, Gang and Zhao, Zhongxin}, title = {A clinical epidemiological study in 187 patients with vertigo.}, journal = {Cell biochemistry and biophysics}, year = {2011}, volume = {59}, issue = {2}, pages = {109--112}, doi = {https://doi.org/10.1007/s12013-010-9120-1}, keywords = {Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Angiography; Cerebrovascular Disorders, diagnosis, epidemiology, etiology; Epidemiologic Studies; Humans; Male; Tomography, X-Ray Computed; Vertigo, diagnosis, epidemiology, etiology; Young Adult}, pmid = {20976571} }
Harada, K., Oda, M., Yamamoto, M., Nomura, T., Ohbayashi, S. and Kitsuda, C.	A clinical observation of benign paroxysmal positional vertigo (BPPV) after vestibular neuronitis (VN). [Abstract] [BibTeX]	1993	Acta oto-laryngologica. Supplementum Vol. 503, pp. 61-63	article
Abstract: We observed 9 cases of BPPV developed after vestibular neuronitis. The interval between the onset of BPPV and vestibular neuronitis ranged from 2 weeks to 20 years. All cases were examined for critical head position which provoked vertigo, non-gaze nystagmus, positional and positioning nystagmus and caloric nystagmus. No characteristic signs and symptoms could be observed. The function of the posterior canal is thought to be necessary to provoke positional vertigo. Thus in BPPV after vestibular neuronitis the function of the posterior canal would presumably have been preserved to some degree. The first possibility is that the function of the posterior canal was not impaired in spite of the damage of the lateral canal. The fact that each canal differs in involvement in vestibular neuronitis may be explained by the difference in the blood supply or the innervation between lateral and posterior canals. If only the artery or nerve which is related to the lateral canal is damaged and the artery or nerve to the posterior canal is not involved, then the function of the posterior canal is preserved. So BPPV may occur soon after the disappearance of severe vertigo. The second possibility is that if the posterior canal had been damaged together with the lateral canal and the functions are recovering, BPPV may occur some time after the onset of vestibular neuronitis. The locus of vestibular neuronitis is in the peripheral vestibular system and the extent and degree of the lesion vary, which may explain why there can be time difference of the recovery between the two canals.
BibTeX: @article{Harada1993, author = {Harada, K and Oda, M and Yamamoto, M and Nomura, T and Ohbayashi, S and Kitsuda, C}, title = {A clinical observation of benign paroxysmal positional vertigo (BPPV) after vestibular neuronitis (VN).}, journal = {Acta oto-laryngologica. Supplementum}, year = {1993}, volume = {503}, pages = {61--63}, keywords = {Adult; Aged; Caloric Tests; Dominance, Cerebral, physiology; Electronystagmography; Female; Humans; Male; Meniere Disease, diagnosis, physiopathology; Middle Aged; Neuritis, diagnosis, physiopathology; Nystagmus, Physiologic, physiology; Orientation, physiology; Vestibular Nerve, physiopathology; Vestibulocochlear Nerve Diseases, diagnosis, physiopathology}, pmid = {8470503} }
Di Muzio, M., Marinucci, A., De Benedictis, A. and Tartaglini, D.	A Comparative Study of Data Collection Methods in the Process of Nursing: Detection of Chemotherapy Side Effects Using a Self-Reporting Questionnaire. [Abstract] [BibTeX]	2017	Acta clinica Croatica Vol. 56(4), pp. 765-772	article	DOI
Abstract: Ocular vestibular evoked myogenic potentials (oVEMP) and cervical VEMP (cVEMP) are newer diagnostic methods, which allow an insight into the otolith senses. Our aim was to determine changes in certain parameters of the VEMP wave complex after successfully performed repositioning procedure, as an indicator of the state of recovery in patients with benign paroxysmal positional vertigo (BPPV). This may confirm the theory of otolith returning into the area of otolithic senses. The study included 48 patients with unilateral posterior semicircular canal BPPV. On their first arrival, otoneurological examinations, oVEMP and cVEMP tests were performed. The same were included in follow up check-ups scheduled at seven days and six months after successful implementation of Epley maneuvers. The initial measurement revealed a significantly reduced amplitude of oVEMP on the affected side. On the 7-day measurement, the amplitude increase was observed on the affected side, with significant reduction in the amplitude ratio (p=0.693), which reached statistical significance on the last measurement at 6 months (p=0.006). These findings confirmed the hypothesis of the return of otoconia into the utricular area.
BibTeX: @article{DiMuzio2017, author = {Di Muzio, Marco and Marinucci, Alessandra and De Benedictis, Anna and Tartaglini, Daniela}, title = {A Comparative Study of Data Collection Methods in the Process of Nursing: Detection of Chemotherapy Side Effects Using a Self-Reporting Questionnaire.}, journal = {Acta clinica Croatica}, year = {2017}, volume = {56}, issue = {4}, pages = {765--772}, doi = {https://doi.org/10.20471/acc.2017.56.04.26}, keywords = {Antineoplastic drugs – adverse effects; Data collection; Neoplasms – drug therapy; Nursing process; Self-assessment; Surveys and questionnaires}, pmid = {29590734} }
Amin, M., Girardi, M., Konrad, H.R. and Hughes, L.	A comparison of electronystagmography results with posturography findings from the BalanceTrak 500. [Abstract] [BibTeX]	2002	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 23(4), pp. 488-493	article
Abstract: To determine a correlation between conventional electronystagmography findings with results obtained from BalanceTrak 500 posturography assessment. Individuals with a variety of dizziness and balance disorder symptoms were tested with both electronystagmography (ocular motor studies, positional/positioning testing, caloric testing) and computer posturography using the BalanceTrak 500. Tertiary referral center. Urban/rural midwesterners referred for dizziness and balance dysfunction symptoms. Results of both testing modalities were sent to referring physicians. Electronystagmography and posturography results. When electronystagmography results were compared with BalanceTrak findings, a majority of patients whose electronystagmography findings indicated central and mixed causes, or peripheral lesions other than benign paroxysmal positional vertigo, had abnormal findings on posturography. Specifically, tests similar to the Balance Master Sensory Organization Tests 4 and 5 and a new test, Limits of Stability, presented the most difficulty for these individuals. Patients with normal electronystagmography findings and those with benign paroxysmal positional vertigo had mixed results on posturography. The results for specific individual electronystagmography tests were compared with those of posturography tests. No correlation was noted among any of the electronystagmography results and posturography findings. Furthermore, no correlation was observed between posturography and the causes of dizziness. For many patients with dizziness and/or balance dysfunctions, posturography can provide additional information to that obtained with electronystagmography. This is especially apparent in individuals who have these symptoms but have normal or borderline normal electronystagmography findings.
BibTeX: @article{Amin2002, author = {Amin, Manali and Girardi, Marian and Konrad, Horst R and Hughes, Larry}, title = {A comparison of electronystagmography results with posturography findings from the BalanceTrak 500.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2002}, volume = {23}, issue = {4}, pages = {488--493}, keywords = {Dizziness, physiopathology; Electronystagmography; Humans; Postural Balance; Posture; Vestibular Diseases, physiopathology}, pmid = {12170151} }
Crespi, R., Capparè, P. and Gherlone, E.	A comparison of manual and electrical mallet in maxillary bone condensing for immediately loaded implants: a randomized study. [Abstract] [BibTeX]	2014	Clinical implant dentistry and related research Vol. 16(3), pp. 374-382	article	DOI
Abstract: The aim of this clinical study was to compare electrical versus hand mallet in osteotome-assisted surgery for maxillary bone condensing in immediately loaded implant procedure. Edentulous patients in maxillary premolar and molar regions with type III or IV bone were enrolled in this prospective clinical study. The patients were randomly divided in two groups: in the test group (magnetic mallet group [MMG]), the implant site was prepared with osteotomes pushed by electrical mallet, while in the control group (hand mallet group [HMG]), the implant site was performed with osteotomes pressed by hand mallet. Implants were immediately loaded. Intraoral digital radiographic measurements were reported at 6, 12, and 24 months. Fifty patients were enrolled in the study. Twenty-five patients were included in MMG and 25 patients in the HMG. One hundred thirty-eight dental implants were placed. In 12 cases, six in MMG and six in HMG, sinus elevation was performed. After 24-month follow-up, a survival rate of 94.93% was reported (MMG and HMG reported a survival rate of 97.10 and 92.75%, respectively, not statistically significant [P > .05]). In control group, two patients claimed benign paroxysmal positional vertigo following the use of osteotomes with hand hammer. Marginal bone levels remained stable over time for both groups, and no statistically significant differences were found. After 12 months, the bone height increased in both groups and, at 24 months, was stable. Statistical analysis reported no significant differences between test and control groups. These results demonstrated a stable marginal bone levels over time and a significant increase in bone height between 6 and 12 months in osteotome technique. The use of electrical mallet provided some essential clinical advantages for the patients during surgical procedure in comparison with hand mallet.
BibTeX: @article{Crespi2014, author = {Crespi, Roberto and Capparè, Paolo and Gherlone, Enrico}, title = {A comparison of manual and electrical mallet in maxillary bone condensing for immediately loaded implants: a randomized study.}, journal = {Clinical implant dentistry and related research}, year = {2014}, volume = {16}, issue = {3}, pages = {374--382}, doi = {https://doi.org/10.1111/j.1708-8208.2012.00485.x}, keywords = {Humans; Immediate Dental Implant Loading; Maxilla, physiopathology; Retrospective Studies; bone condensing; immediate loading; osteotome; surgery mallet}, pmid = {22897742} }
Micarelli, A., Viziano, A. and Alessandrini, M.	A Comprehensive Insight into the Rehabilitative Treatment of Persistent Benign Paroxysmal Positional Vertigo. [BibTeX]	2017	The journal of international advanced otology Vol. 13(1), pp. 147-148	article	DOI
BibTeX: @article{Micarelli2017, author = {Micarelli, Alessandro and Viziano, Andrea and Alessandrini, Marco}, title = {A Comprehensive Insight into the Rehabilitative Treatment of Persistent Benign Paroxysmal Positional Vertigo.}, journal = {The journal of international advanced otology}, year = {2017}, volume = {13}, issue = {1}, pages = {147--148}, doi = {https://doi.org/10.5152/iao.2017.3564}, keywords = {Benign Paroxysmal Positional Vertigo, drug therapy, rehabilitation; Glucocorticoids, administration & dosage; Humans; Injection, Intratympanic, methods; Massage, instrumentation, methods; Methylprednisolone, administration & dosage; Treatment Outcome; Vibration}, pmid = {28555606} }
Gizzi, M.S., Peddareddygari, L.R. and Grewal, R.P.	A familial form of benign paroxysmal positional vertigo maps to chromosome 15. [Abstract] [BibTeX]	2015	The International journal of neuroscience Vol. 125(8), pp. 593-596	article	DOI
Abstract: Benign positional paroxysmal vertigo (BPPV) is characterized by short-lived episodes of vertigo in association with rapid changes in head position, most commonly extension and rotation of the neck while supine. It has been clinically observed that there is a subgroup of patients in whom the BPPV disease is inherited in an autosomal dominant fashion. However, little is known about the familial/genetic factors that may contribute to a predisposition to develop the disease. We ascertained and performed a genome-wide scan on a three-generation family in which multiple family members developed BPPV. We performed whole genome mapping with 400 microsatellite repeat markers and analyzed this trait using both autosomal dominant and recessive models of inheritance. Two point linkage analysis showed LOD scores of one or greater than one on chromosomes 7, 15, 16 and 20. Independent of the model of inheritance, the highest two-point LOD scores localized to same marker on chromosome 15. Multipoint linkage analysis showed the highest LOD score of 2.84 to markers on chromosome 15 with the autosomal dominant model. Haplotype reconstruction indicates that the BPPV gene in this family maps to a critical chromosomal 15 interval between markers GATA151F03N and GATA85D02. Discovery of a BPPV gene (or genes) will facilitate a better understanding of not only BPPV, but also the vestibular system. In addition, with improved understanding of the pathophysiology the potential development of alternative therapies for BPPV may be possible.
BibTeX: @article{Gizzi2015, author = {Gizzi, Martin S and Peddareddygari, Leema Reddy and Grewal, Raji P}, title = {A familial form of benign paroxysmal positional vertigo maps to chromosome 15.}, journal = {The International journal of neuroscience}, year = {2015}, volume = {125}, issue = {8}, pages = {593--596}, doi = {https://doi.org/10.3109/00207454.2014.953157}, keywords = {Age of Onset; Benign Paroxysmal Positional Vertigo, genetics; Chromosome Mapping; Chromosomes, Human, Pair 15, genetics; Family Health; Female; Genetic Linkage; Humans; Male; United States; benign paroxysmal positional vertigo; genetics; linkage analysis; vertigo}, pmid = {25135283} }
Parham, K. and Kuchel, G.A.	A Geriatric Perspective on Benign Paroxysmal Positional Vertigo. [Abstract] [BibTeX]	2016	Journal of the American Geriatrics Society Vol. 64(2), pp. 378-385	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo in older adults. Beyond the unpleasant sensation of vertigo, BPPV also negatively affects older adults' gait and balance and increases their risk of falling. As such it has a profound effect on function, independence, and quality of life. Otoconia are the inner ear structures that help detect horizontal and vertical movements. Aging contributes to the fragmentation of otoconia, whose displacement into the semicircular, most commonly posterior canals, can produce rotatory movement sensations with head movement. BPPV is more commonly idiopathic in older adults than in younger individuals, can present atypically, and has a more-protracted course and higher risk of recurrence. Medications such as meclizine that are commonly prescribed for BPPV can be associated with significant side effects. Dix-Hallpike and Head Roll tests can generally identify the involved canal. Symptoms resolve as otoconia fragments dissolve into the endolymph, but appropriate canalith repositioning (e.g., Epley maneuver) can expedite recovery and reduce the burden of this disorder. Observations suggesting an association between idiopathic BPPV and vitamin D deficiency and osteoporosis indicate that BPPV may share risk factors with other common geriatric conditions, which highlights the importance of moving beyond purely otological considerations and addressing the needs of older adults with vertigo through a systems-based multidisciplinary approach.
BibTeX: @article{Parham2016, author = {Parham, Kourosh and Kuchel, George A}, title = {A Geriatric Perspective on Benign Paroxysmal Positional Vertigo.}, journal = {Journal of the American Geriatrics Society}, year = {2016}, volume = {64}, issue = {2}, pages = {378--385}, doi = {https://doi.org/10.1111/jgs.13926}, keywords = {Aged; Benign Paroxysmal Positional Vertigo, diagnosis, etiology, rehabilitation; Diagnosis, Differential; Humans; benign paroxysmal positional vertigo; canalith repositioning maneuvers; dizziness; geriatric; vitamin D deficiency}, pmid = {26804483} }
Çam, O.H. and Karataş, M.	A Life Threatening Pitfall in Ear Surgery: Extracranial Sigmoid Sinus. [Abstract] [BibTeX]	2015	The Journal of craniofacial surgery Vol. 26(7), pp. e619-e620	article	DOI
Abstract: The aim of this article is to imply the significance of temporal bone computed tomography imaging before temporal surgeries. A 74-years-old patient was admitted to emergency department with dizziness and nausea. The neurologic examination showed a spontaneous nystagmus, whereas otologic examination revealed a left tympanic membrane perforation with mild discharge. A temporal bone computed tomography imaging was scheduled to exclude cholesteatoma and perilymphatic fistula. Computed tomography detected an anterior sigmoid sinus with middle fossa defect and subcutaneous course of the sinus in posterior-superior portion of the external ear canal skin with no cholesteatoma sign. Thus, Dix-Hallpike was performed on the patient and was positive on the right side. The patient was diagnosed as benign positional vertigo. Sigmoid sinus is an important landmark in otologic surgeries and in some patients it may be problematic because of its dehiscence. To avoid any surgical complications it is highly important to evaluate a temporal bone computed tomography imaging before any transmastoid, retroauricular and edoaural surgeries.
BibTeX: @article{Cam2015, author = {Çam, Osman Halit and Karataş, Mehmet}, title = {A Life Threatening Pitfall in Ear Surgery: Extracranial Sigmoid Sinus.}, journal = {The Journal of craniofacial surgery}, year = {2015}, volume = {26}, issue = {7}, pages = {e619--e620}, doi = {https://doi.org/10.1097/SCS.0000000000002116}, keywords = {Aged; Benign Paroxysmal Positional Vertigo, diagnosis; Cranial Sinuses, abnormalities, diagnostic imaging; Diagnosis, Differential; Dizziness, diagnosis; Ear Canal, diagnostic imaging; Humans; Nausea, diagnosis; Otologic Surgical Procedures; Postural Balance, physiology; Sensation Disorders, diagnosis; Temporal Bone, abnormalities, diagnostic imaging; Tomography, X-Ray Computed, methods; Tympanic Membrane Perforation, diagnosis}, pmid = {26468844} }
Scalzitti, N.J. and Pfannenstiel, T.J.	A lightning strike causing a cholesteatoma: a unique form of otologic blast injury. [Abstract] [BibTeX]	2014	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 35(10), pp. e298-e300	article	DOI
Abstract: We present a case of a middle-aged male struck by lightning while walking in a parking lot. Assessment of the patient's injuries demonstrated common sequelae of an otologic blast injury. Review of this case should prepare the otolaryngologist to identify and manage otologic blast injuries regardless of their etiology. Case study and literature review The patient presented to a level 1 trauma and burn center with a ruptured tympanic membrane, otalgia, mixed hearing loss, dizziness, and tinnitus. After 3 months of observation, the patient's tympanic membrane perforation demonstrated little spontaneous closure. Additionally, he was noted to have formation of a posttraumatic cholesteatoma in the posterior-superior mesotympanum. Over-under tympanoplasty with excision of the cholesteatoma was successful, and the ossicular chain remained intact. The patient underwent vestibular therapy for an ipsilateral uncompensated vestibular weakness. His dizziness resolved, allowing him to return to full employment. The patient's final audiogram demonstrated normal hearing thresholds sloping to a mild mixed hearing loss in the high frequencies, and the tinnitus reduced significantly in intensity but did not resolve. The patient's injury pattern clearly resulted from the damaging effects of the shock wave generated by the lightning bolt, which impacted the patient's thorax. Management of his otologic care was conducted after practices developed for otologic blast injury and resulted in his being able to return to his primary occupation.
BibTeX: @article{Scalzitti2014, author = {Scalzitti, Nicholas J and Pfannenstiel, Travis J}, title = {A lightning strike causing a cholesteatoma: a unique form of otologic blast injury.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2014}, volume = {35}, issue = {10}, pages = {e298--e300}, doi = {https://doi.org/10.1097/MAO.0000000000000536}, keywords = {Adult; Benign Paroxysmal Positional Vertigo, etiology; Cholesteatoma, Middle Ear, etiology; Earache, etiology; Hearing Loss, etiology; Hearing Tests; Humans; Lightning Injuries, complications; Male; Tinnitus, etiology; Treatment Outcome; Tympanic Membrane Perforation, etiology, surgery; Tympanoplasty}, pmid = {25111525} }
Squires, T.M., Weidman, M.S., Hain, T.C. and Stone, H.A.	A mathematical model for top-shelf vertigo: the role of sedimenting otoconia in BPPV. [Abstract] [BibTeX]	2004	Journal of biomechanics Vol. 37(8), pp. 1137-1146	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is a mechanical disorder of the vestibular system in which calcite particles called otoconia interfere with the mechanical functioning of the fluid-filled semicircular canals normally used to sense rotation. Using hydrodynamic models, we examine the two mechanisms proposed by the medical community for BPPV: cupulolithiasis, in which otoconia attach directly to the cupula (a sensory membrane), and canalithiasis, in which otoconia settle through the canals and exert a fluid pressure across the cupula. We utilize known hydrodynamic calculations and make reasonable geometric and physical approximations to derive an expression for the transcupular pressure DeltaPc exerted by a settling solid particle in canalithiasis. By tracking settling otoconia in a two-dimensional model geometry, the cupular volume displacement and associated eye response (nystagmus) can be calculated quantitatively. Several important features emerge: (1) a pressure amplification occurs as otoconia enter a narrowing duct; (2) an average-sized otoconium requires approximately 5 s to settle through the wide ampulla, where DeltaPc is not amplified, which suggests a mechanism for the observed latency of BPPV; and (3) an average-sized otoconium beginning below the center of the cupula can cause a volumetric cupular displacement on the order of 30 pL, with nystagmus of order 2 degrees/s, which is approximately the threshold for sensation. Larger cupular volume displacement and nystagmus could result from larger and/or multiple otoconia.
BibTeX: @article{Squires2004, author = {Squires, Todd M and Weidman, Michael S and Hain, Timothy C and Stone, Howard A}, title = {A mathematical model for top-shelf vertigo: the role of sedimenting otoconia in BPPV.}, journal = {Journal of biomechanics}, year = {2004}, volume = {37}, issue = {8}, pages = {1137--1146}, doi = {https://doi.org/10.1016/j.jbiomech.2003.12.014}, keywords = {Calculi, physiopathology; Ear, Inner, physiopathology; Humans; Models, Biological; Nystagmus, Pathologic, etiology; Otolithic Membrane, physiopathology; Semicircular Canals, physiopathology; Time Factors; Vertigo, etiology, physiopathology}, pmid = {15212918} }
Boselli, F., Obrist, D. and Kleiser, L.	A meshless boundary method for Stokes flows with particles: application to canalithiasis. [Abstract] [BibTeX]	2013	International journal for numerical methods in biomedical engineering Vol. 29(11), pp. 1176-1191	article	DOI
Abstract: We propose to couple the method of fundamental solutions (MFS) to the force coupling method (FCM). The resulting method is an efficient, easy to program, meshless method for flows at low Reynolds numbers with finite-size particles. In such an approach, the flow domain is extended across the solid particle phase, and the flow is approximated by a superposition of singular Stokeslets positioned outside the flow domain and finite-size multipoles collocated with the particle. To improve the efficiency of the coupling, we propose new MFS quadratures for the computation of the volume integrals required for the FCM. These are exact and do not require the expensive evaluation of Stokeslets. The proposed method has been developed in the context of investigations of the fluid dynamics of canalithiasis, that is, a pathological condition of the semicircular canals of the inner ear. Numerical examples are presented to illustrate the applicability of the method.
BibTeX: @article{Boselli2013, author = {Boselli, F and Obrist, D and Kleiser, L}, title = {A meshless boundary method for Stokes flows with particles: application to canalithiasis.}, journal = {International journal for numerical methods in biomedical engineering}, year = {2013}, volume = {29}, issue = {11}, pages = {1176--1191}, doi = {https://doi.org/10.1002/cnm.2564}, keywords = {Algorithms; Computer Simulation; Endolymph, physiology; Humans; Hydrodynamics; Labyrinth Diseases, physiopathology; Models, Biological; Semicircular Canals, physiopathology; BPPV; Stokes flow; canalithiasis; endolymph flow; force coupling method; multilayer MFS; particle-driven flow}, pmid = {23852801} }
Anagnostou, E., Varaki, K. and Anastasopoulos, D.	A minute demyelinating lesion causing acute positional vertigo. [Abstract] [BibTeX]	2008	Journal of the neurological sciences Vol. 266(1-2), pp. 187-189	article	DOI
Abstract: Clinico-anatomical correlations in multiple sclerosis patients presenting with central positional vertigo are lacking. We report on a patient with acute onset positional vertigo mimicking benign paroxysmal positional vertigo with a single enhancing lesion in the inner part of the superior cerebellar peduncle, disclosed only after thin slice MR-imaging. This location appears to be a common cause of central positional vertigo and should be regarded as characteristic for demyelinating rather than vascular pathology. In cases presenting with positional nystagmus and vertigo without other cerebellar deficits one should look explicitly for signal abnormalities in the inner part of the superior cerebellar peduncle. High spatial resolution-MRI seems to be mandatory for lesion detection.
BibTeX: @article{Anagnostou2008, author = {Anagnostou, E and Varaki, K and Anastasopoulos, D}, title = {A minute demyelinating lesion causing acute positional vertigo.}, journal = {Journal of the neurological sciences}, year = {2008}, volume = {266}, issue = {1-2}, pages = {187--189}, doi = {https://doi.org/10.1016/j.jns.2007.09.013}, keywords = {Acute Disease; Anti-Inflammatory Agents, therapeutic use; Cerebellar Nuclei, pathology; Demyelinating Diseases, complications, drug therapy, pathology; Female; Humans; Magnetic Resonance Imaging; Methylprednisolone, therapeutic use; Middle Aged; Nystagmus, Physiologic, physiology; Vertigo, drug therapy, etiology; Vestibule, Labyrinth, physiopathology; Vomiting, etiology}, pmid = {17942120} }
Radtke, A., Neuhauser, H., von Brevern, M. and Lempert, T.	A modified Epley's procedure for self-treatment of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	1999	Neurology Vol. 53(6), pp. 1358-1360	article
Abstract: We compared the efficacy of a modified Epley's procedure (MEP) and Brandt-Daroff exercises (BDE) for self-treatment of benign paroxysmal positional vertigo of the posterior semicircular canal (PC-BPPV) in 54 patients. PC-BPPV resolved within 1 week in 18 of 28 patients (64%) using the MEP and in 6 of 26 patients (23%) performing BDE (p<0.01). Type and adequate performance of the maneuver predicted treatment outcome in the multivariate analysis. The frequency of side effects was not significantly different between the two groups. The MEP is more suitable for self-treatment of PC-BPPV than conventional BDE.
BibTeX: @article{Radtke1999, author = {Radtke, A and Neuhauser, H and von Brevern, M and Lempert, T}, title = {A modified Epley's procedure for self-treatment of benign paroxysmal positional vertigo.}, journal = {Neurology}, year = {1999}, volume = {53}, issue = {6}, pages = {1358--1360}, keywords = {Humans; Posture; Self Care; Vertigo, therapy}, pmid = {10522903} }
De Stefano, A., Dispenza, F., Suarez, H., Perez-Fernandez, N., Manrique-Huarte, R., Ban, J.H., Kim, M.-B., Kim, M.B., Strupp, M., Feil, K., Oliveira, C.A., Sampaio, A.L., Araujo, M.F.S., Bahmad, F., Ganança, M.M., Ganança, F.F., Dorigueto, R., Lee, H., Kulamarva, G., Mathur, N., Di Giovanni, P., Petrucci, A.G., Staniscia, T., Citraro, L. and Croce, A.	A multicenter observational study on the role of comorbidities in the recurrent episodes of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2014	Auris, nasus, larynx Vol. 41(1), pp. 31-36	article	DOI
Abstract: Primary objective of this study was to find a statistical link between the most worldwide comorbidities affecting the elderly population (hypertension, diabetes, osteoarthrosis, osteoporosis and depression) and recurrent episodes of BPPV. Secondary objective was defining possible "groups of risk" for people suffering recurrent positional vertigo related to the presence of a well documented comorbidity. This was an observational, cross-sectional, multicenter, spontaneous, non-pharmacological study. The data of 1092 patients suffering BPPV evaluated in 11 different Departments of Otolaryngology, Otoneurology and Neurology, referring Centers for positional vertigo evaluation, were retrospectively collected. Regarding evaluated comorbidities (hypertension, diabetes, osteoarthrosis, osteoporosis and depression), data analysis showed the presence of at least one comorbid disorder in 216 subjects (19.8%) and 2 or more in 408 subjects (37.4%). Moreover there was a statistical significant difference between the number of comorbidities and the number of recurrences, otherwise said as comorbidity disorders increased the number of relapses increased too. The presence of a systemic disease may worsen the status of the posterior labyrinth causing a more frequent otolith detachment. This condition increases the risk for patients suffering BPPV to have recurrent episodes, even if correctly managed by repositioning maneuvers. The combination of two or more of aforementioned comorbidities further increases the risk of relapsing BPPV, worsened by the presence of osteoporosis. On the basis of this results it was possible to define "groups of risk" useful for predicting BPPV recurrence in patients with one or more comorbidity.
BibTeX: @article{DeStefano2014, author = {De Stefano, Alessandro and Dispenza, Francesco and Suarez, Hamlet and Perez-Fernandez, Nicolas and Manrique-Huarte, Raquel and Ban, Jae Ho and Kim, Min-Beom and Kim, Min Beom and Strupp, Michael and Feil, Katharina and Oliveira, Carlos A and Sampaio, Andres L and Araujo, Mercedes F S and Bahmad, Fayez and Ganança, Mauricio M and Ganança, Fernando F and Dorigueto, Ricardo and Lee, Hyung and Kulamarva, Gautham and Mathur, Navneet and Di Giovanni, Pamela and Petrucci, Anna Grazia and Staniscia, Tommaso and Citraro, Leonardo and Croce, Adelchi}, title = {A multicenter observational study on the role of comorbidities in the recurrent episodes of benign paroxysmal positional vertigo.}, journal = {Auris, nasus, larynx}, year = {2014}, volume = {41}, issue = {1}, pages = {31--36}, doi = {https://doi.org/10.1016/j.anl.2013.07.007}, keywords = {Aged; Aged, 80 and over; Asia, epidemiology; Benign Paroxysmal Positional Vertigo; Comorbidity; Cross-Sectional Studies; Depressive Disorder, epidemiology; Diabetes Mellitus, epidemiology; Europe, epidemiology; Female; Humans; Hypertension, epidemiology; Male; Osteoarthritis, epidemiology; Osteoporosis, epidemiology; Recurrence; Retrospective Studies; Risk Factors; Semicircular Canals, physiopathology; South America, epidemiology; Vertigo, epidemiology, physiopathology; ASC; BPPV; CRM; Comorbidity; Diabetes; Elderly; HSC; Hypertension; Neurology; OA; OR; Osteoarthrosis; Osteoporosis; Otolaryngology; PSC; Vertigo; anterior semicircular canal; benign paroxysmal positional vertigo; canalith repositioning maneuver; horizontal semicircular canal; odds ratio; osteoarthrosis; posterior semicircular canals}, pmid = {23932347} }
Lee, J.D., Shim, D.B., Park, H.J., Song, C.I., Kim, M.-B., Kim, C.-H., Byun, J.Y., Hong, S.K., Kim, T.S., Park, K.H., Seo, J.-H., Shim, B.S., Lee, J.H., Lim, H.W. and Jeon, E.-J.	A multicenter randomized double-blind study: comparison of the Epley, Semont, and sham maneuvers for the treatment of posterior canal benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2014	Audiology & neuro-otology Vol. 19(5), pp. 336-341	article	DOI
Abstract: We evaluated the short-term efficacy of Epley, Semont, and sham maneuvers for resolving posterior canal benign paroxysmal positional vertigo (BPPV) in a prospective multicenter randomized double-blind controlled study. Subjects were randomly divided into three groups: Epley (36 patients), Semont (32 patients), and sham (Epley maneuver for the unaffected side, 31 patients). Out of 14 institutes which participated in this study, 5 institutes had previous experience of the Epley but not the Semont maneuver and the other 9 had previous experience of both maneuvers. Each maneuver was repeated twice if there was still positional vertigo or nystagmus on day 0, and the presence of nystagmus and vertigo on positional testing were evaluated immediately, 1 day, and 1 week after treatment. After the first maneuver, the Epley group showed a significantly higher resolution rate of positional nystagmus than the Semont or sham groups (63.9, 37.5, and 38.7%, respectively). After the second maneuver, the resolution rate (83.3%) of the Epley group was significantly higher than that (51.6%) of the sham group. At 1 day and 1 week after treatment, the resolution rate of the Epley group was significantly higher than those of the other groups. Similar results were seen for the resolution of positional vertigo. The Epley maneuver showed persistent resolution rates of positional vertigo and nystagmus without a fatigue phenomenon. The Epley maneuver was significantly more effective per maneuver than Semont or sham maneuvers for the short-term treatment of posterior canal BPPV. The Semont maneuver showed a higher success rate than the sham maneuver, but it was not significantly different.
BibTeX: @article{Lee2014, author = {Lee, Jong Dae and Shim, Dae Bo and Park, Hong Ju and Song, Chan Il and Kim, Min-Beom and Kim, Chang-Hee and Byun, Jae Yong and Hong, Sung Kwang and Kim, Tae Su and Park, Kye Hoon and Seo, Jae-Hyun and Shim, Byoung Soo and Lee, Joon Han and Lim, Hyun Woo and Jeon, Eun-Ju}, title = {A multicenter randomized double-blind study: comparison of the Epley, Semont, and sham maneuvers for the treatment of posterior canal benign paroxysmal positional vertigo.}, journal = {Audiology & neuro-otology}, year = {2014}, volume = {19}, issue = {5}, pages = {336--341}, doi = {https://doi.org/10.1159/000365438}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo, complications, rehabilitation; Double-Blind Method; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, complications, rehabilitation; Physical Therapy Modalities; Treatment Outcome}, pmid = {25377361} }
Edlow, J.A.	A New Approach to the Diagnosis of Acute Dizziness in Adult Patients. [Abstract] [BibTeX]	2016	Emergency medicine clinics of North America Vol. 34(4), pp. 717-742	article	DOI
Abstract: Dizziness is a common chief complaint in emergency medicine. The differential diagnosis is broad and includes serious conditions, such as stroke, cardiac arrhythmia, hypovolemic states, and acute toxic and metabolic disturbances. Emergency physicians must distinguish the majority of patients who suffer from benign self-limiting conditions from those with serious illnesses that require acute treatment. Misdiagnoses are frequent and diagnostic test costs high. The traditional approach does not distinguish benign from dangerous causes and is not consistent with best current evidence. This article presents a new approach to the diagnosis of acutely dizzy patients that highly leverages the history and the physical examination.
BibTeX: @article{Edlow2016, author = {Edlow, Jonathan A}, title = {A New Approach to the Diagnosis of Acute Dizziness in Adult Patients.}, journal = {Emergency medicine clinics of North America}, year = {2016}, volume = {34}, issue = {4}, pages = {717--742}, doi = {https://doi.org/10.1016/j.emc.2016.06.004}, keywords = {Adult; Benign Paroxysmal Positional Vertigo, complications, diagnosis; Dizziness, diagnosis, etiology; Emergency Service, Hospital; Humans; Physical Examination; Stroke, complications, diagnosis; Vestibular Neuronitis, diagnosis; BPPV; Dizziness; Nystagmus; Posterior circulation stroke; Vertigo; Vestibular neuritis}, pmid = {27741985} }
Edlow, J.A., Gurley, K.L. and Newman-Toker, D.E.	A New Diagnostic Approach to the Adult Patient with Acute Dizziness. [Abstract] [BibTeX]	2018	The Journal of emergency medicine Vol. 54(4), pp. 469-483	article	DOI
Abstract: Dizziness, a common chief complaint, has an extensive differential diagnosis that includes both benign and serious conditions. Emergency physicians must distinguish the majority of patients with self-limiting conditions from those with serious illnesses that require acute treatment. This article presents a new approach to diagnosis of the acutely dizzy patient that emphasizes different aspects of the history to guide a focused physical examination with the goal of differentiating benign peripheral vestibular conditions from dangerous posterior circulation strokes in the emergency department. Currently, misdiagnoses are frequent and diagnostic testing costs are high. This relates in part to use of an outdated, prevalent, diagnostic paradigm. The traditional approach, which relies on dizziness symptom quality or type (i.e., vertigo, presyncope, or disequilibrium) to guide inquiry, does not distinguish benign from dangerous causes, and is inconsistent with current best evidence. A new approach divides patients into three key categories using timing and triggers, guiding a differential diagnosis and targeted bedside examination protocol: 1) acute vestibular syndrome, where bedside physical examination differentiates vestibular neuritis from stroke; 2) spontaneous episodic vestibular syndrome, where associated symptoms help differentiate vestibular migraine from transient ischemic attack; and 3) triggered episodic vestibular syndrome, where the Dix-Hallpike and supine roll test help differentiate benign paroxysmal positional vertigo from posterior fossa structural lesions. The timing and triggers diagnostic approach for the acutely dizzy patient derives from current best evidence and offers the potential to reduce misdiagnosis while simultaneously decreases diagnostic test overuse, unnecessary hospitalization, and incorrect treatments.
BibTeX: @article{Edlow2018, author = {Edlow, Jonathan A and Gurley, Kiersten L and Newman-Toker, David E}, title = {A New Diagnostic Approach to the Adult Patient with Acute Dizziness.}, journal = {The Journal of emergency medicine}, year = {2018}, volume = {54}, issue = {4}, pages = {469--483}, doi = {https://doi.org/10.1016/j.jemermed.2017.12.024}, keywords = {Adult; Algorithms; Diagnosis, Differential; Dizziness, diagnosis, therapy; Emergency Service, Hospital, organization & administration, statistics & numerical data; Humans; Physical Examination, methods; BPPV; diagnosis; dizziness; misdiagnosis; nystagmus; posterior circulation stroke; vertigo; vestibular neuritis}, pmid = {29395695} }
Kim, C.-H., Shin, J.E. and Kim, Y.W.	A new method for evaluating lateral semicircular canal cupulopathy. [Abstract] [BibTeX]	2015	The Laryngoscope Vol. 125(8), pp. 1921-1925	article	DOI
Abstract: Persistent direction-changing positional nystagmus (DCPN) during the supine head-roll test is a typical finding of cupulopathy. The aim of this study was to introduce a simple method of evaluating patients with cupulopathy (light cupula and heavy cupula), which is performed in a seated position, and investigate its diagnostic utility and use for lateralization. Retrospective case series. Using video-oculography, nystagmus during head roll in the leaning and bending head positions while seated upright was evaluated in 26 patients with cupulopathy (five light cupula and 21 heavy cupula). The diagnosis of cupulopathy was confirmed with the supine head-roll test. Spontaneous nystagmus while seated upright was directed toward the ipsilesional side in heavy cupula and the contralesional side in light cupula. The first null point was identified when the head was slightly bent in the pitch plane in all 26 patients. Head rolling elicited a persistent geotropic DCPN in light cupula patients and persistent apogeotropic DCPN in heavy cupula patients during both leaning and bending head positions. In both light and heavy cupula, nystagmus disappeared when the head was turned slightly toward the affected side in both leaning (second null point) and bending (third null point) head positions. Cupulopathy and its affected side can be diagnosed by identifying the three null points while seated upright. 4.
BibTeX: @article{Kim2015a, author = {Kim, Chang-Hee and Shin, Jung Eun and Kim, Yong Won}, title = {A new method for evaluating lateral semicircular canal cupulopathy.}, journal = {The Laryngoscope}, year = {2015}, volume = {125}, issue = {8}, pages = {1921--1925}, doi = {https://doi.org/10.1002/lary.25181}, keywords = {Adult; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, diagnosis, physiopathology; Nystagmus, Physiologic, physiology; Posture, physiology; Reproducibility of Results; Retrospective Studies; Semicircular Canals, physiopathology; Vestibular Function Tests, methods; Young Adult; Benign paroxysmal positional vertigo; direction-changing positional nystagmus; heavy cupula; light cupula; null point}, pmid = {25640211} }
Hornibrook, J. and Bird, P.	A New Theory for Ménière's Disease: Detached Saccular Otoconia [Abstract] [BibTeX]	2017	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 156(2), pp. 350-352	article	DOI
Abstract: Ménière's disease is an inner ear disorder characterized by vertigo attacks, fluctuating and progressive hearing loss, tinnitus, and aural fullness in the affected ear. The pathophysiology of Ménière's disease remains elusive. Theories so far are anatomical variation in the size or position of the endolymphatic sac and duct, viral inflammation or autoimmune involvement of the sac, or a genetically determined abnormality of endolymph control. Animal studies on blocking the ductus reuniens and endolymphatic duct have produced hydrops in the cochlea, saccule, and utricle. Cone beam computed tomography images show a similar pattern with apparent obstruction of the ductus reuniens, saccular duct, and endolymphatic sinus. New studies documenting the age of onset of Ménière's disease show a pattern similar to benign paroxysmal positional vertigo, raising the possibility that the fundamental cause of Ménière's disease might be detached saccular otoconia.
BibTeX: @article{Hornibrook2017, author = {Hornibrook, Jeremy and Bird, Philip}, title = {A New Theory for Ménière's Disease: Detached Saccular Otoconia}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2017}, volume = {156}, issue = {2}, pages = {350--352}, doi = {https://doi.org/10.1177/0194599816675843}, keywords = {Animals; Humans; Meniere Disease, physiopathology; Otolithic Membrane, physiopathology; Saccule and Utricle, physiopathology; Vestibular Evoked Myogenic Potentials; BPPV; Ménière’s disease; otoconia; saccule}, pmid = {28145833} }
Yetiser, S.	A New Variant of Posterior Canal Benign Paroxysmal Positional Vertigo: A Nonampullary or Common Crus Canalolithiasis. [Abstract] [BibTeX]	2015	Case reports in otolaryngology Vol. 2015, pp. 816081	article	DOI
Abstract: Clockwise or counterclockwise, rotational, upbeating nystagmus is seen in patients with posterior canal benign paroxysmal positional vertigo during left or right head-hanging test, respectively. Rotating of nystagmus in opposite direction to the ear tested or even reversal of initial positioning rotational nystagmus is not usual and has never been reported before. We propose a new variant of posterior canal benign paroxysmal positional vertigo due to unusual behavior and location of the otoliths inside the membranous labyrinth. Unexpected rotational direction may lead to confusion about the site. The examiner should be aware of this abnormal or atypical variant of posterior canal benign paroxysmal positional vertigo.
BibTeX: @article{Yetiser2015a, author = {Yetiser, Sertac}, title = {A New Variant of Posterior Canal Benign Paroxysmal Positional Vertigo: A Nonampullary or Common Crus Canalolithiasis.}, journal = {Case reports in otolaryngology}, year = {2015}, volume = {2015}, pages = {816081}, doi = {https://doi.org/10.1155/2015/816081}, pmid = {26114003} }
Parry, S.W., Hill, H., Lawson, J., Lawson, N., Green, D., Trundle, H., McNaught, J., Strassheim, V., Caldwell, A., Mayland, R., Earley, P. and McMeekin, P.	A Novel Approach to Proactive Primary Care-Based Case Finding and Multidisciplinary Management of Falls, Syncope, and Dizziness in a One-Stop Service: Preliminary Results. [Abstract] [BibTeX]	2016	Journal of the American Geriatrics Society Vol. 64(11), pp. 2368-2373	article	DOI
Abstract: National and international evidence and guidelines on falls prevention and management in community-dwelling elderly adults recommend that falls services should be multifactorial and their interventions multicomponent. The way that individuals are identified as having had or being at risk of falls in order to take advantage of such services is far less clear. A novel multidisciplinary, multifactorial falls, syncope, and dizziness service model was designed with enhanced case ascertainment through proactive, primary care-based screening (of individual case notes of individuals aged ≥60) for individual fall risk factors. The service model identified 4,039 individuals, of whom 2,232 had significant gait and balance abnormalities according to senior physiotherapist assessment. Significant numbers of individuals with new diagnoses ranging from cognitive impairment to Parkinson's disease to urgent indications for a pacemaker were discovered. More than 600 individuals were found who were at high risk of osteoporosis according to World Health Association Fracture Risk Assessment Tool score, 179 with benign positional paroxysmal vertigo and 50 with atrial fibrillation. Through such screening and this approach, Comprehensive Geriatric Assessment Plus (Plus falls, syncope and dizziness expertise), unmet need was targeted on a scale far outside the numbers seen in clinical trials. Further work is needed to determine whether this approach translates into fewer falls and decreases in syncope and dizziness.
BibTeX: @article{Parry2016, author = {Parry, Steve W and Hill, Harry and Lawson, Joanna and Lawson, Nick and Green, David and Trundle, Heidi and McNaught, Judith and Strassheim, Victoria and Caldwell, Alma and Mayland, Richard and Earley, Phillip and McMeekin, Peter}, title = {A Novel Approach to Proactive Primary Care-Based Case Finding and Multidisciplinary Management of Falls, Syncope, and Dizziness in a One-Stop Service: Preliminary Results.}, journal = {Journal of the American Geriatrics Society}, year = {2016}, volume = {64}, issue = {11}, pages = {2368--2373}, doi = {https://doi.org/10.1111/jgs.14389}, keywords = {Accidental Falls, prevention & control; Aged; England; Female; Geriatric Assessment, methods; Humans; Male; Mass Screening, methods; Middle Aged; Primary Health Care, organization & administration; Risk Assessment; Risk Factors; Syncope, complications; Vertigo, complications; community; elderly; falls; screening; syncope}, pmid = {27676247} }
Kelkar, A. and Johnson, I.	A novel use of intratympanic dexamethasone for intractable posterior canal benign paroxysmal positional vertigo: report of two cases. [Abstract] [BibTeX]	2018	The Journal of laryngology and otology Vol. 132(12), pp. 1147-1149	article	DOI
Abstract: Benign paroxysmal positional vertigo is a common inner-ear pathology, characterised by episodic vertigo lasting for a few seconds that is associated with sudden change in the head position. Benign paroxysmal positional vertigo is treated with canalolith repositioning manoeuvres. Intractable vertigo describes a small group of patients who either do not improve with canalolith repositioning manoeuvres (persistent cases) or who relapse after improvement of initial symptoms (recurrent cases). These cases are difficult to treat and may have to be treated surgically.Case reportsThis paper reports two cases of intractable posterior canal benign paroxysmal positional vertigo that were treated with intratympanic dexamethasone injections on an interval basis. Both patients showed good control of their vertiginous symptoms, with negative Dix-Hallpike test findings following the intervention. The findings support an underlying inflammatory pathology in intractable benign paroxysmal positional vertigo; intratympanic steroids should be considered as an intermediate option before proceeding to a definitive surgical intervention.
BibTeX: @article{Kelkar2018, author = {Kelkar, A and Johnson, I}, title = {A novel use of intratympanic dexamethasone for intractable posterior canal benign paroxysmal positional vertigo: report of two cases.}, journal = {The Journal of laryngology and otology}, year = {2018}, volume = {132}, issue = {12}, pages = {1147--1149}, doi = {https://doi.org/10.1017/S0022215118002037}, keywords = {Benign Paroxysmal Positional Vertigo; Dexamethasone; Injections; Middle Ear; Steroids}, pmid = {30486912} }
Gacek, R.R.	A perspective on recurrent vertigo. [Abstract] [BibTeX]	2013	ORL; journal for oto-rhino-laryngology and its related specialties Vol. 75(2), pp. 91-107	article	DOI
Abstract: The recurrent nature of the 3 most common vestibulopathies suggests a recurrent cause. Histopathology in temporal bones from patients with these syndromes - vestibular neuronitis (VN, n = 7), Ménière's disease (MD, n = 8) and benign paroxysmal positional vertigo (BPPV, n = 5) - shows focal degeneration of vestibular nerve axons and degenerated nearby facial nerve meatal ganglion cells. Transmission electron microscopic confirmation of intracytoplasmic viral particles in surgically excised vestibular nerves from patients with VN and MD support a viral etiology in these vestibulopathies. Antiviral treatment of these syndromes in a series of 211 patients with a 3- to 8-year follow-up resulted in complete control of vertigo in VN (88%), MD (90%) and BPPV (60%).
BibTeX: @article{Gacek2013, author = {Gacek, Richard R}, title = {A perspective on recurrent vertigo.}, journal = {ORL; journal for oto-rhino-laryngology and its related specialties}, year = {2013}, volume = {75}, issue = {2}, pages = {91--107}, doi = {https://doi.org/10.1159/000348710}, keywords = {Benign Paroxysmal Positional Vertigo; Humans; Meniere Disease, etiology, pathology, therapy; Recurrence; Vertigo, etiology, pathology, therapy; Vestibular Neuronitis, etiology, pathology, therapy}, pmid = {23796949} }
Pérez, P., Franco, V., Oliva, M. and López Escámez, J.A.	A Pilot Study Using Intratympanic Methylprednisolone for Treatment of Persistent Posterior Canal Benign Paroxysmal Positional Vertigo. [Abstract] [BibTeX]	2016	The journal of international advanced otology Vol. 12(3), pp. 321-325	article	DOI
Abstract: To assess the effect of intratympanic methylprednisolone (ITMP) in posterior canal benign paroxysmal positional vertigo (BPPV) that fails treatment involving repositioning maneuver in a case series. Nine patients with persistent posterior canal BPPV after 6 or more repositioning maneuvers were treated by ITMP (two weekly doses of 0.3-0.4 mL at 40 mg/mL) before repeating the repositioning procedures. Following ITMP treatment, 7 out of 9 patients were relieved of their symptoms and did not exhibit positional nystagmus after 1 or 2 repositioning maneuvers. The number of positional maneuvers performed before and after ITMP treatment in these 7 patients showed a statistically significant (p=0.016) reduction in the amount of repositioning treatments required. None of the 7 respondent patients showed any relapses during the follow-up period (follow-up range: 11-95 months). Administering ITMP before resuming repositioning procedures can be a useful treatment for persistent BPPV of the posterior canal.
BibTeX: @article{Perez2016, author = {Pérez, Paz and Franco, Virginia and Oliva, Manuel and López Escámez, José A}, title = {A Pilot Study Using Intratympanic Methylprednisolone for Treatment of Persistent Posterior Canal Benign Paroxysmal Positional Vertigo.}, journal = {The journal of international advanced otology}, year = {2016}, volume = {12}, issue = {3}, pages = {321--325}, doi = {https://doi.org/10.5152/iao.2016.3014}, keywords = {Aged; Benign Paroxysmal Positional Vertigo, drug therapy; Female; Glucocorticoids, therapeutic use; Humans; Injection, Intratympanic; Male; Methylprednisolone, therapeutic use; Middle Aged; Patient Positioning; Pilot Projects; Prospective Studies; Vestibular Function Tests}, pmid = {27897129} }
Kerber, K.A., Burke, J.F., Skolarus, L.E., Callaghan, B.C., Fife, T.D., Baloh, R.W. and Fendrick, A.M.	A prescription for the Epley maneuver: www.youtube.com? [Abstract] [BibTeX]	2012	Neurology Vol. 79(4), pp. 376-380	article	DOI
Abstract: Video-sharing Web sites are being used for information about common conditions including dizziness. The Epley maneuver (EM) is a simple and effective treatment for benign paroxysmal positional vertigo (BPPV) of the posterior canal. However, the maneuver is underused in routine care. In this study, we aimed to describe and analyze the available information about the EM on youtube.com. A YouTube search was performed on August 31, 2011, for videos that demonstrated the entire EM. Detailed data were abstracted from each video and corresponding Web site. Videos were rated on the accuracy of the maneuver by 2 authors, with differences resolved by adjudication. Comments posted by viewers were assessed for themes regarding video use. Of the 3,319 videos identified, 33 demonstrated the EM. The total number of hits for all videos was 2,755,607. The video with the most hits (802,471) was produced by the American Academy of Neurology. Five of the videos accounted for 85% of all the hits. The maneuver demonstration was rated as accurate in 64% (21) of the videos. Themes derived from the 424 posted comments included patients self-treating with the maneuver after reviewing the videos, and providers using the videos as a prescribed treatment or for educational purposes. Accurate video demonstration of the Epley maneuver is available and widely viewed on YouTube. Video-sharing media may be an important way to disseminate effective interventions such as the EM. The impact of video Web sites on outcomes and costs of care is not known and warrants future study.
BibTeX: @article{Kerber2012, author = {Kerber, Kevin A and Burke, James F and Skolarus, Lesli E and Callaghan, Brian C and Fife, Terry D and Baloh, Robert W and Fendrick, A Mark}, title = {A prescription for the Epley maneuver: www.youtube.com?}, journal = {Neurology}, year = {2012}, volume = {79}, issue = {4}, pages = {376--380}, doi = {https://doi.org/10.1212/WNL.0b013e3182604533}, keywords = {Benign Paroxysmal Positional Vertigo; Dizziness, therapy; Humans; Internet; Patient Positioning, methods; Posture; Treatment Outcome; Vertigo, therapy; Video Recording}, pmid = {22826542} }
Douglas, V.C. and Josephson, S.A.	A proposed roadmap for inpatient neurology quality indicators. [Abstract] [BibTeX]	2011	The Neurohospitalist Vol. 1(1), pp. 8-15	article	DOI
Abstract: In recent years, there has been increasing pressure to measure and report quality in health care. However, there has been little focus on quality measurement in the field of neurology for conditions other than stroke and transient ischemic attack. As the number of evidence-based treatments for neurological conditions grows, so will the demand to measure the quality of care delivered. The purpose of this study was to review essential components of hospital performance measures for neurological disease and propose potential quality indicators for commonly encountered inpatient neurological diagnoses. We determined the most common inpatient neurological diagnoses at a major tertiary care medical center by reviewing the billing database. We then searched PubMed and the National Guidelines Clearinghouse to identify treatment guidelines for these conditions. Guideline recommendations with class I/level A evidence were evaluated as possible quality indicators. We found 94 guidelines for 14 inpatient neurological conditions other than stroke and transient ischemic attack. Of these, 36 guidelines contained at least 1 recommendation with class I evidence. Based on these, potential quality indicators for intracerebral hemorrhage, subarachnoid hemorrhage, pneumococcal meningitis, coma following cardiac arrest, encephalitis, Guillain-Barre syndrome, multiple sclerosis, and benign paroxysmal positional vertigo are proposed. There are several inpatient neurological conditions with treatments or diagnostic test routines supported by high levels of evidence that could be used in the future as quality indicators.
BibTeX: @article{Douglas2011, author = {Douglas, Vanja C and Josephson, S Andrew}, title = {A proposed roadmap for inpatient neurology quality indicators.}, journal = {The Neurohospitalist}, year = {2011}, volume = {1}, issue = {1}, pages = {8--15}, doi = {https://doi.org/10.1177/1941875210380676}, keywords = {brain; central nervous system diseases; cerebrovascular disorders; epidemiology; hypoxia-ischemia; intracranial hemorrhages; outcomes; stroke delirium}, pmid = {23983832} }
Li, J., Zou, S. and Tian, S.	A prospective randomized controlled study of Li quick repositioning maneuver for geotropic horizontal canal BPPV. [Abstract] [BibTeX]	2018	Acta oto-laryngologica Vol. 138(9), pp. 779-784	article	DOI
Abstract: Li quick repositioning maneuver for treatment of geotropic horizontal canal benign paroxysmal positional vertigo (HC-BPPV) was reported in the literature. The aim of this study is to observe the clinical efficacy of the Li quick repositioning maneuver for the treatment of geotropic HC-BPPV. The single-blind method was used to conduct a prospective controlled study on 120 patients with geotropic HC-BPPV from May 2014 to May 2017. Patients were randomly assigned to the Li quick repositioning maneuver (Li maneuver) group or the barbecue repositioning maneuver (barbecue maneuver) group. The successful repositioning rates were 53.3%, 70.4%, 90.7% and 92.3%, respectively, in barbecue maneuver group and 61.7%, 80.7%, 93.0% and 96.3%, respectively, in Li maneuver group at 1-day, 3-day, 1-week and 1-month follow-up. Differences in success rates of repositioning between Li and barbecue maneuver groups at 1 day, 3 days, 1 week and 1 month after initial treatment were not statistically significant using the Kaplan-Meier survival curve with a log-rank test (p = .270) . The Li maneuver is a rapid, simple and efficacious repositioning method for geotropic HC-BPPV and can be widely applied in clinical practice as an alternative method.
BibTeX: @article{Li2018a, author = {Li, Jinrang and Zou, Shizhen and Tian, Shiyu}, title = {A prospective randomized controlled study of Li quick repositioning maneuver for geotropic horizontal canal BPPV.}, journal = {Acta oto-laryngologica}, year = {2018}, volume = {138}, issue = {9}, pages = {779--784}, doi = {https://doi.org/10.1080/00016489.2018.1476778}, keywords = {Benign Paroxysmal Positional Vertigo, therapy; Female; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Patient Positioning, methods; Prospective Studies; Single-Blind Method; Vestibular diseases; geotropic nystagmus; horizontal canal; positional vertigo; repositioning maneuver}, pmid = {30015550} }
Bruintjes, T.D., Companjen, J., van der Zaag-Loonen, H.J. and van Benthem, P.P.G.	A randomised sham-controlled trial to assess the long-term effect of the Epley manoeuvre for treatment of posterior canal benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2014	Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery Vol. 39(1), pp. 39-44	article	DOI
Abstract: To evaluate the long-term efficacy of the Epley manoeuvre as a therapeutic procedure for posterior canal benign paroxysmal positional vertigo. Randomised, double-blind, sham-controlled trial. A multidisciplinary dizziness unit in a non-academic Hospital. Forty-four patients with posterior canal benign paroxysmal positional vertigo (BPPV) with a duration of at least 1 month. Participants were randomised in two groups of 22 and treated with either the Epley manoeuvre or a sham manoeuvre and followed up for 1 year after treatment. Conversion of a 'positive' Dix-Hallpike test to a 'negative' Dix-Hallpike test, impairments perceived by the dizziness assessed by the Dizziness Handicap Inventory (DHI). Absolute and relative risks were computed, and Fisher's exact test was used to compare the treatments. Six patients were lost to follow up (five in the sham group, one in the Epley group). The Epley procedure resulted in a treatment success in 20/22 patients (91%) after 12 months of follow-up, whereas the sham procedure had a positive effect in 10/22 patients (46%; P = 0.001). The DHI was significantly lower in the Epley group at all follow-up assessments (median scores 12 months 0 (0-51) versus 20 (0-76), P = 0.003). The Epley manoeuvre provides long-term resolution of symptoms in patients with posterior canal BPPV.
BibTeX: @article{Bruintjes2014, author = {Bruintjes, Tj D and Companjen, J and van der Zaag-Loonen, H J and van Benthem, P P G}, title = {A randomised sham-controlled trial to assess the long-term effect of the Epley manoeuvre for treatment of posterior canal benign paroxysmal positional vertigo.}, journal = {Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery}, year = {2014}, volume = {39}, issue = {1}, pages = {39--44}, doi = {https://doi.org/10.1111/coa.12217}, keywords = {Benign Paroxysmal Positional Vertigo; Double-Blind Method; Female; Humans; Male; Middle Aged; Physical Therapy Modalities; Treatment Outcome; Vertigo, therapy}, pmid = {24438128} }
Yimtae, K., Srirompotong, S., Srirompotong, S. and Sae-Seaw, P.	A randomized trial of the canalith repositioning procedure. [Abstract] [BibTeX]	2003	The Laryngoscope Vol. 113(5), pp. 828-832	article	DOI
Abstract: To compare the effectiveness and complications of our adaptation of the canalith repositioning procedure (CRP) with the expectation treatment for benign paroxysmal positional vertigo. A randomized, controlled trial in the setting of a neurotological clinic in Thailand. Fifty-eight patients with posterior benign paroxysmal positional vertigo were randomly assigned to treatment and control groups using a block of four. The treatment group was treated with the modified CRP technique until the nystagmus disappeared. A mastoid oscillator was not used, nor were any instructions given for patients after the maneuver. Both groups recorded the daily grading of symptoms and the amount of anti-vertiginous drugs (cinnarizine) taken. Objective and subjective assessments were made weekly until the nystagmus disappeared or until 4 weeks had passed since treatment began. The rates of effectiveness of CRP treatment and the control treatment for benign paroxysmal positional vertigo were 75.9% and 48.2%, respectively. There was a significant difference in the treatment outcomes of the CRP and control groups (P =.03). The CRP group used significantly fewer drugs than the control group (P =.001). Complications in the CRP group, such as lateral canalithiasis and fainting, were observed in 13.8% of the patients. The CRP was more effective than the expectation treatment for benign paroxysmal positional vertigo insofar as it provided faster recovery and required less dependence on medication. Complications of CRP were limited to 13.8% of patients.
BibTeX: @article{Yimtae2003, author = {Yimtae, Kwanchanok and Srirompotong, Somchai and Srirompotong, Supaporn and Sae-Seaw, Patchareeporn}, title = {A randomized trial of the canalith repositioning procedure.}, journal = {The Laryngoscope}, year = {2003}, volume = {113}, issue = {5}, pages = {828--832}, doi = {https://doi.org/10.1097/00005537-200305000-00011}, keywords = {Adult; Calcium Channel Blockers, therapeutic use; Cinnarizine, therapeutic use; Female; Humans; Male; Middle Aged; Posture; Semicircular Canals, physiopathology; Surveys and Questionnaires; Vertigo, drug therapy, physiopathology, therapy}, pmid = {12792318} }
Modugno, G.C., Pirodda, A., Ferri, G.G., Montana, T., Rasciti, L. and Ceroni, A.R.	A relationship between autoimmune thyroiditis and benign paroxysmal positional vertigo? [Abstract] [BibTeX]	2000	Medical hypotheses Vol. 54(4), pp. 614-615	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is a labyrinthine disorder with a typical behavior: intense crises of rotational vertigo induced by postural changes of the head, with short duration and usually good responsiveness to rehabilitative maneuvers. This phenomenon is thought to be subsequent to the movement of floating particles in the labyrinthine fluids, which can provoke gravitational stimulations. In order to conduct a metabolic and autoimmune examination, 70 patients affected by BPPV were examined. In 34 cases (48.5%) autoimmune alterations were found: in 19 cases (27.1%) the level of anti-thyroid antibodies far exceeded the normal values with a significant incidence in comparison with a control group (P<0.01). No other 'risk factors' were present. It can be hypothesized that the diffusion of immune-complexes in the inner ear could change the composition of the endolymphatic fluid exerting a mechanical stimulation of the receptors and provoking the typical vertigo.
BibTeX: @article{Modugno2000, author = {Modugno, G C and Pirodda, A and Ferri, G G and Montana, T and Rasciti, L and Ceroni, A R}, title = {A relationship between autoimmune thyroiditis and benign paroxysmal positional vertigo?}, journal = {Medical hypotheses}, year = {2000}, volume = {54}, issue = {4}, pages = {614--615}, doi = {https://doi.org/10.1054/mehy.1999.0905}, keywords = {Humans; Thyroiditis, Autoimmune, complications; Vertigo, complications}, pmid = {10859648} }
Parham, K., Kuchel, G.A., McElhaney, J.E. and Haynes, L.	A Relationship Between Blood Levels of Otolin-1 and Vitamin D. [Abstract] [BibTeX]	2018	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 39(4), pp. e269-e273	article	DOI
Abstract: Low vitamin D levels have been associated with and could play a role in the pathogenesis of idiopathic benign paroxysmal positional vertigo (iBPPV). Since otoconia degeneration contributes to iBPPV and a lack of vitamin D may impact otoconia structure and integrity, we proposed a negative association between vitamin D levels and levels of a proposed circulatory biomarker for otolithic degeneration, otolin-1. Cross-sectional clinical study. Clinical research center. Seventy-nine men and women ranging in age from 22 to 95 years old without known vertigo. Diagnostic. Blood levels of 25-OH vitamin D and otolin-1. Previously, we had reported higher otolin-1 levels in older age groups. The majority of the subjects (83%) had vitamin D levels that were below 40 ng/ml. Vitamin D level was lowest in the young and increased with age before declining in subjects 70 years of age and older (p = 0.005). There was a negative correlation between vitamin D and otolin-1 levels of subjects over 70 (r = -0.36, p = 0.036). Our results demonstrate a relationship between vitamin D and otolin-1. The majority of our subjects had abnormally low vitamin D levels, but only those over 70 years of age showed a negative correlation with high otolin-1 levels. We postulate that a seasonal drop in vitamin D may not be sufficient for otoconia fragmentation and ultimately iBPPV, rather, chronically low vitamin D maybe required to induce otoconia degeneration.
BibTeX: @article{Parham2018, author = {Parham, Kourosh and Kuchel, George A and McElhaney, Janet E and Haynes, Laura}, title = {A Relationship Between Blood Levels of Otolin-1 and Vitamin D.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2018}, volume = {39}, issue = {4}, pages = {e269--e273}, doi = {https://doi.org/10.1097/MAO.0000000000001747}, pmid = {29533337} }
Lurati, A.R.	A Return to Work Program for an Employee With Resolving Vertigo. [Abstract] [BibTeX]	2017	Workplace health & safety Vol. 65(1), pp. 4-8	article	DOI
Abstract: Vertigo is a disorder that affects equilibrium. Symptoms include a loss of balance with nausea and vomiting. Employees diagnosed with vertigo can return to work safely; however, they may need workplace restrictions and accommodation as symptoms may persist for months. This article reviews the evaluation and treatment of vertigo with back-to-work recommendations.
BibTeX: @article{Lurati2017, author = {Lurati, Ann Regina}, title = {A Return to Work Program for an Employee With Resolving Vertigo.}, journal = {Workplace health & safety}, year = {2017}, volume = {65}, issue = {1}, pages = {4--8}, doi = {https://doi.org/10.1177/2165079916680214}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis, therapy; Electronystagmography; Female; Humans; Magnetic Resonance Imaging; Middle Aged; Occupational Health Nursing, methods; Physical Therapy Modalities; Return to Work; Scopolamine, administration & dosage; Dix-Hallpike test; balance; vertigo}, pmid = {28055516} }
Beynon, G.J.	A review of management of benign paroxysmal positional vertigo by exercise therapy and by repositioning manoeuvres. [Abstract] [BibTeX]	1997	British journal of audiology Vol. 31(1), pp. 11-26	article
Abstract: Benign paroxysmal positional vertigo (BPPV) is a common condition that often resolves spontaneously, but can cause significant distress to a patient. Management of this condition includes no intervention, medication, surgery, physical exercises and more recently 'particle repositioning' manoeuvres. Repositioning manoeuvres aim to relocate free-floating particles from the posterior semicircular canal into the utricle where they will no longer cause vertiginous symptoms. This article describes the different exercises and repositioning manoeuvres in use and examines their efficacy. In the light of this review a management strategy for BPPV is suggested.
BibTeX: @article{Beynon1997, author = {Beynon, G J}, title = {A review of management of benign paroxysmal positional vertigo by exercise therapy and by repositioning manoeuvres.}, journal = {British journal of audiology}, year = {1997}, volume = {31}, issue = {1}, pages = {11--26}, keywords = {Exercise; Humans; Posture; Saccule and Utricle; Semicircular Canals; Vertigo, rehabilitation}, pmid = {9056040} }
Saberi, A., Nemati, S., Sabnan, S., Mollahoseini, F. and Kazemnejad, E.	A safe-repositioning maneuver for the management of benign paroxysmal positional vertigo: Gans vs. Epley maneuver; a randomized comparative clinical trial. [Abstract] [BibTeX]	2017	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 274(8), pp. 2973-2979	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vertigo. Some repositioning maneuvers have been described for its management. The aim of this study was comparing the therapeutic effect of Epley and Gans maneuvers in BPPV. This randomized clinical trial was performed from September to December 2015. 73 patients with true vertigo diagnosed as BPPV enrolled the study. They randomly assigned in quadripartite blocks to modified Epley maneuver group (E) or Gans maneuver group (G). 1 day and 1 week after intervention, the objective and subjective responses to treatment were assessed. Statistical analysis was performed using the Chi-square test and regression model in the SPSS software version 21. Thirty patients enrolled each group with a mean age of 46.9 ± 13.4 (E group) and 46.7 ± 7.5 year (G group). 23.3 % of E group and 26.7 % of G group were men (p = 0.766). In E and G groups in the first day, subjective outcomes revealed 86.7 and 60 % rate of success (p = 0.02); and 86.7 and 56.7 % of patients exhibited objective improvement, respectively (p = 0.01). After 1 week, the subjective and objective outcomes revealed improvement among 70 % of E group and 46.7 % of G group (p = 0.067). The only complication with significant difference was cervical pain with a higher rate in E group (23.3 vs. 0.0 %, p = 0.005). These results revealed the similar long-term efficacy of Epley and Gans maneuver for the treatment of BPPV. Cervical pain was most frequent complication of Epley maneuver.
BibTeX: @article{Saberi2017, author = {Saberi, Alia and Nemati, Shadman and Sabnan, Salah and Mollahoseini, Fatemeh and Kazemnejad, Ehsan}, title = {A safe-repositioning maneuver for the management of benign paroxysmal positional vertigo: Gans vs. Epley maneuver; a randomized comparative clinical trial.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2017}, volume = {274}, issue = {8}, pages = {2973--2979}, doi = {https://doi.org/10.1007/s00405-016-4235-7}, keywords = {Adult; Benign Paroxysmal Positional Vertigo, complications, physiopathology, therapy; Female; Humans; Male; Middle Aged; Neck Pain, etiology, prevention & control; Patient Positioning, methods; Physical Therapy Modalities; Posture; Treatment Outcome; Vertigo, etiology, prevention & control; Benign paroxysmal positional vertigo; Complication; Efficacy; Epley maneuver; Gans maneuver; Repositioning maneuver}, pmid = {27488837} }
Chu, L.-C., Yang, C.-C., Tsai, H.-T. and Lin, H.-C.	A simple algorithm for treating horizontal benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2014	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 35(9), pp. 1621-1625	article	DOI
Abstract: Horizontal benign paroxysmal positional vertigo (H-BPPV) is more difficult to successfully treat than posterior benign paroxysmal positional vertigo (P-BPPV) because of the diverse mechanisms required. We developed a simple, rapid, and effective treatment algorithm for treating all subtypes of H-BPPV in an ear, nose, and throat (ENT) outpatient department. Four hundred ninety patients with BPPV receiving outpatient treatment at Mackay Memorial Hospital were investigated. Among the 490 patients, 86 (17.6%; 86/490) were diagnosed as having H-BPPV variants using the McClure-Pagnini test. Fifty-four patients were female, and 32 were male; they ranged in age from 18 to 92 years (mean age, 56.2 yr). Among the 86 H-BPPV patients, 74.4% (64/86) were hypothesized to have canalithiasis, 20.9% (18/86) were hypothesized to have cupulolithiasis-utricle type (Cup-U), and 4.7% (4/86) were hypothesized to have the cupulolithiasis-cupula type (Cup-C). The primary treatment maneuver was the forced prolonged position (FPP). For 3 patients exhibiting refractory symptoms, we introduced the Gufoni maneuver. The total average success rate of treatment was 96%. We concluded that for H-BPPV patients with initial geotropic nystagmus, the FPP alone yielded an excellent treatment-control rate, and the barbecue-rotation maneuver was unnecessary. However, observing the nystagmus transformation of apogeotropic patients was necessary before administering treatment. For cupulolithiasis patients with the apogeotropic variant who did not respond to FPP treatment alone, we determined that the Gufoni maneuver was necessary as well.
BibTeX: @article{Chu2014, author = {Chu, Li-Chen and Yang, Cheng-Chien and Tsai, Hsen-Tien and Lin, Hung-Ching}, title = {A simple algorithm for treating horizontal benign paroxysmal positional vertigo.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2014}, volume = {35}, issue = {9}, pages = {1621--1625}, doi = {https://doi.org/10.1097/MAO.0000000000000442}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Algorithms; Benign Paroxysmal Positional Vertigo, therapy; Female; Humans; Male; Middle Aged; Musculoskeletal Manipulations, methods; Retrospective Studies; Treatment Outcome; Young Adult}, pmid = {25144642} }
Chiou, W.-Y., Lee, H.-L., Tsai, S.-C., Yu, T.-H. and Lee, X.-X.	A single therapy for all subtypes of horizontal canal positional vertigo. [Abstract] [BibTeX]	2005	The Laryngoscope Vol. 115(8), pp. 1432-1435	article	DOI
Abstract: To demonstrate that a single therapy is effective for treating all subtypes of horizontal canal benign paroxysmal positional vertigo (HC-BPPV). Prospective study. Patients with HC-BPPV (n = 89) were diagnosed when the supine to the head-lateral test resulted in geotropic or ageotropic bilateral horizontal nystagmus. Three subtypes of HC-BPPV were defined by their characteristic patterns of nystagmus as well as by their speculative mechanism. Canalolithiasis (Can) denotes geotropic nystagmus induced by free-moving otoliths in the HC. Two forms of cupulolithiasis, characterized by otoliths attached either on the utricle-sided (Cup-U) or the canal-sided (Cup-C) cupula, were identified by whether ageotropic nystagmus resolved or changed to geotropic nystagmus on follow-up tests. Forced prolonged position (FPP), lying on the healthy side for 12 hours to easily move free otoliths to the utricle, has proven successful in treating Can. Although Cup-U and contralateral Cup-C were associated with the same positional nystagmus pattern, FPP with lying on the side of the weaker nystagmus was found to be effective treatment, as well as consistent with the speculated underlying mechanism. All HC-BPPV patients including 49 with Can, 11 with Cup-C and 29 with Cup-U had complete resolution of symptoms and positional nystagmus after less than four treatment sessions. FPP with lying on the side of the weaker nystagmus, combined with careful observation of nystagmus evolvement, was found to be effective treatment for all subtypes of HC-BPPV in this series.
BibTeX: @article{Chiou2005, author = {Chiou, Wen-Yaw and Lee, Hui-Ling and Tsai, Shih-Che and Yu, Tu-Hsueh and Lee, Xin-Xian}, title = {A single therapy for all subtypes of horizontal canal positional vertigo.}, journal = {The Laryngoscope}, year = {2005}, volume = {115}, issue = {8}, pages = {1432--1435}, doi = {https://doi.org/10.1097/01.mlg.0000168092.91251.d3}, keywords = {Adult; Aged; Aged, 80 and over; Electronystagmography; Female; Follow-Up Studies; Head Movements; Humans; Male; Middle Aged; Nystagmus, Pathologic, diagnosis, therapy; Otolaryngology, methods; Prospective Studies; Risk Assessment; Severity of Illness Index; Treatment Outcome; Vertigo, diagnosis, therapy}, pmid = {16094118} }
Burman, D., Goswami, S. and Majumdar, P.K.	A study on peripheral vertigo in a Kolkata based hospital. [Abstract] [BibTeX]	2002	Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India Vol. 54(2), pp. 101-104	article	DOI
Abstract: A dizzy patient always remains a challenge to an E.N.T. surgeon. History is the key role and may be the only positive clue. An overall neurological assesment with special emphasis on nystagmus should be given. A comprehensive workout has been attempted in this study of vestibular disorders.
BibTeX: @article{Burman2002, author = {Burman, Debasish and Goswami, Saileswar and Majumdar, Pallab Kumar}, title = {A study on peripheral vertigo in a Kolkata based hospital.}, journal = {Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India}, year = {2002}, volume = {54}, issue = {2}, pages = {101--104}, doi = {https://doi.org/10.1007/BF02968726}, keywords = {BPPV; ENG; Meniere’s Disease; Nystagmus; Peripheral Vertigo}, pmid = {23119868} }
Male, A.J., Ramdharry, G.M., Grant, R., Davies, R.A. and Beith, I.D.	A survey of current management of Benign Paroxysmal Positional Vertigo (BPPV) by physiotherapists' interested in vestibular rehabilitation in the UK. [Abstract] [BibTeX]	2018	Physiotherapy	article	DOI
Abstract: Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of dizziness. Extensive research has identified the best assessment and treatment manoeuvres for each subtype of BPPV. Education in vestibular rehabilitation (VR) is inconsistent. It is unclear if the evidence has been adopted by UK physiotherapists in clinical practice and no research has investigated this specifically. An online survey with closed- and open-text answers. A purposive sample of physiotherapists interested in VR. A response rate of 67% (100/150) was obtained, from which 20 responses were excluded. Participants had good evidence-based awareness in assessment (79/80, 99%) and treatment (72/80, 90%) of posterior BPPV. Horizontal BPPV assessment awareness was lower than treatment (37/80, 46% vs 60/80, 75%). Differential diagnosis was poor in subjective (20/80, 25%) and objective stages of assessment (34/80, 43%). Thirty six percent (29/80) were able to list ≥3 test precautions with all three nystagmus characteristics described by 29% (23/80). Eighty one percent (65/80) encourage activity restrictions post-treatment. Only 28% (22/80) were aware of practice guidelines or Cochrane reviews in BPPV. External courses were rated the top method for learning how to manage BPPV. Lack of peer support (26/77, 34%) was the main challenge faced whilst learning. Recommendations for improving BPPV education included more external courses (23/87, 26%) and competency guidelines (13/87, 15%). Good awareness of research evidence was observed in some aspects of BPPV management but many areas require development. Translation and implementation of evidence remains poor and suggests changes in education and knowledge dissemination are warranted.
BibTeX: @article{Male2018, author = {Male, A J and Ramdharry, G M and Grant, R and Davies, R A and Beith, I D}, title = {A survey of current management of Benign Paroxysmal Positional Vertigo (BPPV) by physiotherapists' interested in vestibular rehabilitation in the UK.}, journal = {Physiotherapy}, year = {2018}, doi = {https://doi.org/10.1016/j.physio.2018.08.007}, keywords = {Assessment; Benign Paroxysmal Positional Vertigo (BPPV); Evidence-based practice; Physical therapy; Treatment; Vertigo}, pmid = {30389100} }
Pisani, V., Mazzone, S., Di Mauro, R., Giacomini, P.G. and Di Girolamo, S.	A survey of the nature of trauma of post-traumatic benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2015	International journal of audiology Vol. 54(5), pp. 329-333	article	DOI
Abstract: A clinical description of post-traumatic benign paroxysmal positional vertigo (t-BPPV) in a large cohort is reported, sometimes caused by apparently insignificant minor head traumas. The aim of the study was to carefully assess the prevalence of t-BPPV and the main outcomes belonging to specific traumatic events. Retrospective analysis of medical records of t-BPPV cases among patients suffering from BPPV. Among 3060 patients with a clinical diagnosis of BPPV, we reviewed 716 clinical cases in which a clear association to a traumatic event was present. A traumatic event was identified in 23.4% of total enrolled BPPV patients. Some minor head traumas could be more prone to determine BPPV in females. We confirmed that t-BPPV appeared significantly more difficult to treat than idiopathic form. Posterior canal t-BPPV cases required more treatment sessions before obtaining therapeutic success, while horizontal ones recovered at most after two repositioning maneuvers. Post-traumatic BPPV is considered one of the most common known etiologies. An accurate understanding of trauma mechanism, gender prevalence, and therapeutic success rates of each event, could be useful in adequately treating and planning follow-up examinations.
BibTeX: @article{Pisani2015, author = {Pisani, Valerio and Mazzone, Sara and Di Mauro, Roberta and Giacomini, Pier Giorgio and Di Girolamo, Stefano}, title = {A survey of the nature of trauma of post-traumatic benign paroxysmal positional vertigo.}, journal = {International journal of audiology}, year = {2015}, volume = {54}, issue = {5}, pages = {329--333}, doi = {https://doi.org/10.3109/14992027.2014.989454}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo, etiology, therapy; Craniocerebral Trauma, complications; Female; Humans; Male; Middle Aged; Retrospective Studies; Semicircular Canals, injuries; Sex Factors; BPPV; Post-traumatic; outcome; semicircular canal; vertigo}, pmid = {25594333} }
Parker, I.G., Hartel, G., Paratz, J., Choy, N.L. and Rahmann, A.	A Systematic Review of the Reported Proportions of Diagnoses for Dizziness and Vertigo. [Abstract] [BibTeX]	2019	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 40(1), pp. 6-15	article	DOI
Abstract: To determine the typical proportions of diagnoses for patients presenting with dizziness or vertigo based on clinical speciality and to assess the change in proportions of diagnoses over time. Following PRISMA guidelines, systematic searches of PubMed and CINAHL databases and follow-up reference searches were performed for articles published in English up to October 2016. Analysis of searches yielded 42 studies meeting the criteria of case series of adult patients with dizziness and/or vertigo presenting to general practice, emergency departments or specialist outpatient clinics. Data comprising demographics, diagnostic cases, and the total number of cases were recorded and independently tested, followed by a risk of bias analysis. Sample size weighted proportions expressed as percentages with confidence intervals were calculated and compared using χ analysis and a reference proportion formed by the combination of Ear Nose and Throat and Neurotology case series published between 2010 and 2016. Analysis of diagnostic trends over time used Poisson regression with consideration for overdispersion. This systematic review of case series demonstrated significant differences in the proportions of diagnoses for patients presenting with dizziness or vertigo, depending on the specialty making the diagnosis. ENT proportions were dominated by BPPV, Psychogenic and Menière's disease diagnostic categories, whereas emergency proportions were dominated by Other, Cardiac, and Neurological categories. Analysis of case series proportions over time revealed increases in diagnoses such as Benign Paroxysmal Positional Vertigo and Vestibular Migraine, and a corresponding decrease in the diagnoses of Menière's disease.
BibTeX: @article{Parker2019, author = {Parker, Ian Gerard and Hartel, Gunter and Paratz, Jennifer and Choy, Nancy Low and Rahmann, Ann}, title = {A Systematic Review of the Reported Proportions of Diagnoses for Dizziness and Vertigo.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2019}, volume = {40}, issue = {1}, pages = {6--15}, doi = {https://doi.org/10.1097/MAO.0000000000002044}, pmid = {30439765} }
Fujisaka, M., Akaogi, K.-I. and Shojaku, H.	A tangible head model showing semicircular canals for demonstrating the physical treatment for BPPV. [Abstract] [BibTeX]	2015	Acta oto-laryngologica Vol. 135(12), pp. 1212-1218	article	DOI
Abstract: It was shown that practicing with a tangible head model with semicircular canals is a useful educational tool for learning the physical treatment for BPPV. To assess the efficacy of using a tangible head model with semicircular canals to teach the physical treatment for BPPV. This study compared the number of canalith particles in the posterior semicircular canal that 20 participants could move from the ampulla to the utricle, before and after practicing with the tangible model. Before practicing with the model, they could move 2.5 (mean value) of 10 canalith particles. However, after practicing, they could move 6.6 (mean value) of 10 canalith particles. There was a statistical difference (p < 0.01) between the two trials.
BibTeX: @article{Fujisaka2015, author = {Fujisaka, Michiro and Akaogi, Katsu-Ichi and Shojaku, Hideo}, title = {A tangible head model showing semicircular canals for demonstrating the physical treatment for BPPV.}, journal = {Acta oto-laryngologica}, year = {2015}, volume = {135}, issue = {12}, pages = {1212--1218}, doi = {https://doi.org/10.3109/00016489.2015.1064546}, keywords = {Benign Paroxysmal Positional Vertigo, therapy; Education, Medical, methods; Educational Measurement, methods; Head Movements; Humans; Models, Anatomic; Otolaryngology, education; Patient Positioning; Semicircular Canals, anatomy & histology; Surveys and Questionnaires; BPPV; canalith repositioning procedure (CRP); tangible head model}, pmid = {26271968} }
Phillips, J.S. and Prinsley, P.R.	A unified hypothesis for vestibular dysfunction? [Abstract] [BibTeX]	2009	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 140(4), pp. 477-479	article	DOI
Abstract: It is our hypothesis that three distinct syndromes of vertigo (ie, labyrinthitis, Ménière's disease, and BPPV), which arise from a malfunction of the vestibular labyrinth, are in fact a spectrum of disorders all resulting from the presence of free-floating particles within the vestibular fluid chambers.
BibTeX: @article{Phillips2009a, author = {Phillips, John S and Prinsley, Peter R}, title = {A unified hypothesis for vestibular dysfunction?}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2009}, volume = {140}, issue = {4}, pages = {477--479}, doi = {https://doi.org/10.1016/j.otohns.2008.12.028}, keywords = {Hearing Loss, Sensorineural, etiology, physiopathology, therapy; Humans; Meniere Disease, etiology, physiopathology, therapy; Vertigo, etiology, physiopathology, therapy; Vestibule, Labyrinth, physiopathology}, pmid = {19328333} }
Steiner, K.V., Teixido, M., Kung, B., Sorensen, M., Forstrom, R. and Coller, P.	A virtual-reality approach for the treatment of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2007	Studies in health technology and informatics Vol. 125, pp. 451-453	article
Abstract: Benign Paroxysmal Positional Vertigo (BPPV) is a common cause of dizziness caused by debris, which has collected within the semicircular canals of the inner ear. Stereoscopic representations of the human labyrinth are constructed and incorporated into a downloadable viewing platform to allow visualization of straightforward and complex variations of BPPV.
BibTeX: @article{Steiner2007, author = {Steiner, Karl V and Teixido, Michael and Kung, Brian and Sorensen, Mads and Forstrom, Robert and Coller, Patrick}, title = {A virtual-reality approach for the treatment of benign paroxysmal positional vertigo.}, journal = {Studies in health technology and informatics}, year = {2007}, volume = {125}, pages = {451--453}, keywords = {Computer Simulation; Ear, Inner, physiopathology, surgery; Humans; United States; User-Computer Interface; Vertigo, surgery}, pmid = {17377323} }
Pulec, J.L.	Ablation of posterior semicircular canal for benign paroxysmal positional vertigo. [Abstract] [BibTeX]	1997	Ear, nose, & throat journal Vol. 76(1), pp. 17-22, 24	article
Abstract: Obstruction of the posterior semicircular canal to prevent fluid movement without injury to the neurosensory end organ has been shown to be effective treatment for benign paroxysmal positional vertigo. Risk of injury to the inner ear with loss of hearing has been reported with a variety of techniques. This paper will describe a modification of the procedure to ablate the posterior semicircular canal and to minimize the risk of inner ear injury. The procedure has been performed on 17 patients with prompt and lasting relief of vertigo and no hearing loss. The procedure seems to be a valuable and effective treatment for the disturbing condition of benign paroxysmal positional vertigo.
BibTeX: @article{Pulec1997a, author = {Pulec, J L}, title = {Ablation of posterior semicircular canal for benign paroxysmal positional vertigo.}, journal = {Ear, nose, & throat journal}, year = {1997}, volume = {76}, issue = {1}, pages = {17--22, 24}, keywords = {Adult; Aged; Audiometry; Electronystagmography; Evaluation Studies as Topic; Female; Hearing Disorders, etiology, physiopathology, surgery; Humans; Labyrinth Diseases, complications, physiopathology, surgery; Male; Middle Aged; Otolaryngology, methods; Semicircular Canals, pathology, surgery; Treatment Outcome; Vertigo, etiology, physiopathology, surgery}, pmid = {9018930} }
Lee, J.D., Park, M.K., Lee, B.D., Lee, T.K., Sung, K.-B. and Park, J.Y.	Abnormality of cervical vestibular-evoked myogenic potentials and ocular vestibular-evoked myogenic potentials in patients with recurrent benign paroxysmal postitional vertigo. [Abstract] [BibTeX]	2013	Acta oto-laryngologica Vol. 133(2), pp. 150-153	article	DOI
Abstract: Our results show that cervical vestibular-evoked myogenic potential (cVEMP) or ocular VEMP (oVEMP) abnormalities in the recurrent benign paroxysmal positional vertigo (BPPV) group were significantly higher than those in the non-recurrent BPPV group. Therefore, we can infer that VEMP abnormality is one of risk factors for BPPV recurrence. This prospective study aimed to test the hypothesis that otolith dysfunction using the VEMP test is a cause of recurrence of BPPV. cVEMP and oVEMP tests using 500 Hz tone-burst stimuli were performed on 16 patients with recurrent BPPV between March 2010 and December 2011. Both VEMP tests were performed in 20 patients with non-recurrent BPPV. The differences in age, sex, and involved canal between the recurrent and non-recurrent BPPV groups were not significant. Abnormal cVEMP responses were detected in 5 of 16 (31.3%) subjects in the recurrent BPPV group and abnormal oVMEP responses were detected in 4 of 16 (25%) subjects in the recurrent BPPV group. When we defined VEMP abnormality as an abnormal cVEMP or abnormal oVEMP, VEMP abnormalities were detected in eight (50%) subjects in the recurrent BPPV group and in three (15%) subjects in the non-recurrent BPPV group; the difference between groups was significant.
BibTeX: @article{Lee2013, author = {Lee, Jong Dae and Park, Moo Kyun and Lee, Byung Don and Lee, Tae Kyeong and Sung, Ki-Bum and Park, Ji Yun}, title = {Abnormality of cervical vestibular-evoked myogenic potentials and ocular vestibular-evoked myogenic potentials in patients with recurrent benign paroxysmal postitional vertigo.}, journal = {Acta oto-laryngologica}, year = {2013}, volume = {133}, issue = {2}, pages = {150--153}, doi = {https://doi.org/10.3109/00016489.2012.723823}, keywords = {Benign Paroxysmal Positional Vertigo; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Male; Middle Aged; Prospective Studies; Recurrence; Saccule and Utricle, physiopathology; Severity of Illness Index; Time Factors; Vertigo, diagnosis, physiopathology; Vestibular Evoked Myogenic Potentials, physiology; Vestibular Function Tests, methods}, pmid = {22953719} }
Vannucchi, P. and Pecci, R.	About nystagmus transformation in a case of apogeotropic lateral semicircular canal benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2011	International journal of otolaryngology Vol. 2011, pp. 687921	article	DOI
Abstract: THERE ARE TWO FORMS OF LATERAL SEMICIRCULAR CANAL BENIGN PAROXYSMAL POSITIONAL VERTIGO: geotropic and apogeotropic. When the pathophysiological mechanism of the apogeotropic form is that of canalolithiasis, we can observe a transformation from an apogeotropic nystagmus into a geotropic one. Usually, this phenomenon happens simultaneously on both sides, thus enabling us to observe a right-beating paroxysmal positional nystagmus when the patient lies on the right side and a left-beating paroxysmal positional nystagmus on the left side. We describe a case in which the transformation occurred gradually, so that, after three head rotations from side to side in supine position, there was a right nystagmus beating toward the ground (geotropic) with the patient on the right side and a right nystagmus beating away from the ground (apogeotropic) on the left side. However, after further rotations we observed the nystagmus transformation also on the left side, with a geotropic nystagmus on both sides. The phenomenon of gradual transformation could happen because initially only a part of the debris moved from the anterior to the posterior aspect of the canal during head rotations.
BibTeX: @article{Vannucchi2011, author = {Vannucchi, Paolo and Pecci, Rudi}, title = {About nystagmus transformation in a case of apogeotropic lateral semicircular canal benign paroxysmal positional vertigo.}, journal = {International journal of otolaryngology}, year = {2011}, volume = {2011}, pages = {687921}, doi = {https://doi.org/10.1155/2011/687921}, pmid = {21808647} }
Murofushi, T., Halmagyi, G.M., Yavor, R.A. and Colebatch, J.G.	Absent vestibular evoked myogenic potentials in vestibular neurolabyrinthitis. An indicator of inferior vestibular nerve involvement? [Abstract] [BibTeX]	1996	Archives of otolaryngology--head & neck surgery Vol. 122(8), pp. 845-848	article
Abstract: Benign paroxysmal positioning vertigo (BPPV) is generally thought to be caused by canalolithiasis in the posterior semicircular canal, an organ that is innervated by the inferior vestibular nerve. We hypothesized that absent vestibular evoked myogenic potentials (VEMPs) would indicate involvement of the inferior vestibular nerve and that posterior semicircular canal-type BPPV could not develop after vestibular neurolabyrinthitis (VNL) in patients with absent VEMPs. To find out if VEMPs could be helpful in evaluating involvement of the inferior vestibular nerve in acute VNL. We reviewed the VEMP findings in 47 patients (34 men and 13 women) with acute VNL, 10 of whom had then developed posterior semicircular canal-type BPPV. While p13-n23, the first positive-negative peak of the VEMP, was ipsilaterally present on stimulation of the unaffected side in all patients, it was absent on the affected side in 16 patients (34%). The absence or presence of p13-n23 was independent of the results of caloric tests, pure tone audiometry, and auditory brain-stem responses. Typical posterior semicircular canal BPPV developed in 10 of the 47 patients after the acute attack of VNL, always on the same side as the neurolabyrinthitis. The p13-n23 potentials were preserved on stimulation of the affected ear in all 10 patients with BPPV. These results suggest that if VEMPs are absent from an ear that has suffered acute VNL, then posterior semicircular canal BPPV is unlikely to develop as a consequence of the VNL. The reason for this appears to be that the absence of VEMPs is due to involvement of the inferior vestibular nerve or involvement of the structures that it innervates.
BibTeX: @article{Murofushi1996, author = {Murofushi, T and Halmagyi, G M and Yavor, R A and Colebatch, J G}, title = {Absent vestibular evoked myogenic potentials in vestibular neurolabyrinthitis. An indicator of inferior vestibular nerve involvement?}, journal = {Archives of otolaryngology--head & neck surgery}, year = {1996}, volume = {122}, issue = {8}, pages = {845--848}, keywords = {Acoustic Stimulation; Acute Disease; Adult; Aged; Audiometry, Pure-Tone; Electromyography; Evoked Potentials, Auditory; Female; Humans; Labyrinthitis, complications, physiopathology; Male; Middle Aged; Muscle Contraction; Neck Muscles, innervation, physiopathology; Neuritis, complications, physiopathology; Semicircular Canals, physiopathology; Vertigo, etiology, physiopathology; Vestibular Nerve, physiopathology; Vestibule, Labyrinth, physiopathology; Vestibulocochlear Nerve Diseases, complications, physiopathology}, pmid = {8703387} }
Carrington-Ford, A. and Prochazka, A.V.	ACP journal club. Review: in benign paroxysmal positional vertigo, the Epley maneuver increases symptom resolution. [BibTeX]	2015	Annals of internal medicine Vol. 162(6), pp. JC10	article	DOI
BibTeX: @article{Carrington-Ford2015, author = {Carrington-Ford, Alexis and Prochazka, Allan V}, title = {ACP journal club. Review: in benign paroxysmal positional vertigo, the Epley maneuver increases symptom resolution.}, journal = {Annals of internal medicine}, year = {2015}, volume = {162}, issue = {6}, pages = {JC10}, doi = {https://doi.org/10.7326/ACPJC-2015-162-6-010}, keywords = {Benign Paroxysmal Positional Vertigo, rehabilitation; Female; Humans; Male; Semicircular Canals}, pmid = {25775341} }
Ganança, F.F., Ganança, C.F., Caovilla, H.H., Ganança, M.M. and Albernaz, P.L.M.	Active head rotation in benign positional paroxysmal vertigo. [Abstract] [BibTeX]	2009	Brazilian journal of otorhinolaryngology Vol. 75(4), pp. 586-592	article
Abstract: Benign Positional Paroxysmal Vertigo (BPPV) is one of the most common vestibular diseases and the active head rotation test one of the most modern methods of vestibular function assessment. this study aims to verify if the active head rotation test may reveal signs of horizontal and/or vertical vestibulo-ocular reflex dysfunction in vertigo patients suspected for BPPV. retrospective series study. Neurotological evaluation including computerized electronystagmography and active head rotation on the horizontal and vertical axes were conducted in 100 patients suspected for BPPV patients. Isolated or associated abnormalities of the horizontal and/or vertical vestibulo-ocular reflex gain, phase and symmetry were indicative of vestibular involvement and found in 77.0% of the BPPV patients. the active head rotation test revealed horizontal and/or vertical vestibulo-ocular reflex dysfunctions in a relevant number of BPPV patients.
BibTeX: @article{Gananca2009, author = {Ganança, Fernando Freitas and Ganança, Cristina Freitas and Caovilla, Heloisa Helena and Ganança, Maurício Malavasi and Albernaz, Pedro Luiz Mangabeira}, title = {Active head rotation in benign positional paroxysmal vertigo.}, journal = {Brazilian journal of otorhinolaryngology}, year = {2009}, volume = {75}, issue = {4}, pages = {586--592}, keywords = {Adult; Aged; Aged, 80 and over; Electronystagmography, methods; Female; Humans; Male; Middle Aged; Posture, physiology; Reflex, Vestibulo-Ocular, physiology; Retrospective Studies; Rotation; Sensitivity and Specificity; Vertigo, physiopathology}, pmid = {19784430} }
Eid, E., Dastan, S. and Heckmann, J.G.	Acute dizziness in rural practice: Proposal of a diagnostic procedure. [Abstract] [BibTeX]	2015	Journal of neurosciences in rural practice Vol. 6(2), pp. 272-276	article	DOI
Abstract: Acute dizziness is a frequent index symptom in the emergency department as well as in the rural practice office. Most acute dizziness, however, is not dangerous, but some types are highly dangerous. Clinical routine acute dizziness can be separated into frequent benign syndromes including benign paroxysmal positional vertigo (BPPV), vestibular neuritis, Meniθre's disease or vestibular migraine, and what is here referred to as the "white shark" of dizziness, i.e. a stroke in the posterior circulation or more rarely a tumor in the posterior fossa. A practical concept is presented to clarify most frequent acute dizziness syndromes using clinical and low budget methods.
BibTeX: @article{Eid2015, author = {Eid, Ehab and Dastan, Sajed and Heckmann, Josef G}, title = {Acute dizziness in rural practice: Proposal of a diagnostic procedure.}, journal = {Journal of neurosciences in rural practice}, year = {2015}, volume = {6}, issue = {2}, pages = {272--276}, doi = {https://doi.org/10.4103/0976-3147.153238}, keywords = {Bedside examination; Dix-Hallpike test; clinical examination; dizziness; head impulse test; neurootological techniques; nystagmus; vertigo}, pmid = {25883501} }
Lindeman, R.C.	Acute labyrinthine disorders. [Abstract] [BibTeX]	1979	Otolaryngologic clinics of North America Vol. 12(2), pp. 375-387	article
Abstract: A patient seeking emergency treatment for a labyrinthine disorder is usually complaining of dizziness. The task at hand in the emergency room is, first, to rule out the truly life threatening emergent disorders, and then by means of a rapid but adequate history and physical examination to aid in the differentiation between central and peripheral etiologies. If the problem is central, and especially if there are signs of a true emergency, there should be no hesitation in sharing the responsibility for the care of this patient with a neurologist or neurosurgeon. If one is convinced that the problem is of a peripheral etiology, one most likely is dealing with Meniere's disease, vestibular neuronitis, benign paroxysmal positional vertigo, or true labyrinthitis. An acoustic tumor must always be considered. Appropriate laboratory and x-ray studies may be initiated and therapy begun. Although the emergency room evaluation can be inclusive and accurate, it is necessarily incomplete. There is no substitute for a more thorough history and physical examination under more relaxed conditions, complete audiometry, electronystagmography, polytomography, myelography, angiography, or whatever additional sophisticated studies are deemed necessary. If performed well, however, the emergency room encounter forms an invaluable foundation upon which further diagnostic and treatment decisions are based.
BibTeX: @article{Lindeman1979, author = {Lindeman, R C}, title = {Acute labyrinthine disorders.}, journal = {Otolaryngologic clinics of North America}, year = {1979}, volume = {12}, issue = {2}, pages = {375--387}, keywords = {Acute Disease; Brain Diseases, diagnosis; Caloric Tests; Cranial Nerves, physiology; Diagnosis, Differential; Dizziness, diagnosis; Ear, Middle, anatomy & histology; Emergencies; Eye Movements; Facial Paralysis, diagnosis; Hearing Loss, diagnosis; Hearing Tests; Humans; Labyrinth Diseases, diagnosis; Labyrinthitis, diagnosis; Medical History Taking; Meniere Disease, diagnosis; Neuritis, diagnosis; Neuroma, Acoustic, diagnosis; Nystagmus, Pathologic, diagnosis; Physical Examination; Posture; Radiography; Skull, diagnostic imaging; Trigeminal Nerve, physiology; Vertigo, diagnosis; Vestibular Nerve}, pmid = {460880} }
Volgger, V. and Gürkov, R.	Acute vestibular syndrome in cerebellar stroke : A case report and review of the literature. [Abstract] [BibTeX]	2017	HNO Vol. 65(Suppl 2), pp. 149-152	article	DOI
Abstract: The current paper reports on a patient with recurrent rotational vertigo and persistent dizziness and imbalance lasting several weeks, who underwent extensive neuro-otological and radiological examinations. Pathological findings initially included right-sided benign paroxysmal positional vertigo (BPPV), persistent horizontal spontaneous nystagmus (SPN) to the left, and a pathological bedside and video head impulse test (HIT) on the left. The pathological HIT on the left and the SPN to the left indicated a central origin. Therefore, cranial magnetic resonance imaging was performed which revealed a left-sided ischemic stroke in the territory of the medial branch of the posterior inferior cerebellar artery (mPICA).
BibTeX: @article{Volgger2017, author = {Volgger, V and Gürkov, R}, title = {Acute vestibular syndrome in cerebellar stroke : A case report and review of the literature.}, journal = {HNO}, year = {2017}, volume = {65}, issue = {Suppl 2}, pages = {149--152}, doi = {https://doi.org/10.1007/s00106-016-0315-7}, keywords = {Benign paroxysmal positional vertigo; Cerebellar disease; Cerebellar stroke; Magnetic resonance imaging; Pathologic nystagmus}, pmid = {28271170} }
Cha, Y.-H.	Acute vestibulopathy. [Abstract] [BibTeX]	2011	The Neurohospitalist Vol. 1(1), pp. 32-40	article	DOI
Abstract: The presentation of acute vertigo may represent both a common benign disorder or a life threatening but rare one. Familiarity with the common peripheral vestibular disorders will allow the clinician to rapidly "rule-in" a benign disorder and recognize when further testing is required. Key features of vertigo required to make an accurate diagnosis are duration, chronicity, associated symptoms, and triggers. Bedside tests that are critical to the diagnosis of acute vertigo include the Dix-Hallpike maneuver and canalith repositioning manuever, occlusive ophthalmoscopy, and the head impulse test. The goal of this review is to provide the clinician with the clinical and pathophysiologic background of the most common disorders that present with vertigo to develop a logical differential diagnosis and management plan.
BibTeX: @article{Cha2011, author = {Cha, Yoon-Hee}, title = {Acute vestibulopathy.}, journal = {The Neurohospitalist}, year = {2011}, volume = {1}, issue = {1}, pages = {32--40}, doi = {https://doi.org/10.1177/1941875210386235}, keywords = {BPPV; Dix-Hallpike; Meniere disease; vertigo; vestibular neuritis}, pmid = {23983835} }
Tang, H. and Li, W.	Advances in the diagnosis and treatment of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2017	Experimental and therapeutic medicine Vol. 14(3), pp. 2424-2430	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) (otolith disease) is the most common neurological and position change related vertigo, accounting for 17-20% of peripheral vertigo. BPPV occur in the elderly. The high incidence age for BPPC was 50 to 70 years and mostly in female. According to the different parts of the lesions, it is divided into anterior canal BPPV (AC-BPPV), posterior canal BPPV (PC-BPPV), horizontal canal BPPV (HC-BPPV). Studies have shown that the incidence of PC-BPPV was 86.36%, the incidence of HC-BPPV was 11.37%, the incidence rate of AC-BPPV was 2.27%. Treatment for PC-BPPV includes manual reduction, drug treatment, psychological treatment, and surgical treatment. Repositioning is the preferred method for the treatment of PC-BPPV with high effective rate and low risk. The mechanism is through the different changes of head position to make the otolith back to utricle. Many manual reduction methods have been reported in clinical treatment of PC-BPPV. With the increasing emphasis on the BPPV, a variety of new methods are being developed and designed.
BibTeX: @article{Tang2017, author = {Tang, Hengyong and Li, Wei}, title = {Advances in the diagnosis and treatment of benign paroxysmal positional vertigo.}, journal = {Experimental and therapeutic medicine}, year = {2017}, volume = {14}, issue = {3}, pages = {2424--2430}, doi = {https://doi.org/10.3892/etm.2017.4837}, keywords = {benign paroxysmal positional vertigo; otolith disease; peripheral vertigo; repositioning; utricle}, pmid = {28962176} }
Herdman, S.J.	Advances in the treatment of vestibular disorders. [Abstract] [BibTeX]	1997	Physical therapy Vol. 77(6), pp. 602-618	article
Abstract: This article discusses the pathophysiology, evidence of treatment efficacy, and factors that contribute to improved treatment outcome in three different vestibular disorders. In patients with unilateral and bilateral vestibular loss, recent research suggests that customized, supervised exercises facilitate recovery of postural stability. These exercises are based on knowledge of normal vestibular function as well as on our understanding of the various compensatory mechanisms that can contribute to recovery. Recognizing the limitations of these compensatory mechanisms as substitutes for lost vestibular function is important in establishing treatment goals. Treatment of patients with benign paroxysmal positional vertigo (BPPV) is based on the identification of the specific canal involved and the anatomy of the labyrinth. Although patients with BPPV primarily experience brief episodes of vertigo, this disorder is also associated with postural instability, which may not resolve with remission of the positional vertigo.
BibTeX: @article{Herdman1997, author = {Herdman, S J}, title = {Advances in the treatment of vestibular disorders.}, journal = {Physical therapy}, year = {1997}, volume = {77}, issue = {6}, pages = {602--618}, keywords = {Adaptation, Physiological; Exercise Therapy, methods; Feedback; Habituation, Psychophysiologic; Head; Humans; Posture; Reflex, Vestibulo-Ocular; Vestibular Diseases, diagnosis, physiopathology, rehabilitation}, pmid = {9184686} }
Honaker, J.A., Gilbert, J.M., Shepard, N.T., Blum, D.J. and Staab, J.P.	Adverse effects of health anxiety on management of a patient with benign paroxysmal positional vertigo, vestibular migraine and chronic subjective dizziness. [Abstract] [BibTeX]	2013	American journal of otolaryngology Vol. 34(5), pp. 592-595	article	DOI
Abstract: Care of patients with vestibular symptoms focuses primarily on physical otoneurologic disorders; however, psychological factors can sustain symptoms, confound assessment, and adversely affect treatment. Health anxiety is a particularly pernicious process that simultaneously magnifies physical symptoms and inhibits medical care. To demonstrate the excess morbidity caused by vestibular health anxiety and its successful management in a patient with otoneurologic disease. Report of a 41-year-old woman with recurrent benign paroxysmal positional vertigo, vestibular migraine, and chronic subjective dizziness, who expressed grave concerns about her health, repeatedly questioned her otoneurologic diagnoses, and failed physical therapy and medication treatment until her health anxiety and otoneurologic illnesses were addressed simultaneously. Health anxiety is an empirically validated concept that explains troublesome health-related beliefs and behaviors. It is frustrating for patients and health care teams, but can be treated successfully in otoneurology practice, thereby reducing physical symptoms, emotional distress, functional impairment, and health care overutilization.
BibTeX: @article{Honaker2013, author = {Honaker, Julie A and Gilbert, Jane M and Shepard, Neil T and Blum, Daniel J and Staab, Jeffrey P}, title = {Adverse effects of health anxiety on management of a patient with benign paroxysmal positional vertigo, vestibular migraine and chronic subjective dizziness.}, journal = {American journal of otolaryngology}, year = {2013}, volume = {34}, issue = {5}, pages = {592--595}, doi = {https://doi.org/10.1016/j.amjoto.2013.02.002}, keywords = {Adult; Anxiety, etiology; Attitude to Health; Benign Paroxysmal Positional Vertigo; Dizziness, complications, therapy; Female; Humans; Migraine Disorders, complications, therapy; Vertigo, complications, therapy; Vestibule, Labyrinth, physiopathology}, pmid = {23578435} }
Ichijo, H.	Affected-ear-up 120° maneuver for treatment of lateral semicircular canal benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2017	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 274(9), pp. 3351-3357	article	DOI
Abstract: Although several researchers have tried various canalith repositioning procedures for lateral canalolithiasis, a standard treatment has not been established. We adopt 120° rotation, which is anatomically appropriate because the principle of cure may be the fixing of pathological debris to the dark cells of the utricle. The aims of this study were to clarify the efficacy rate of the affected-ear-up 120° maneuver and to elucidate the appearance rate of lying-down nystagmus in patients with lateral canalolithiasis. The subjects were 31 patients (26 females, 5 males) who revealed transient direction-changing geotropic positional nystagmus. After determining the involved side, we performed the canalith repositioning procedure immediately. To perform this maneuver: (1) Place the patient in the supine position. (2) Rotate the head toward the healthy side until facing downward 120° from supine. (3) Sit up. (4) Ask the patient to remain upright with the chin down until going to bed. Twenty-nine patients (94%) became symptom free by only one maneuver. However, one patient converted to ipsilateral posterior cupulolithiasis, and another required a second maneuver. Lying-down nystagmus was found in 29 patients (94%), the transient type in 23 (74%), and the persistent type in 6 (19%). The direction of transient (not persistent) lying-down nystagmus was mostly toward the healthy side. These results suggest that the affected-ear-up 120° maneuver is effective and that lying-down nystagmus appears at a high rate.
BibTeX: @article{Ichijo2017, author = {Ichijo, Hiroaki}, title = {Affected-ear-up 120° maneuver for treatment of lateral semicircular canal benign paroxysmal positional vertigo.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2017}, volume = {274}, issue = {9}, pages = {3351--3357}, doi = {https://doi.org/10.1007/s00405-017-4663-z}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo, therapy; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, therapy; Patient Positioning, methods; Prospective Studies; Canalolithiasis; Cupulolithiasis; Ewald’s second law; Lying-down nystagmus; Positional nystagmus}, pmid = {28685312} }
Rajguru, S.M. and Rabbitt, R.D.	Afferent responses during experimentally induced semicircular canalithiasis. [Abstract] [BibTeX]	2007	Journal of neurophysiology Vol. 97(3), pp. 2355-2363	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is a common vestibular disorder that results in brief periods of vertigo and nystagmus, when the head is tipped relative to gravity. Symptoms are commonly attributed to the pathological presence of heavy calcium carbonate particles within the lumen of the semicircular canal(s)-a condition termed canalithiasis. In the present work, we induced canalithiasis in an animal model (oyster toadfish, Opsanus tau) by introducing heavy glass microbeads into the lumen of the lateral semicircular canal. Bead movement under the action of gravity and canal afferent nerve discharge were recorded in vivo. When the head was oriented nose-down, beads moved toward the nose and the lateral canal afferent discharge rate increased. Afferents that normally encoded angular velocity during oscillatory head rotations responded with tonic increases in the discharge rate during gravity-dependent bead movement. Other afferents, such as the units that rapidly adapt to a step increase in angular head velocity, responded with an initial increase in discharge rate followed by a period of adaptation. Afferent responses occurred in the complete absence of head movement and quantify the pathological inputs to the brain that arise from canalithiasis. The magnitude and time course of the responses reported here are sufficient to explain the symptoms of BPPV.
BibTeX: @article{Rajguru2007, author = {Rajguru, Suhrud M and Rabbitt, Richard D}, title = {Afferent responses during experimentally induced semicircular canalithiasis.}, journal = {Journal of neurophysiology}, year = {2007}, volume = {97}, issue = {3}, pages = {2355--2363}, doi = {https://doi.org/10.1152/jn.01152.2006}, keywords = {Action Potentials, physiology; Afferent Pathways, pathology, physiopathology; Animals; Batrachoidiformes; Disease Models, Animal; Female; Male; Nystagmus, Pathologic, pathology, physiopathology; Physical Stimulation, methods; Semicircular Canals; Time Factors; Vestibular Diseases, pathology, physiopathology}, pmid = {17229824} }
Jang, Y.S., Hwang, C.H., Shin, J.Y., Bae, W.Y. and Kim, L.S.	Age-related changes on the morphology of the otoconia. [Abstract] [BibTeX]	2006	The Laryngoscope Vol. 116(6), pp. 996-1001	article	DOI
Abstract: Although there are numerous reports on otoconial morphology using field-emission scanning electron microscopy (FESEM), there are few reports regarding the changes of otoconial morphology with aging. The aim of the current study was to investigate changes in otoconial morphology in rats according to age, using FESEM. Laboratory study using experimental animals. We investigated age-related changes in otoconial morphology using FESEM in three groups of rats: young (1 wk old), middle-aged (6 mo old), and aged (23 mo old). There was great size variation in utricular otoconia in the young and aged rats, but we found no clear regional separation of saccular otoconia in all groups based on size. In the oldest rats, the bodies of many otoconia in both maculae were pitted, fissured, penetrated, and eventually broken into several fragments. However, the terminal facets were smooth and the lines of intersection of facets were sharp, despite the degenerated bodies of the otoconia in this group. Giant otoconia were discovered frequently on the outer margin of the utricular maculae in aged rats. We directly observed weakened or broken linking filaments and otoconial fragments in the aged group. The oldest rats showed the most degeneration of otoconia and linking filaments with otoconial fragments. This study of age-related morphologic changes in otoconia might help us understand the origin of idiopathic benign paroxysmal positional vertigo.
BibTeX: @article{Jang2006, author = {Jang, Yoon Seok and Hwang, Chan Ho and Shin, Ji Young and Bae, Woo Yang and Kim, Lee Suk}, title = {Age-related changes on the morphology of the otoconia.}, journal = {The Laryngoscope}, year = {2006}, volume = {116}, issue = {6}, pages = {996--1001}, doi = {https://doi.org/10.1097/01.mlg.0000217238.84401.03}, keywords = {Aging, physiology; Animals; Humans; Male; Microscopy, Electron, Scanning; Otolithic Membrane, ultrastructure; Rats; Rats, Inbred F344; Vertigo, pathology}, pmid = {16735917} }
Tabtabai, R., Haynes, L., Kuchel, G.A. and Parham, K.	Age-Related Increase in Blood Levels of Otolin-1 in Humans. [Abstract] [BibTeX]	2017	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 38(6), pp. 865-869	article	DOI
Abstract: To test the hypothesis that age-related demineralization of otoconia will result in an age-related increase in blood levels of otoconia matrix protein, otolin-1. Cross-sectional observational clinical trial. Clinical research center. Seventy nine men and women ranging in age from 22 to 95 years old. Diagnostic. Blood levels of otolin-1 in relation to age. Levels of otolin-1 of subjects divided into four age groups (1: 20-30 [n = 20], 2: 50-65 [n = 20], 3: 66-80 [n = 20], 4: 81-95 [n = 19] years old) demonstrated an increasing trend with age. The difference between otolin levels of groups 2 and 3, as well as, (p = 0.04) and 2 and 4 (p = 0.031) were statistically significant, but there was no significant difference between the two oldest groups. Otolin-1 blood levels are significantly higher in patients older than 65 years of age. This is consistent with previous scanning electron microscopy findings of age-related otoconia degeneration and increased prevalence of benign paroxysmal positional vertigo (BPPV) with age. Normative data provided here can serve as important reference values against which levels from BPPV patients can be compared with further evaluate otolin-1 as a circulatory biomarker for otoconia degeneration.
BibTeX: @article{Tabtabai2017, author = {Tabtabai, Ryan and Haynes, Laura and Kuchel, George A and Parham, Kourosh}, title = {Age-Related Increase in Blood Levels of Otolin-1 in Humans.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2017}, volume = {38}, issue = {6}, pages = {865--869}, doi = {https://doi.org/10.1097/MAO.0000000000001426}, keywords = {Adult; Aged; Aged, 80 and over; Aging, blood; Benign Paroxysmal Positional Vertigo, blood; Biomarkers, blood; Cross-Sectional Studies; Extracellular Matrix Proteins, blood; Female; Humans; Male; Middle Aged; Young Adult}, pmid = {28498270} }
Liu, D.-H., Kuo, C.-H., Wang, C.-T., Chiu, C.-C., Chen, T.-J., Hwang, D.-K. and Kao, C.-L.	Age-Related Increases in Benign Paroxysmal Positional Vertigo Are Reversed in Women Taking Estrogen Replacement Therapy: A Population-Based Study in Taiwan. [Abstract] [BibTeX]	2017	Frontiers in aging neuroscience Vol. 9, pp. 404	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vertigo. Numerous investigations have reported an increased BPPV incidence in females and in the aged population. The hormonal characteristics of BPPV patients have not been previously investigated. This study aimed to determine the risk of BPPV in relation to menopause in a population-based study. : This retrospective population-based study was designed to use a nationwide longitudinal health insurance database to follow and analyze the incidence of and protective factors against BPPV in a Taiwanese population. : Univariate and multivariate analyses were performed to calculate the adjusted hazard ratio (aHR) for the incidence of BPPV using Cox-proportional regression models. : In the multivariate analyses, we found that older people (older than 65 years old) were more prone to develop BPPV (aHR: 5.37, 95% CI: 0 4.83-5.97, < 0.001). The risk of BPPV was analyzed in two specific age subgroups of elderly females. Results revealed that in both age groups (45-65 years old and >65 years old), patients who took estrogen for menopausal syndromes had a significantly lower incidence of BPPV (aHR; 0.01, 95% CI: 0.06-0.23, < 0.001). : Our study provides a novel etiology and possible treatment method for the prevention of BPPV. Further studies may focus on the pathophysiological mechanism of estrogen in BPPV patients and the development of new drugs for the prevention and treatment of BPPV.
BibTeX: @article{Liu2017, author = {Liu, Ding-Hao and Kuo, Chia-Hua and Wang, Chia-To and Chiu, Ch-Chih and Chen, Tzeng-Ji and Hwang, De-Kuang and Kao, Chung-Lan}, title = {Age-Related Increases in Benign Paroxysmal Positional Vertigo Are Reversed in Women Taking Estrogen Replacement Therapy: A Population-Based Study in Taiwan.}, journal = {Frontiers in aging neuroscience}, year = {2017}, volume = {9}, pages = {404}, doi = {https://doi.org/10.3389/fnagi.2017.00404}, keywords = {benign paroxysmal positional vertigo; estrogen; hormone replacement; menopause; population based study}, pmid = {29311896} }
Fujimoto, C., Kawahara, T., Kinoshita, M., Kikkawa, Y.S., Sugasawa, K., Yagi, M., Yamasoba, T., Iwasaki, S. and Murofushi, T.	Aging Is a Risk Factor for Utricular Dysfunction in Idiopathic Benign Paroxysmal Positional Vertigo. [Abstract] [BibTeX]	2018	Frontiers in neurology Vol. 9, pp. 1049	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most common cause of balance disorders in the elderly. Dislodgement of the otoconia in BPPV might have an association with damage to the otolith organs. The aim of this study was to investigate whether aging is a risk factor for otolith organ dysfunction in idiopathic BPPV. We retrospectively reviewed the medical records of 112 consecutive idiopathic BPPV patients who underwent cervical VEMP testing to air-conducted sound (ACS cVEMP), ocular VEMP testing to bone-conducted vibration (BCV oVEMP), and caloric testing. We performed binomial logistic regression analyses to see whether age, the side affected by BPPV or the canal affected by BPPV have an association with the presence of peripheral vestibular dysfunction in idiopathic BPPV patients. The elderly group (aged ≥65 years) had a significantly positive association with abnormalities in BCV oVEMPs ( = 0.0109), while the side affected by BPPV ( = 0.598) and the canal affected by BPPV ( = 0.576) did not. The odds ratio of the abnormal BCV oVEMPs for the elderly group compared with the non-elderly group (aged < 65 years) was 2.676 (95% confidence interval, 1.254-5.079). The elderly group had no significant association with the abnormalities in ACS cVEMPs ( = 0.0955) or caloric testing ( = 0.488). Dysfunction of the utricle, where the dislodgement of the otoconia mainly occurs, is affected by aging in idiopathic BPPV.
BibTeX: @article{Fujimoto2018, author = {Fujimoto, Chisato and Kawahara, Takuya and Kinoshita, Makoto and Kikkawa, Yayoi S and Sugasawa, Keiko and Yagi, Masato and Yamasoba, Tatsuya and Iwasaki, Shinichi and Murofushi, Toshihisa}, title = {Aging Is a Risk Factor for Utricular Dysfunction in Idiopathic Benign Paroxysmal Positional Vertigo.}, journal = {Frontiers in neurology}, year = {2018}, volume = {9}, pages = {1049}, doi = {https://doi.org/10.3389/fneur.2018.01049}, keywords = {aging; benign paroxysmal positional vertigo; risk factors; vestibular diseases; vestibular function tests}, pmid = {30559714} }
Michael, P., Oliva, C.E., Nuñez, M., Barraza, C., Faúndez, J.P. and Breinbauer, H.A.	An Abbreviated Diagnostic Maneuver for Posterior Benign Positional Paroxysmal Vertigo. [Abstract] [BibTeX]	2016	Frontiers in neurology Vol. 7, pp. 115	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) secondary to canalolithiasis of the posterior semicircular canal is perhaps the most frequent cause of vertigo and dizziness. One of its properties is a high response rate to canalith repositioning maneuvers. However, delays in the diagnosis and treatment of this entity can range from days to years, depending on the setting. Here, we present an abbreviated variation of the Dix-Hallpike maneuver, which can be used to diagnose this disease. It is similar to the standard maneuver but can be performed without an examination bed/table and requires only a backed chair (a difference that we feel is very important in settings where a clinical bed/table is not readily available). A diagnostic assessment study was conducted in 163 patients who presented with vertigo or dizziness. The abbreviated test had fairly good sensitivity (80%) and high specificity (95%) for diagnosing posterior BPPV. This new diagnostic maneuver may serve as a screening procedure for quickly identifying this pathology. This will allow patients to be more directly treated, without requiring unnecessary referrals or full vestibular testing, and will be especially useful in primary care settings or heavily overloaded otolaryngology or neurology departments.
BibTeX: @article{Michael2016, author = {Michael, Pia and Oliva, Carolina Estibaliz and Nuñez, Marcia and Barraza, Cristian and Faúndez, Juan Pablo and Breinbauer, Hayo A}, title = {An Abbreviated Diagnostic Maneuver for Posterior Benign Positional Paroxysmal Vertigo.}, journal = {Frontiers in neurology}, year = {2016}, volume = {7}, pages = {115}, doi = {https://doi.org/10.3389/fneur.2016.00115}, keywords = {Dix–Hallpike maneuver; benign paroxysmal positional vertigo; diagnostic test assessment; dizziness; vestibular function test}, pmid = {27486432} }
Vital, V., Psillas, G., Printza, A., Vital, I., Triaridis, S., Konstantinidis, I., Markou, K. and Tsalighopoulos, M.	An alternative manoeuvre for posterior canal BPPV treatment. [Abstract] [BibTeX]	2010	B-ENT Vol. 6(1), pp. 9-13	article
Abstract: The aim of this study is to evaluate the effectiveness of a new manoeuvre in the treatment of posterior canal benign paroxysmal positional vertigo (p-BPPV) based on the idea that highly accelerated endolymphatic flow may lead a mass of otoconia to collide with the walls of the posterior semicircular canal, resulting in its disintegration and/or in the expulsion of the free particles from the posterior semicircular canal. Our study group included 146 patients with a diagnosis of p-BPPV. All patients underwent the new manoeuvre, which consisted of several high-acceleration successive head movements in the horizontal plane performed by the same physician. The results of the study group were compared with those of a sham control group of 30 patients with p-BPPV undergoing placebo treatment. The patients of both groups were reviewed in a follow-up appointment 1 month and 1 year after the initial treatment. Complete resolution of symptoms immediately after the manoeuvre was observed in 92% of patients. At 1-month and 1-year follow-up assessment, all the patients in the study group reported complete relief from their symptoms compared with only 13% and 43% of control patients respectively. Recurrence of symptoms was reported in 12 patients (8%) from the study group, who responded successfully to one additional session. This study establishes the efficacy of the new manoeuvre in the short- and long-term management of p-BPPV. It is a quick office procedure, usually resolving this disorder with a single session, although there some limitations in patients with underlying cervical spine pathology.
BibTeX: @article{Vital2010, author = {Vital, V and Psillas, G and Printza, A and Vital, I and Triaridis, S and Konstantinidis, I and Markou, K and Tsalighopoulos, M}, title = {An alternative manoeuvre for posterior canal BPPV treatment.}, journal = {B-ENT}, year = {2010}, volume = {6}, issue = {1}, pages = {9--13}, keywords = {Adolescent; Adult; Aged; Female; Humans; Male; Middle Aged; Prospective Studies; Recurrence; Vertigo, physiopathology, therapy; Young Adult}, pmid = {20420074} }
Takemori, S., Tanaka, M. and Moriyama, H.	An analysis of ocular counter-rolling measured with search coils. [Abstract] [BibTeX]	1989	Acta oto-laryngologica. Supplementum Vol. 468, pp. 271-276	article
Abstract: Ocular counter-rolling (OCR) was studied by using a scleral search coil magnetic system in normal subjects and in pathological cases. Normal ocular counter-rolling was 2.7 degrees-7 degrees when the head was tilted 10 to 30 degrees. In most cases of benign paroxysmal positional vertigo, the OCR to the ipsilateral side was reduced, while that to the contralateral side was normal or only slightly reduced. Soon after unilateral labyrinthectomy, the OCR to the ipsilateral side was reduced or was 0, whereas OCR to the contralateral side was normal or slightly reduced. Some 3-5 years after the operation, however, the OCR seemed to depend on the compensation achieved. In cases of acoustic neurinoma, OCR to both sides was reduced, that to the ipsilateral side being more strongly impaired than the OCR to the contralateral side.
BibTeX: @article{Takemori1989, author = {Takemori, S and Tanaka, M and Moriyama, H}, title = {An analysis of ocular counter-rolling measured with search coils.}, journal = {Acta oto-laryngologica. Supplementum}, year = {1989}, volume = {468}, pages = {271--276}, keywords = {Ear, Inner, surgery; Electromagnetic Phenomena; Electronystagmography, instrumentation; Eye Movements, physiology; Head; Humans; Neuroma, Acoustic, physiopathology; Vertigo, physiopathology}, pmid = {2635517} }
Yetiser, S., Ince, D. and Gul, M.	An analysis of vestibular evoked myogenic potentials in patients with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2014	The Annals of otology, rhinology, and laryngology Vol. 123(10), pp. 686-695	article	DOI
Abstract: Vestibular evoked myogenic potentials (VEMPs) selectively test the vestibular end-organ. The aim of this study was to analyze how the site of the diseased canal, type of particulate deposition, duration of symptoms, severity of nystagmus, recurrence, and age affect the VEMP in patients with benign paroxysmal positional vertigo (BPPV). One hundred two patients were enrolled in the study between 2009 and 2012. There were 36 men and 66 women with ages ranging from 16 to 71 years (mean age, 42.28 ± 11.29 years). Patients with BPPV were tested with roll-on and head-hanging maneuvers under video-electronystagmography monitoring and with air conduction cervical VEMP testing. Patients were grouped for duration, severity, recurrence, age, site of canal involvement, and so on, and the results were compared in each subgroup. Kruskal-Wallis and Mann-Whitney U tests were used for the comparative analysis. Twenty-four patients (23.5%) had a gross VEMP abnormality (absence of VEMP in 6 and greater than 25% depression of the amplitude in 18). Abnormality of VEMPs was not correlated with factors including age, severity of nystagmus, number of maneuvers applied, and the site of canal involvement (P < .05). However, persistence or recurrence of symptoms has an effect on VEMP results (P = .016). Vestibular evoked myogenic potential is a useful tool to study the otolithic function in patients with BPPV and should be included in the test battery.
BibTeX: @article{Yetiser2014a, author = {Yetiser, Sertac and Ince, Dilay and Gul, Murat}, title = {An analysis of vestibular evoked myogenic potentials in patients with benign paroxysmal positional vertigo.}, journal = {The Annals of otology, rhinology, and laryngology}, year = {2014}, volume = {123}, issue = {10}, pages = {686--695}, doi = {https://doi.org/10.1177/0003489414532778}, keywords = {Adolescent; Adult; Age Factors; Aged; Benign Paroxysmal Positional Vertigo, diagnosis, physiopathology, therapy; Case-Control Studies; Electronystagmography; Female; Humans; Male; Middle Aged; Otolithic Membrane, physiopathology; Recurrence; Severity of Illness Index; Statistics, Nonparametric; Vestibular Evoked Myogenic Potentials, physiology; Young Adult; benign paroxysmal positional vertigo; vestibular evoked myogenic potential}, pmid = {24789801} }
Dommaraju, S. and Perera, E.	An approach to vertigo in general practice. [Abstract] [BibTeX]	2016	Australian family physician Vol. 45(4), pp. 190-194	article
Abstract: Dizziness is a common and very distressing presentation in general practice. In more than half of these cases, the dizziness is due to vertigo, which is the illusion of movement of the body or its surroundings. It can have central or peripheral causes, and determining the cause can be difficult. The aim of this article is to provide a clear framework for approaching patients who present with vertigo. A suggested approach to the assessment of vertigo is outlined. The causes of vertigo may be central (involving the brainstem or cerebellum) or peripheral (involving the inner ear). A careful history and physical examination can distinguish between these causes. The most common causes of vertigo seen in primary care are benign paroxysmal positional vertigo (BPPV), vestibular neuronitis (VN) and Ménière's disease. These peripheral causes of vertigo are benign, and treatment involves reassurance and management of symptoms.
BibTeX: @article{Dommaraju2016, author = {Dommaraju, Sindhu and Perera, Eshini}, title = {An approach to vertigo in general practice.}, journal = {Australian family physician}, year = {2016}, volume = {45}, issue = {4}, pages = {190--194}, keywords = {General Practice, methods; Humans; Labyrinthitis, complications; Medical History Taking; Meniere Disease, complications; Physical Examination; Vertigo, diagnosis, etiology, therapy; Vestibular Neuronitis, complications}, pmid = {27052132} }
Cohen, H.S. and Murphy, E.K.	An augmented liberatory maneuver for benign paroxysmal positional vertigo for patients who are difficult to move. [BibTeX]	2007	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 136(2), pp. 309-310	article	DOI
BibTeX: @article{Cohen2007, author = {Cohen, Helen S and Murphy, Emily K}, title = {An augmented liberatory maneuver for benign paroxysmal positional vertigo for patients who are difficult to move.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2007}, volume = {136}, issue = {2}, pages = {309--310}, doi = {https://doi.org/10.1016/j.otohns.2006.05.016}, keywords = {Aged; Humans; Male; Physical Therapy Modalities; Posture, physiology; Vertigo, physiopathology, therapy}, pmid = {17275561} }
Baykara, M., Polat, C., Oztürk, C. and Karlıdağ, T.	An investigation of atherosclerotic markers in patients with posterior semi-circular canal benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2014	Kulak burun bogaz ihtisas dergisi : KBB = Journal of ear, nose, and throat Vol. 24(3), pp. 159-163	article	DOI
Abstract: This study aims to investigate the presence and incidence of arteriosclerosis in patients with benign paroxysmal positional vertigo (BPPV). A total of 89 patients who were admitted to the ear, nose, throat outpatient clinic with complaint of vertigo and were diagnosed with BPPV based on the positive Dix-Hallpike test results were included (BPPV group) between January 2010 and July 2010. Data from otological asymptomatic controls (n=129) who were referred to the radiology department from other clinics for ultrasound examination were obtained. Intima-media thickness and arteriosclerosis measurements were carried out. Arteriosclerosis measurement was performed through a Doppler ultrasound. No statistically significant difference in carotid, femoral intima-media thicknesses and elastic modulus measurements between the controls and BPPV group. In the BPPV group, carotid artery cross-sectional compliance, cross-sectional distensibility, femoral artery cross-sectional compliance and cross-sectional distensibility were statistically significantly lower. Our study results suggest that atherosclerotic changes may play a role in the underlying etiology of BPPV.
BibTeX: @article{Baykara2014, author = {Baykara, Murat and Polat, Cahit and Oztürk, Cansu and Karlıdağ, Turgut}, title = {An investigation of atherosclerotic markers in patients with posterior semi-circular canal benign paroxysmal positional vertigo.}, journal = {Kulak burun bogaz ihtisas dergisi : KBB = Journal of ear, nose, and throat}, year = {2014}, volume = {24}, issue = {3}, pages = {159--163}, doi = {https://doi.org/10.5606/kbbihtisas.2014.00018}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Atherosclerosis, complications, diagnosis, diagnostic imaging; Benign Paroxysmal Positional Vertigo, complications; Biomarkers; Carotid Arteries, diagnostic imaging; Carotid Intima-Media Thickness; Case-Control Studies; Cross-Sectional Studies; Female; Femoral Artery, diagnostic imaging; Humans; Male; Middle Aged; Ultrasonography, Doppler; Young Adult}, pmid = {25010805} }
Organ, B., Liu, H. and Bromwich, M.	An iPhone-assisted particle repositioning maneuver for benign paroxysmal positional vertigo (BPPV): a prospective randomized study. [Abstract] [BibTeX]	2015	Journal of the American Board of Family Medicine : JABFM Vol. 28(1), pp. 118-120	article	DOI
Abstract: The Epley particle repositioning maneuver (PRM) is an effective treatment for benign paroxysmal positional vertigo (BPPV), the most common cause of peripheral vertigo in primary care settings. The goal of this study was to determine whether the use of an iPhone application (DizzyFIX; Clearwater Clinical Ltd, Ottawa, Ontario, Canada) by medical students had a significant impact on the performance of the PRM. We recruited senior medical students who had previously been trained in the management of BPPV and asked them to perform the PRM on a healthy volunteer. One half of the students used a real iPhone application, whereas the others used a sham application. The PRM performance scores of the 2 groups were compared. iPhone application users scored significantly higher on their PRM performance compared with controls (P < .0001) and performed the PRM significantly more slowly (P < .0001). Senior medical students performed a more correct PRM when assisted by the iPhone application. This application represents a significant improvement from standard medical school training using written instructions. Family physicians could also use this iPhone application for the quick and effective treatment of BPPV.
BibTeX: @article{Organ2015, author = {Organ, Brock and Liu, Hao and Bromwich, Matthew}, title = {An iPhone-assisted particle repositioning maneuver for benign paroxysmal positional vertigo (BPPV): a prospective randomized study.}, journal = {Journal of the American Board of Family Medicine : JABFM}, year = {2015}, volume = {28}, issue = {1}, pages = {118--120}, doi = {https://doi.org/10.3122/jabfm.2015.01.120295}, keywords = {Benign Paroxysmal Positional Vertigo, therapy; Healthy Volunteers; Humans; Mobile Applications; Prospective Studies; Benign Paroxysmal Positional Vertigo; Delivery of Health Care; Graduate Education; Mobile Applications; Otolaryngology}, pmid = {25567831} }
Breivik, H.	An overlooked cause of head- and neck-pain: Chronic canalithiasis, or Benign Paroxysmal Positional Vertigo - BPPV. [BibTeX]	2015	Scandinavian journal of pain Vol. 8(1), pp. 8-9	article	DOI
BibTeX: @article{Breivik2015, author = {Breivik, Harald}, title = {An overlooked cause of head- and neck-pain: Chronic canalithiasis, or Benign Paroxysmal Positional Vertigo - BPPV.}, journal = {Scandinavian journal of pain}, year = {2015}, volume = {8}, issue = {1}, pages = {8--9}, doi = {https://doi.org/10.1016/j.sjpain.2015.02.005}, pmid = {29911626} }
Andaz, C., Whittet, H.B. and Ludman, H.	An unusual cause of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	1993	The Journal of laryngology and otology Vol. 107(12), pp. 1153-1154	article
Abstract: Benign paroxysmal positional vertigo (BPPV) is a self-limiting condition characterized by vertigo and nystagmus induced by certain head positions. The most common causes of BPPV are post-traumatic following head injury and post-viral labyrinthitis. We present an interesting case of BPPV following an otherwise uneventful neurosurgical removal of a parietal osteoma using hammer and chisel. Caution should be exercised during such procedures as disabling vertigo can result for a considerable period of time.
BibTeX: @article{Andaz1993, author = {Andaz, C and Whittet, H B and Ludman, H}, title = {An unusual cause of benign paroxysmal positional vertigo.}, journal = {The Journal of laryngology and otology}, year = {1993}, volume = {107}, issue = {12}, pages = {1153--1154}, keywords = {Adult; Female; Humans; Osteoma, diagnostic imaging, surgery; Parietal Bone, diagnostic imaging, surgery; Postoperative Complications; Radiography; Skull, diagnostic imaging; Skull Neoplasms, diagnostic imaging, surgery; Vertigo, etiology}, pmid = {8289008} }
Alzuabi, M.A., Saad, A.M., Al-Husseini, M.J. and Nada, M.A.	An unusual cause of cerebellovestibular symptoms. [Abstract] [BibTeX]	2016	BMJ case reports Vol. 2016	article	DOI
Abstract: Hashimoto encephalopathy (HE) is a controversial autoimmune disorder, probably underdiagnosed, that causes a wide variety of neurological manifestations. Symptoms differ among patients and may be very severe in some cases. However, it can be treated, with a very good prognosis. In our case, a teenaged girl with a family history of migraine, vitiligo and benign paroxysmal positional vertigo presented with severe ataxia, vomiting and hypotension. She had a history of similar, but milder, symptoms and was misdiagnosed several times. She had subclinical hypothyroidism, and high levels of antithyroid antibodies. There were abnormal MRI and visual evoked potential findings. After excluding other more common causes, we diagnosed her as having 'Hashimoto Encephalopathy', and started treatment with corticosteroids, on which she showed dramatic improvement. After about 2 years of presentation, the patient is able to continue her life independently.
BibTeX: @article{Alzuabi2016, author = {Alzuabi, Muayad A and Saad, Anas M and Al-Husseini, Muneer J and Nada, Maha A}, title = {An unusual cause of cerebellovestibular symptoms.}, journal = {BMJ case reports}, year = {2016}, volume = {2016}, doi = {https://doi.org/10.1136/bcr-2015-211263}, keywords = {Adolescent; Ataxia, etiology; Brain Diseases, diagnosis; Diagnosis, Differential; Encephalitis, diagnosis, drug therapy; Female; Glucocorticoids, therapeutic use; Hashimoto Disease, diagnosis, drug therapy; Humans; Hypotension, etiology; Magnetic Resonance Imaging; Peroxidases, immunology}, pmid = {26762347} }
Di Girolamo, S., Fetoni, A.R., Di Nardo, W. and Paludetti, G.	An unusual complication of cochlear implant: benign paroxysmal positional vertigo. [Abstract] [BibTeX]	1999	The Journal of laryngology and otology Vol. 113(10), pp. 922-923	article
Abstract: Three days after the initial fitting of the cochlear device a 40-year-old woman complained of severe rotational vertigo following head movements associated with neurovegetative symptoms. Otoneurological evaluation revealed a horizontal paroxysmal positional nystagmus beating towards the lowermost ear, induced by rolling the patient's head from supine both to the right or to the left lateral position suggesting the diagnosis of benign paroxysmal positional vertigo of the left horizontal semicircular canal. The nystagmus characteristics were the same whether the cochlear device was switched on or off. The hypothesis of an otolith dislodging due to the electrical stimulation during the initial fitting is discussed.
BibTeX: @article{DiGirolamo1999, author = {Di Girolamo, S and Fetoni, A R and Di Nardo, W and Paludetti, G}, title = {An unusual complication of cochlear implant: benign paroxysmal positional vertigo.}, journal = {The Journal of laryngology and otology}, year = {1999}, volume = {113}, issue = {10}, pages = {922--923}, keywords = {Adult; Cochlear Implantation, adverse effects; Female; Hearing Loss, Sensorineural, pathology, surgery; Humans; Posture; Semicircular Canals, pathology; Vertigo, etiology, pathology}, pmid = {10664711} }
Vernamonte, S., Mauro, V., Vernamonte, S. and Messina, A.M.	An unusual complication of osteotome sinus floor elevation: benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2011	International journal of oral and maxillofacial surgery Vol. 40(2), pp. 216-218	article	DOI
Abstract: Maxillary sinus floor elevation in cases of reduced vertical bone height in the posterior maxilla allows predictable implant placement. The osteotome sinus floor elevation (OSFE) technique has shorter healing and waiting times because the fixture can be placed in the implant recipient site simultaneously with the ridge augmentation. Implant site preparation is more comfortable for the patient when performed with spiral drills than with continuous malleting of the osteotomes. Membrane perforation is the most frequent complication with the OSFE technique; postoperative infection is rare. Benign paroxysmal positional vertigo (BPPV) may be a complication of OSFE and may cause stress if not identified correctly and managed properly. The available treatment options, diagnostic strategies and the pathophysiology of this unusual complication are discussed. The authors present a case in which intense BPPV developed during OSFE, focusing on dental and maxillofacial surgery as risk factors for this pathology.
BibTeX: @article{Vernamonte2011, author = {Vernamonte, S and Mauro, V and Vernamonte, S and Messina, A M}, title = {An unusual complication of osteotome sinus floor elevation: benign paroxysmal positional vertigo.}, journal = {International journal of oral and maxillofacial surgery}, year = {2011}, volume = {40}, issue = {2}, pages = {216--218}, doi = {https://doi.org/10.1016/j.ijom.2010.07.010}, keywords = {Benign Paroxysmal Positional Vertigo; Calculi, complications; Dental Implantation, Endosseous, methods; Humans; Male; Maxillary Sinus, surgery; Middle Aged; Oral Surgical Procedures, Preprosthetic, adverse effects, instrumentation; Osteotomy, adverse effects, instrumentation; Patient Positioning; Semicircular Canals, pathology; Vertigo, etiology, therapy}, pmid = {20801616} }
Çınar, Y., Bayram, A., Culfa, R. and Mutlu, C.	Analyses with the Video Head Impulse Test During the Canalith Repositioning Maneuver in Patients with Isolated Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo. [Abstract] [BibTeX]	2018	Turkish archives of otorhinolaryngology Vol. 56(2), pp. 81-84	article	DOI
Abstract: To evaluate the posterior semicircular canal (PSCC) functions using video head impulse test (vHIT) during canalith repositioning maneuver (CRM) treatment in patients with isolated, posterior semicircular canal benign paroxysmal positional vertigo (PSCC-BPPV). A total of 44 subjects comprising of 24 subjects with isolated PSCC-BPPV and 20 age- and sex-matched healthy control subjects were enrolled in the present study. vHIT was performed for the affected PSCC before and just after CRM and at the third and seventh day and first month to evaluate vestibulo-ocular reflex (VOR) gain, gain asymmetry (GA), and corrective saccades. Repeated determinations of VOR gain and GA were compared to evaluate the time course of vHIT measurements during CRM treatment in isolated PSCC-BPPV patients, and the values were also compared with the control group. VOR gains and GA values were not statistically different before and after CRM and at the third-day, seventh-day and first-month visits for the affected PSCC. Moreover, values did not differ between the BPPV and control groups, and none of the subjects demonstrated corrective saccades. To our knowledge, this study is the first report to investigate vHIT measurements with a time course of alterations during CRM treatment in PSCC-BPPV patients. vHIT may not provide an additional contribution for evaluating vestibular dysfunction during the diagnosis and treatment of isolated PSCC-BPPV.
BibTeX: @article{Cinar2018, author = {Çınar, Yusuf and Bayram, Ali and Culfa, Ramazan and Mutlu, Cemil}, title = {Analyses with the Video Head Impulse Test During the Canalith Repositioning Maneuver in Patients with Isolated Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo.}, journal = {Turkish archives of otorhinolaryngology}, year = {2018}, volume = {56}, issue = {2}, pages = {81--84}, doi = {https://doi.org/10.5152/tao.2018.3166}, keywords = {Benign paroxysmal positional vertigo; head impulse test; semicircular canals; vestibular function tests}, pmid = {30197804} }
Saka, N., Imai, T., Seo, T., Ohta, S., Fujimori, K., Masumura, C., Inohara, H. and Sakagami, M.	Analysis of benign paroxysmal positional nystagmus in children. [Abstract] [BibTeX]	2013	International journal of pediatric otorhinolaryngology Vol. 77(2), pp. 233-236	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most common vestibular disorder. However, BPPV in children has been studied less extensively than in the adult population. This is because the observation of benign paroxysmal positional nystagmus (BPPN) in children is technically very difficult and BPPV is rare in children. In this study, we present the only two cases of BPPV in children in which we successfully recorded and analyzed the BPPN. One case was an 11-year-old boy and the other was a 3-year-old girl. We analyzed their BPPN three-dimensionally. Apogeotropic positional nystagmus was observed in the first case. We analyzed it to verify the presence of cupulolithiasis in the horizontal semicircular canal (HSCC). Geotropic positional nystagmus was observed in the second case, and the analyzed data indicated the presence of canalolithiasis in HSCC. Over the last decade, we have examined 3341 patients complaining of vertigo or dizziness. Among them, there were 63 children with the same complaint, so that the proportion of cases of BPPV in children was only 3% (2/63). Among patients complaining of vertigo or dizziness, children with BPPV are rare (3%). However, we have recorded their BPPN to confirm that BPPV does occur in children and that their characteristics of positional nystagmus are generally identical to those in adults. We emphasize that this is the first report of a child as young as 3 years old being diagnosed with BPPV.
BibTeX: @article{Saka2013, author = {Saka, Naoki and Imai, Takao and Seo, Toru and Ohta, Shigeto and Fujimori, Kiyoko and Masumura, Chisako and Inohara, Hidenori and Sakagami, Masafumi}, title = {Analysis of benign paroxysmal positional nystagmus in children.}, journal = {International journal of pediatric otorhinolaryngology}, year = {2013}, volume = {77}, issue = {2}, pages = {233--236}, doi = {https://doi.org/10.1016/j.ijporl.2012.11.003}, keywords = {Benign Paroxysmal Positional Vertigo; Child; Child, Preschool; Female; Humans; Male; Nystagmus, Physiologic, physiology; Vertigo, diagnosis, physiopathology; Vestibular Function Tests}, pmid = {23200871} }
Gu, X., Dong, F. and Gu, J.	Analysis of effect of 1α-hydroxyvitamin D3 on benign paroxysmal positional vertigo and risk factors. [Abstract] [BibTeX]	2018	Experimental and therapeutic medicine Vol. 15(3), pp. 2321-2326	article	DOI
Abstract: The purpose of this study was to investigate the curative effect of 1α-hydroxyvitamin D3 on the benign paroxysmal positional vertigo (BPPV). Fifty BPPV patients diagnosed in the ENT Department of Anzhen Hospital from October 2015 to December 2016 were randomly selected as the treatment group, and treated with 0.25 µg 1α-hydroxyvitamin D3 once per day, in addition to the routine diagnosis and treatment. Moreover, 50 BPPV patients in the same period were selected as the control group, and received the routine diagnosis and treatment. The detection results of bone mineral density (BMD) t-value, vitamin D3 and bone metabolic markers before and after treatment were compared, and statistical analysis was performed on the results. There were no differences in the general data between treatment group and control group. There were no statistically significant differences in the BMD and age distribution of males and females between treatment group and control group (P>0.05). The BMD of male BPPV patients in each age group in the treatment group was significantly increased after treatment, and the difference was statistically significant (P<0.05). Although the BMD of male BPPV patients in each age group in control group was somewhat increased after treatment, the difference was not statistically significant (P>0.05). The BMD of female BPPV patients in each age group in treatment group was increased after treatment, and the difference was statistically significant (P<0.05). Similarly, although the BMD of female BPPV patients in each age group in control group was somewhat increased after treatment, the difference was not statistically significant (P>0.05). The average BMD of female BPPV patients in each age group was significantly lower than that of male patients, and the difference was statistically significant (P<0.05) (Table II). The BMD t-value of patients in treatment group showed a decreasing trend with the increase of age (Fig. 1). The levels of 25-hydroxyvitamin D3 and bone metabolic markers in treatment group were significantly improved compared with those before treatment (P<0.05). Multivariate Logistic regression analysis was performed to identify whether the treatment of BPPV was effective or not as a dependent variable, and six items, including the sex (female), hypertension, diabetes mellitus, age (>50 years), 25-hydroxyvitamin D3 and osteopenia/osteoporosis, as the independent variables, and the results suggested that the level of 25-hydroxyvitamin D3 and osteopenia/osteoporosis are the clinical features of whether the BPPV treatment is effective (P<0.05). The results showed that the treatment of BPPV with 1α-hydroxyvitamin D3 can effectively improve the symptoms of patients, and the level of vitamin D3 and the occurrence of osteopenia/osteoporosis are the clinical indexes of whether the BPPV treatment is effective.
BibTeX: @article{Gu2018, author = {Gu, Xiang and Dong, Feilin and Gu, Jianhua}, title = {Analysis of effect of 1α-hydroxyvitamin D3 on benign paroxysmal positional vertigo and risk factors.}, journal = {Experimental and therapeutic medicine}, year = {2018}, volume = {15}, issue = {3}, pages = {2321--2326}, doi = {https://doi.org/10.3892/etm.2018.5699}, keywords = {1α-hydroxyvitamin D3; benign paroxysmal positional vertigo; bone metabolism; curative effect}, pmid = {29456639} }
Luryi, A.L., Wright, D., Lawrence, J., Babu, S., LaRouere, M., Bojrab, D.I., Sargent, E.W., Zappia, J. and Schutt, C.A.	Analysis of non-posterior canal benign paroxysmal positional vertigo in patients treated using the particle repositioning chair: A large, single-institution series. [Abstract] [BibTeX]	2018	American journal of otolaryngology Vol. 39(3), pp. 313-316	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) involving the horizontal and superior semicircular canals is difficult to study due to variability in diagnosis. We aim to compare disease, treatment, and outcome characteristics between patients with BPPV of non-posterior semicircular canals (NP-BPPV) and BPPV involving the posterior canal only (P-BPPV) using the particle repositioning chair as a diagnostic and therapeutic tool. Retrospective review of patients diagnosed with and treated for BPPV at a high volume otology institution using the particle repositioning chair. A total of 610 patients with BPPV were identified, 19.0% of whom had NP-BPPV. Patients with NP-BPPV were more likely to have bilateral BPPV (52.6% vs. 27.6%, p < 0.0005) and Meniere's disease (12.1% vs. 5.9%, p = 0.02) and were more likely to have caloric weakness (40.3% vs. 24.3%, p = 0.01). Patients with NP-BPPV required more treatments for BPPV (average 3.4 vs. 2.4, p = 0.01) but did not have a significantly different rate of resolution, rate of recurrence, or time to resolution or recurrence than patients with posterior canal BPPV. Comparison of NP-BPPV and P-BPPV is presented with reliable diagnosis by the particle repositioning chair. NP-BPPV affects 19% of patients with BPPV, and these patients are more likely to have bilateral BPPV and to require more treatment visits but have similar outcomes to those with P-BPPV. NP-BPPV is common and should be part of the differential diagnosis for patients presenting with positional vertigo.
BibTeX: @article{Luryi2018e, author = {Luryi, Alexander L and Wright, David and Lawrence, Juliana and Babu, Seilesh and LaRouere, Michael and Bojrab, Dennis I and Sargent, Eric W and Zappia, John and Schutt, Christopher A}, title = {Analysis of non-posterior canal benign paroxysmal positional vertigo in patients treated using the particle repositioning chair: A large, single-institution series.}, journal = {American journal of otolaryngology}, year = {2018}, volume = {39}, issue = {3}, pages = {313--316}, doi = {https://doi.org/10.1016/j.amjoto.2018.03.019}, keywords = {Academic Medical Centers; Adult; Age Factors; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, diagnosis, therapy; Chi-Square Distribution; Cohort Studies; Databases, Factual; Female; Follow-Up Studies; Humans; Male; Middle Aged; Patient Positioning, instrumentation, methods; Retrospective Studies; Risk Assessment; Semicircular Canals, physiopathology; Severity of Illness Index; Sex Factors; Treatment Outcome; Benign paroxysmal positional vertigo; Canalithiasis; Horizontal semicircular canal; Outcomes; Particle repositioning chair; Superior semicircular canal}, pmid = {29544670} }
Lee, N.H., Kwon, H.J. and Ban, J.H.	Analysis of residual symptoms after treatment in benign paroxysmal positional vertigo using questionnaire. [Abstract] [BibTeX]	2009	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 141(2), pp. 232-236	article	DOI
Abstract: Canalith repositioning procedure (CRP) provides rapid and long-lasting relief of symptoms in most patients with benign paroxysmal positional vertigo. However, some patients express nonspecific symptoms such as anxiety or discomfort after treatment, even after the disappearance of nystagmus and vertigo. The purpose of this study was to assess the residual symptoms after CRP in patients with benign paroxysmal positional vertigo using the Dizziness Handicap Inventory (DHI) in a questionnaire format. Controlled, prospective study. CRP was performed in 135 patients until nystagmus and vertigo disappeared. Patients were asked to complete the questionnaire before and 5 to 7 days after treatment. A control group of 135 normal volunteers was selected and cross-matched according to the age and sex of the patient group. The data were compared for the pre-CRP, post-CRP, and control groups. There was a significant improvement in the DHI scores when comparing the pre- and post-CRP groups (P=0.000), although six items showed incomplete improvement. Subsequent comparison of DHI scores between the control group and the post-CRP group still showed a difference in some items so that the improvement was incomplete. Even after successful CRPs, Dizziness Handicap Inventory scores indicated that residual subjective symptoms may remain. Thus, additional follow-up and management are important for these patients.
BibTeX: @article{Lee2009a, author = {Lee, No Hee and Kwon, Hee Jun and Ban, Jae Ho}, title = {Analysis of residual symptoms after treatment in benign paroxysmal positional vertigo using questionnaire.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2009}, volume = {141}, issue = {2}, pages = {232--236}, doi = {https://doi.org/10.1016/j.otohns.2009.04.006}, keywords = {Aged; Case-Control Studies; Dizziness, surgery; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nystagmus, Pathologic, surgery; Otolithic Membrane, surgery; Otologic Surgical Procedures, methods; Posture; Prognosis; Prospective Studies; Quality of Life; Semicircular Canals, surgery; Surveys and Questionnaires; Treatment Outcome; Vertigo, prevention & control, surgery; Vestibular Function Tests}, pmid = {19643257} }
Domínguez-Durán, E., Domènech-Vadillo, E., Álvarez-Morujo de Sande, M.G., González-Aguado, R., Guerra-Jiménez, G., Ramos-Macías, Á., Morales-Angulo, C., Martín-Mateos, A.J., Figuerola-Massana, E. and Galera-Ruiz, H.	Analysis of risk factors influencing the outcome of the Epley maneuver. [Abstract] [BibTeX]	2017	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 274(10), pp. 3567-3576	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most frequent type of vertigo. The treatment of canalithiasis of the posterior semicircular canal consists in performing a particle-repositioning maneuver, such as the Epley maneuver (EM). However, the EM is not effective in all cases. The objective of this study is to identify risk factors, which predict the EM failure, among the clinical variables recorded in anamnesis and patient examination. This is an observational prospective multicentric study. All patients presenting with BPPV were recruited and applied the EM and appointed for a follow-up visit 7 days later. The following variables were recorded: sex, age, arterial hypertension, diabetes, hyperlipidemia, smoking habit, alcohol consumption, migraine, osteoporosis, diseases of the inner ear, previous ipsilateral BPPV, previous traumatic brain injury, previous sudden head deceleration, time of evolution, sulpiride or betahistine treatment, experienced symptoms, outcome of the Halmagyi maneuver, laterality, cephalic hyperextension of the neck, intensity of nystagmus, intensity of vertigo, duration of nystagmus, occurrence of orthotropic nystagmus, symptoms immediately after the EM, postural restrictions, and symptoms 7 days after the EM. Significant differences in the rate of loss of nystagmus were found for six variables: hyperlipidemia, previous ipsilateral BPPV, intensity of nystagmus, duration of nystagmus, post-maneuver sweating, and subjective status. The most useful significant variables in the clinical practice to predict the success of the EM are previous BPPV and intensity of nystagmus. In the other significant variables, no physiopathological hypothesis can be formulated or differences between groups are too small.
BibTeX: @article{Dominguez-Duran2017, author = {Domínguez-Durán, E and Domènech-Vadillo, E and Álvarez-Morujo de Sande, M G and González-Aguado, R and Guerra-Jiménez, G and Ramos-Macías, Á and Morales-Angulo, C and Martín-Mateos, A J and Figuerola-Massana, E and Galera-Ruiz, H}, title = {Analysis of risk factors influencing the outcome of the Epley maneuver.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2017}, volume = {274}, issue = {10}, pages = {3567--3576}, doi = {https://doi.org/10.1007/s00405-017-4674-9}, keywords = {Adult; Benign Paroxysmal Positional Vertigo, physiopathology, therapy; Female; Functional Laterality; Humans; Male; Middle Aged; Nystagmus, Pathologic, diagnosis, physiopathology; Patient Positioning, methods; Prognosis; Prospective Studies; Risk Factors; Semicircular Canals, pathology, physiopathology; Treatment Outcome; Age; Alcohol-related disorders; BPPV; Betahistine; Cervical extension; Diabetes mellitus; Epley maneuver; Head impulse test; Hyperlipidemia; Hypertension; Labyrinth diseases; Lateralization; Migraine disorders; Nystagmus; Orthotropic nystagmus; Osteoporosis; Prognosis; Sex; Signs and symptoms; Smoking; Sulpiride; Time-to-treatment; Traumatic brain injury; Whiplash injuries}, pmid = {28725982} }
Buckingham, R.A.	Anatomical and theoretical observations on otolith repositioning for benign paroxysmal positional vertigo. [Abstract] [BibTeX]	1999	The Laryngoscope Vol. 109(5), pp. 717-722	article
Abstract: To determine if there is an anatomic basis for the assumption that loose, "rogue" otoliths presumed to arise from the utricular macula and theorized to cause benign paroxysmal positional vertigo (BPPV) by impinging on semicircular canal ampullae could be returned to their original site by a series of changes in the position of the head called particle repositioning maneuvers (PRMs). Further, if such otolith movement were possible, once they were replaced into the utricle, would they adhere to the utricular macula? Kodachrome photographs of 2-mm-thick macrosections of human temporal bones were available for evaluation. The bones were sectioned in horizontal, coronal, and sagittal planes. Rice grains were placed on the photographs of the cross-sections to demonstrate the possible paths taken by loose otoliths under the influence of gravity in different positions of the head. A study of cross-sections of the temporal bone shows that loose macular otoliths after PRMs would tend to fall into the lumen of the utricle. Once the patient assumes the erect position, however, repositioned otoliths would tend to fall into the near or utriculopetal side of the cupula of the posterior semicircular canal, which opens directly into the inferior portion of the utricle, and could cause labyrinth stimulation and BPPV by the same mechanism of misplaced otoliths on the opposite or far side of the cupula. Loose otoliths in the utricle could also stimulate the horizontal ampullae. PRMs do not remove or fix otoliths in any specific site in the labyrinth. Repositioning of loose otoliths onto the original site in the macula of the utricle, which lies superiorly in the vestibule, could not be accomplished by any of the repositioning maneuvers. If otoliths were to be repositioned on the utricular macula, there is no evidence that the otoliths would adhere to the macula when the patient assumes the erect position. The good results obtained by physiotherapeutic procedures suggest that some other mechanism than repositioning of otoliths is responsible for the relief of BPPV.
BibTeX: @article{Buckingham1999, author = {Buckingham, R A}, title = {Anatomical and theoretical observations on otolith repositioning for benign paroxysmal positional vertigo.}, journal = {The Laryngoscope}, year = {1999}, volume = {109}, issue = {5}, pages = {717--722}, keywords = {Humans; Otolithic Membrane, anatomy & histology; Temporal Bone, anatomy & histology; Vertigo, pathology}, pmid = {10334220} }
Ottaviano, G., Marioni, G., Marchese-Ragona, R., Trevisan, C.P., De Filippis, C. and Staffieri, A.	Anosmia associated with hearing loss and benign positional vertigo after head trauma. [Abstract] [BibTeX]	2009	Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale Vol. 29(5), pp. 270-273	article
Abstract: It is well known that head trauma may cause hearing loss, which can be either conductive or sensorineural. Benign paroxysmal positional vertigo and olfactory dysfunction due to head trauma are also well known. The association between sensorineural hearing loss and anosmia, following head trauma, is extremely rare. Two rare cases of post-traumatic occurrence of hearing loss, olfactory dysfunction and benign positional vertigo are reported and the pathophysiology of the association between sensorineural hearing loss, anosmia and benign paroxysmal positional vertigo, after head injury, are briefly discussed. ENT specialists should, in the authors' opinion, be aware of the possible association between anosmia, sensorineural hearing loss and benign paroxysmal positional vertigo after head injury, even in the absence of skull fracture.
BibTeX: @article{Ottaviano2009, author = {Ottaviano, G and Marioni, G and Marchese-Ragona, R and Trevisan, C P and De Filippis, C and Staffieri, A}, title = {Anosmia associated with hearing loss and benign positional vertigo after head trauma.}, journal = {Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale}, year = {2009}, volume = {29}, issue = {5}, pages = {270--273}, keywords = {Adult; Audiometry, Speech; Brain Injuries, complications, diagnostic imaging; Fatal Outcome; Female; Hearing Loss, Sensorineural, etiology; Humans; Middle Aged; Olfaction Disorders, etiology; Tomography, X-Ray Computed; Vertigo, etiology; Anosmia; Head trauma; Sensorineural hearing loss; Vertigo}, pmid = {20162029} }
Roberts, R.A., Rivas, A. and Makowiec, K.F.	Anterior Canal benign paroxysmal positional Vertigo following surgical Management of superior canal dehiscence. [Abstract] [BibTeX]	2018	American journal of otolaryngology Vol. 39(6), pp. 796-799	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is a common post-surgical finding in patients managed for superior semicircular canal dehiscence (SSCD). The posterior semicircular canal has been reported as the involved canal in the majority of cases of post-surgical BPPV, with only two cases reported of lateral canal involvement. The objective of this report is to present a case in which an anterior semicircular canal BPPV response was identified in a patient following surgical management for SSCD. This case report presents an adult with residual dizziness following surgical management of SSCD and vestibular rehabilitation therapy (VRT). During subsequent evaluation of vestibular function, a transient and torsional, down-beating nystagmus was provoked along with vertigo during Dix-Hallpike positioning to the right. This was consistent with BPPV affecting the left superior (anterior) semicircular canal. The patient was treated with a repositioning maneuver to manage anterior semicircular canal BPPV and no nystagmus response was recorded with post-repositioning Dix-Hallpike test. Review of radiographic images, obtained prior to vestibular function testing, showed a hyperintensity in the area of the left anterior semicircular canal ampulla. It was felt this was likely a bone chip from the SSCD repair that was pushing against the ampulla with further mobile debris within the canal. It is reported that BPPV is a common complication in patients surgically managed for SSCD. Posterior semicircular canal BPPV is reported most often, with a couple of cases of lateral semicircular canal BPPV also reported. As far as we are aware, the current case represents the first report of anterior semicircular canal BPPV in this type of patient.
BibTeX: @article{Roberts2018, author = {Roberts, Richard A and Rivas, Alejandro and Makowiec, Kathryn F}, title = {Anterior Canal benign paroxysmal positional Vertigo following surgical Management of superior canal dehiscence.}, journal = {American journal of otolaryngology}, year = {2018}, volume = {39}, issue = {6}, pages = {796--799}, doi = {https://doi.org/10.1016/j.amjoto.2018.09.001}, keywords = {Anterior semicircular canal; Benign paroxysmal positional vertigo (BPPV); Superior canal dehiscence; Vestibular}, pmid = {30224218} }
Jackson, L.E., Morgan, B., Fletcher, J.C. and Krueger, W.W.O.	Anterior canal benign paroxysmal positional vertigo: an underappreciated entity. [Abstract] [BibTeX]	2007	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 28(2), pp. 218-222	article	DOI
Abstract: Evaluate the frequency and characteristics of benign paroxysmal positional vertigo (BPPV) arising from involvement of the anterior semicircular canal (AC) as compared with the posterior canal (PC) and horizontal canal (HC). Prospective review of patients with BPPV. Tertiary referral center. A total of 260 patients who were evaluated for vertigo were identified as experiencing BPPV. Standard vestibular assessment including the use of electrooculography (EOG) or video-oculography (VOG) was completed on all patients. Based on EOG/VOG findings, the BPPV origin was attributed to AC, PC, or HC involvement secondary to canalithiasis versus cupulolithiasis. Treatment was performed with canalith repositioning maneuvers (CRMs) appropriate for type of canal involvement. For the 260 patients, the positionally induced nystagmus patterns suggested the canal of origin to be AC in 21.2%, PC in 66.9%, and HC in 11.9%. Cupulolithiasis was observed in 27.3% of the AC, 6.3% of the PC, and 41.9% of the HC patients. Head trauma was confirmed in the history preceding the onset of vertigo in 36.4% of the AC, versus 9.2% of the PC and 9.7% of the HC patients (p < 0.001). The number of CRMs completed to treat the BPPV did not differ between canals involved (1.32 for AC, 1.49 for PC, and 1.34 for HC). The direction of subtle vertical-beating nystagmus underlying the torsional component is critical in differentiating AC versus PC origin; EOG/VOG aids in accurate assessment of the vertical component for the diagnosis of canal involvement. AC involvement may be more prevalent than previously appreciated, particularly if the examiner does not appreciate the vertical component of the nystagmus or the diagnosis is made without the assistance of EOG/VOG. Head trauma history is significantly more frequent in AC versus other forms of BPPV, and patients with a history of head trauma should be examined closely for AC involvement. CRM is as successful for treatment of AC BPPV as for other types of BPPV.
BibTeX: @article{Jackson2007, author = {Jackson, Lance E and Morgan, Barry and Fletcher, Jeffrey C and Krueger, Wesley W O}, title = {Anterior canal benign paroxysmal positional vertigo: an underappreciated entity.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2007}, volume = {28}, issue = {2}, pages = {218--222}, doi = {https://doi.org/10.1097/01.mao.0000247825.90774.6b}, keywords = {Adult; Aged; Aged, 80 and over; Ear Canal, pathology, physiopathology; Ear Diseases, epidemiology, pathology, physiopathology; Electronystagmography; Electrooculography; Female; Humans; Lithiasis, epidemiology, pathology, physiopathology; Male; Middle Aged; Prospective Studies; Severity of Illness Index; Vertigo, diagnosis, epidemiology, physiopathology; Videotape Recording}, pmid = {17159665} }
Califano, L., Salafia, F., Mazzone, S., Melillo, M.G. and Califano, M.	Anterior canal BPPV and apogeotropic posterior canal BPPV: two rare forms of vertical canalolithiasis. [Abstract] [BibTeX]	2014	Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale Vol. 34(3), pp. 189-197	article
Abstract: Posterior canal benign paroxysmal positional vertigo (BPPV) is the most frequent form of BPPV. It is characterized by a paroxysmal positioning nystagmus evoked through Dix-Hallpike and Semont positioning tests. Anterior canal BPPV (AC) is more rare than posterior canal BPPV; it presents a prevalent down beating positioning nystagmus, with a torsional component clockwise for the left canal, counterclockwise for the right canal. Due to the possible lack of the torsional component, it is sometimes difficult to identify the affected ear. An apogeotropic variant of posterior BPPV (APC) has recently been described, characterised by a paroxysmal positional nystagmus in the opposite direction to the one evoked in posterior canal BPPV: the linear component is down-beating, the torsional component is clockwise for the right canal, counter-clockwise for the left canal, so that a contra-lateral anterior canal BPPV could be simulated. During a 16 month period, of 934 BPPV patients observed, the authors identified 23 (2.5%) cases of apogeotropic posterior canal BPPV and 11 (1.2%) cases of anterior canal BPPV, diagnosed using the specific oculomotor patterns described in the literature. Anterior canal BPPV was treated with the repositioning manoeuvre proposed by Yacovino, which does not require identification of the affected side, whereas apogeotropic posterior canal BPPV was treated with the Quick Liberatory Rotation manoeuvre for the typical posterior canal BPPV, since in the Dix-Hallpike position otoliths are in the same position if they come either from the ampullary arm or from the non-ampullary arm. The direct resolution of BPPV (one step therapy) was obtained in 12/34 patients, 8/23 patients with APC and 4/11 patients with AC; canalar conversion into typical posterior canal BPPV, later treated through Quick Liberatory Rotation (two-step therapy), was obtained in 19 patients,14/23 with APC and 5/11 with AC. Three patients were lost to follow-up. Considering the effects of therapeutic manoeuvres, the authors propose a grading system for diagnosis of AC and APC: "certain" when a canalar conversion in ipsilateral typical posterior canal BPPV is obtained; "probable" when APC or AC are directly resolved; "possible" when disease is not resolved and cerebral neuroimaging is negative for neurological diseases. Our results show that the oculomotor patterns proposed in the literature are effective in diagnosing APC and AC, and that APC is more frequent than AC. Both of these rare forms of vertical canal BPPV can be treated effectively with liberatory manoeuvres.
BibTeX: @article{Califano2014, author = {Califano, L and Salafia, F and Mazzone, S and Melillo, M G and Califano, M}, title = {Anterior canal BPPV and apogeotropic posterior canal BPPV: two rare forms of vertical canalolithiasis.}, journal = {Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale}, year = {2014}, volume = {34}, issue = {3}, pages = {189--197}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo, classification, therapy; Female; Humans; Male; Middle Aged; Otolithic Membrane; Semicircular Canals; Anterior canal BPPV; Apogeotropic posterior canal BPPV; Posterior canal BPPV; Quick Liberatory Rotation manoeuvre; Yacovino manoeuvre}, pmid = {24882928} }
Casani, A.P., Cerchiai, N., Dallan, I. and Sellari-Franceschini, S.	Anterior canal lithiasis: diagnosis and treatment. [Abstract] [BibTeX]	2011	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 144(3), pp. 412-418	article	DOI
Abstract: To describe the clinical and oculographic features in patients with anterior semicircular canal benign paroxysmal positional vertigo and to determine the efficacy of a canalith repositioning procedure for its management. Case series with chart review of patients presenting positional vertigo and positional downbeating nystagmus during a 2-year period. Outpatients' tertiary referral center for balance disorders. Eighteen patients suffering from positional vertigo and presenting positional downbeating nystagmus were treated with a maneuver based on a modification of the procedure proposed by Crevits. disappearance of positional downbeating nystagmus. Positional downbeating nystagmus was elicited unilaterally with the Dix-Hallpike maneuver in 6 cases. In 4 patients, it was triggered by both left and right Dix-Hallpike tests. In 8 patients, the positional nystagmus was elicited by a straight head-hanging maneuver. The positional nystagmus was purely downbeating in 12 patients. In the remaining, a torsional component was detected. After the treatment, only 1 patient showed positional nystagmus at 30 days. In anterior canal benign paroxysmal positional vertigo, the presence of a positional downbeating nystagmus in response to positional tests is key for diagnosis. In a significant number of patients, the affected side may not be detected because of the inconstant presence of a torsional component. Treatment with a simplified maneuver based on Crevits's technique can be considered an effective method for the treatment of anterior canal lithiasis, especially when the affected side cannot be detected clearly.
BibTeX: @article{Casani2011, author = {Casani, Augusto Pietro and Cerchiai, Niccolò and Dallan, Iacopo and Sellari-Franceschini, Stefano}, title = {Anterior canal lithiasis: diagnosis and treatment.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2011}, volume = {144}, issue = {3}, pages = {412--418}, doi = {https://doi.org/10.1177/0194599810393879}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo; Ear Canal; Ear Diseases, diagnosis, therapy; Female; Humans; Lithiasis, complications, diagnosis, physiopathology, therapy; Male; Middle Aged; Nystagmus, Pathologic, complications; Physical Therapy Modalities; Semicircular Canals, physiopathology; Vertigo, complications, etiology}, pmid = {21493205} }
Lopez-Escamez, J.A., Molina, M.I. and Gamiz, M.J.	Anterior semicircular canal benign paroxysmal positional vertigo and positional downbeating nystagmus. [Abstract] [BibTeX]	2006	American journal of otolaryngology Vol. 27(3), pp. 173-178	article	DOI
Abstract: The aim of this study was to describe the clinical features and video-oculographic findings in patients with anterior semicircular canal benign paroxysmal positional vertigo (BPPV). This is a prospective case series. The study was set at an outpatient clinic in a general hospital. Fourteen individuals with symptoms of BPPV and positional downbeating nystagmus (pDBN) were included in the study. The diagnosis was based on a history of brief episodes of vertigo and the presence of pDBN confirmed in the video-oculographic examination during Dix-Hallpike test (DH) or head-hanging maneuver. Patients were treated by particle repositioning maneuver and the effectiveness was evaluated at 7, 30, and 180 days posttreatment. The treatment was repeated up to 4 times if pDBN was persistent. The main outcome measure is the number of patients without pDBN at 30 and 180 days. Video-oculography showed a predominant pDBN in response to DH. Of the 14 patients, 7 had arterial hypertension, and 5 of 14 cases presented abnormalities on the caloric test. Horizontal spontaneous nystagmus was found in 3 of 14 individuals. Positional nystagmus at different positional test was observed in 5 of 14 individuals, suggesting the involvement of several canals. Of the 14 patients, 10 (71%) did not present vertigo, and the positional tests were negative at 30 days. However, 3 cases presented a positive DH with persistence of BPPV episodes and pDBN at 30 days, and another developed a contralateral posterior canal affectation. One of the patients maintained a persistent pDBN at 180 days despite the repeated maneuvers. Video-oculography demonstrates that anterior canal BPPV is characterized by a predominant downbeating nystagmus in response to DH. These individuals may show alterations in the vestibular caloric, and they can have multicanal affectation.
BibTeX: @article{Lopez-Escamez2006, author = {Lopez-Escamez, Jose A and Molina, Maria I and Gamiz, Maria J}, title = {Anterior semicircular canal benign paroxysmal positional vertigo and positional downbeating nystagmus.}, journal = {American journal of otolaryngology}, year = {2006}, volume = {27}, issue = {3}, pages = {173--178}, doi = {https://doi.org/10.1016/j.amjoto.2005.09.010}, keywords = {Adult; Aged; Aged, 80 and over; Comorbidity; Female; Humans; Male; Middle Aged; Nystagmus, Physiologic, physiology; Prospective Studies; Semicircular Canals, physiopathology; Vertigo, diagnosis, physiopathology, therapy; Video Recording}, pmid = {16647981} }
Imbaud-Genieys, S.	Anterior semicircular canal benign paroxysmal positional vertigo: a series of 20 patients. [Abstract] [BibTeX]	2013	European annals of otorhinolaryngology, head and neck diseases Vol. 130(6), pp. 303-307	article	DOI
Abstract: The purpose of this study is to define the diagnostic criteria for anterior semicircular canal benign paroxysmal positional vertigo (BPPV) based on clinical data and the available anatomical and pathophysiological data. Between July 2006 and June 2007, 4320 patients consulting for otoneurological disease were investigated by otological examination, videonystagmography and neurological examination. BPPV was diagnosed in 1430 patients, involving the posterior semicircular canal in 1325 patients, the horizontal semicircular canal in 85 patients, the posterior semicircular canal and ipsilateral anterior (superior) semicircular canal in 19 patients and the anterior semicircular canal only in one patient. In the 20 patients with anterior semicircular canal BPPV, the Dix-Hallpike (DH) test induced ageotropic horizontal torsional nystagmus beating towards the uppermost ear in the lateral supine position with reversal on standing. The modified Epley manoeuvre was effective in 94.1% of cases on the 8th day and in 97.5% of cases at 1 month. Nystagmus beating towards the uppermost ear on the DH test is consistent with BPPV involving the anterior semicircular canal of the uppermost ear. The torsional component of nystagmus and not just the vertical component must be taken into account to facilitate the diagnosis with videonystagmoscopy glasses and identify the affected side. The anterior semicircular canal is rarely affected due to its anatomical position. Settling of otoconia in this canal requires hyperextension of the head. Treatment is simple, consisting of the modified Epley particle repositioning manoeuvre.
BibTeX: @article{Imbaud-Genieys2013, author = {Imbaud-Genieys, S}, title = {Anterior semicircular canal benign paroxysmal positional vertigo: a series of 20 patients.}, journal = {European annals of otorhinolaryngology, head and neck diseases}, year = {2013}, volume = {130}, issue = {6}, pages = {303--307}, doi = {https://doi.org/10.1016/j.anorl.2012.01.007}, keywords = {Benign Paroxysmal Positional Vertigo; Electronystagmography, methods; Female; Humans; Male; Middle Aged; Neurologic Examination; Nystagmus, Pathologic, physiopathology; Otoscopy; Patient Positioning, methods; Posture, physiology; Semicircular Canals, physiopathology; Vertigo, diagnosis, physiopathology, therapy; Video Recording; Anterior semicircular canal benign positional paroxysmal vertigo; Torsional nystagmus; Videonystagmoscopy}, pmid = {23845290} }
Adamec, I. and Habek, M.	Anterior semicircular canal BPPV with positional downbeat nystagmus without latency, habituation and adaptation. [BibTeX]	2012	Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology Vol. 33(4), pp. 955-956	article	DOI
BibTeX: @article{Adamec2012, author = {Adamec, Ivan and Habek, Mario}, title = {Anterior semicircular canal BPPV with positional downbeat nystagmus without latency, habituation and adaptation.}, journal = {Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology}, year = {2012}, volume = {33}, issue = {4}, pages = {955--956}, doi = {https://doi.org/10.1007/s10072-011-0843-6}, keywords = {Benign Paroxysmal Positional Vertigo; Female; Humans; Middle Aged; Nystagmus, Pathologic, complications; Semicircular Canals, physiopathology; Vertigo, complications, pathology}, pmid = {22057266} }
Pham, B.-N., Rudic, M., Bouccara, D., Sterkers, O., Belmatoug, N., Bébéar, J.-P., Couloigner, V., Fraysse, B., Gentine, A., Ionescu, E., Robier, A., Sauvage, J.-P., Truy, E., Van Den Abbeele, T. and Ferrary, E.	Antibodies to myelin protein zero (P0) protein as markers of auto-immune inner ear diseases. [Abstract] [BibTeX]	2007	Autoimmunity Vol. 40(3), pp. 202-207	article	DOI
Abstract: The inner ear can be the target of autoimmune disorders. Recognition of autoimmune inner ear disease is important, as it is one of the very few forms of sensorineural hearing loss (HL) that can be successfully treated by medical therapy. The aim of this study was to evaluate whether the detection of antibodies to myelin protein P0 (MPZ) could be a diagnostic test for inner ear disease of autoimmune cause. This multicentric prospective study included 129 patients: patients with progressive sensorineural HL or with Menière's disease, together with their control group corresponding to patients with similar symptoms, but of presumably known origin. Detection of antibodies to myelin P0 protein was performed by using western blots. NORMAL: The prevalence of antibodies to myelin P0 protein in patients with rapidly progressive HL was not statistically different from that of the control group corresponding to genetic HL patients (30 versus 28%). In patients with Menière's disease, the prevalence was lower than that of the control group corresponding to patients with benign paroxysmal positional vertigo (5.4 versus 18.7%). No patient with auto-immune disease had antibodies to myelin P0 protein. The sole presence of antibodies to myelin P0 may not be used as a marker of inner ear disease of autoimmune origin.
BibTeX: @article{Pham2007, author = {Pham, Bach-Nga and Rudic, Milan and Bouccara, Didier and Sterkers, Olivier and Belmatoug, Nadia and Bébéar, Jean-Pierre and Couloigner, Vincent and Fraysse, Bernard and Gentine, André and Ionescu, Eugène and Robier, Alain and Sauvage, Jean-Pierre and Truy, Eric and Van Den Abbeele, Thierry and Ferrary, Evelyne}, title = {Antibodies to myelin protein zero (P0) protein as markers of auto-immune inner ear diseases.}, journal = {Autoimmunity}, year = {2007}, volume = {40}, issue = {3}, pages = {202--207}, doi = {https://doi.org/10.1080/08916930701248555}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Autoantibodies, biosynthesis, blood; Autoimmune Diseases of the Nervous System, blood, immunology; Biomarkers, blood; Child; Child, Preschool; Ear Diseases, blood, immunology; Ear, Inner, immunology; Female; Humans; Male; Middle Aged; Myelin P0 Protein, immunology; Prospective Studies}, pmid = {17453719} }
Yuan, Q., Yu, L., Shi, D., Ke, X. and Zhang, H.	Anxiety and depression among patients with different types of vestibular peripheral vertigo. [Abstract] [BibTeX]	2015	Medicine Vol. 94(5), pp. e453	article	DOI
Abstract: Numerous studies have been published on comorbid anxiety and depression in patients with vertigo. However, very few studies have separately described and analyzed anxiety or depression in patients with different types of vestibular peripheral vertigo. The present study investigated anxiety and depression among patients with 4 different types of peripheral vertigo. A total of 129 patients with 4 types of peripheral vertigo, namely, benign paroxysmal positional vertigo (BPPV, n = 49), migrainous vertigo (MV, n = 37), Menière disease (MD, n = 28), and vestibular neuritis (VN, n = 15), were included in the present study. Otological and neurootological examinations were carefully performed, and self-rating anxiety scale and self-rating depression scale were used to evaluate anxiety and depression. Patients were divided into 2 groups, according to the vestibular function: normal and abnormal vestibular function. There was no significant difference in the risk of anxiety/depression between these 2 groups. However, for patients with the 4 different vertigo types, the prevalence of anxiety (MV = 45.9%, MD = 50%) and depression (MV = 27%, MD = 28.6%) was significantly higher in the patients with MV or MD than those with BPPV or VN (P < 0.05). Vestibular function is not significantly associated with the risk of anxiety/depression. Anxiety/depression is more common in patients with MV or MD than those with BPPV or VN. This may be due to the different mechanisms involved in these 4 types of vertigo, as well as differences in the prevention and self-control of the patients against the vertigo.
BibTeX: @article{Yuan2015b, author = {Yuan, Qing and Yu, Lisheng and Shi, Dongmei and Ke, Xingxing and Zhang, Hua}, title = {Anxiety and depression among patients with different types of vestibular peripheral vertigo.}, journal = {Medicine}, year = {2015}, volume = {94}, issue = {5}, pages = {e453}, doi = {https://doi.org/10.1097/MD.0000000000000453}, keywords = {Adult; Aged; Anxiety, epidemiology; Benign Paroxysmal Positional Vertigo, epidemiology, psychology; Depression, epidemiology; Female; Humans; Male; Meniere Disease, epidemiology, psychology; Middle Aged; Vertigo, epidemiology, psychology; Vestibular Neuronitis, epidemiology, psychology}, pmid = {25654382} }
Peluso, É.T.P., Quintana, M.I. and Ganança, F.F.	Anxiety and depressive disorders in elderly with chronic dizziness of vestibular origin. [Abstract] [BibTeX]	2016	Brazilian journal of otorhinolaryngology Vol. 82(2), pp. 209-214	article	DOI
Abstract: Dizziness is one of the most prevalent symptoms in the elderly. Anxiety and depression are common in dizzy adult patients, but there is scarce information about comorbidity between vestibular disturbances and psychiatric disorders in the aged. To assess the prevalence of anxiety and depression disorders in elderly with chronic dizziness of vestibular origin. Transversal study that used the Brazilian version of the Composite International Diagnostic Interview 2.1 to assess anxiety and depressive disorders in elderly patients (≥ 60 years old) with chronic dizziness. Most of the 44 patients included in the study were female (88.6%) with a mean age of 71 years (± 7.5), 68.1% had experienced dizziness for 1 year or more. The most prevalent diagnosis was benign paroxysmal positional vertigo (52.3%). The prevalence of generalized anxiety disorder and specific phobias during life were 29.5% and 22.7%, respectively, and, in the last 12 months, 18.2% and 15.9%. There was no patient with panic disorder, agoraphobia or social phobia. The prevalence of depressive disorder during life was 45.4%, and, in the last 12 months, were 11.3%. Aged patients with chronic dizziness had high prevalence of some mental disorders.
BibTeX: @article{Peluso2016, author = {Peluso, Érica Toledo Piza and Quintana, Maria Inês and Ganança, Fernando Freitas}, title = {Anxiety and depressive disorders in elderly with chronic dizziness of vestibular origin.}, journal = {Brazilian journal of otorhinolaryngology}, year = {2016}, volume = {82}, issue = {2}, pages = {209--214}, doi = {https://doi.org/10.1016/j.bjorl.2015.04.015}, keywords = {Aged; Aged, 80 and over; Anxiety Disorders, psychology; Chronic Disease; Cross-Sectional Studies; Depressive Disorder, psychology; Dizziness, psychology; Female; Humans; Male; Middle Aged; Prevalence; Ansiedade; Anxiety; Depression; Depressão; Dizziness; Elderly; Idoso; Tontura}, pmid = {26515771} }
Fife, T.D.	Anxiety in a dizzy patient: the importance of communication in improving outcome. [Abstract] [BibTeX]	2012	Continuum (Minneapolis, Minn.) Vol. 18(5 Neuro-otology), pp. 1163-1166	article	DOI
Abstract: Most patients with dizziness have a benign self-limited condition, often of labyrinthine origin; however, some develop a more intractable form of dizziness that can be challenging to evaluate. In many of these patients, brain imaging, vestibular testing, and clinical examination are normal, but the patient is significantly impaired. Many such patients have coexisting anxiety, which can make it difficult to determine whether the anxiety is a reaction to the dizziness or its primary cause. A careful history, including an assessment of the impact of symptoms on quality-of-life, social, and work-related issues is critical, and effective patient communication is essential. The following case exemplifies how a high-functioning person can become severely limited because of the complex intertwining of several types of dizziness with anxiety.
BibTeX: @article{Fife2012, author = {Fife, Terry D}, title = {Anxiety in a dizzy patient: the importance of communication in improving outcome.}, journal = {Continuum (Minneapolis, Minn.)}, year = {2012}, volume = {18}, issue = {5 Neuro-otology}, pages = {1163--1166}, doi = {https://doi.org/10.1212/01.CON.0000421625.41278.27}, keywords = {Anxiety Disorders, etiology; Benign Paroxysmal Positional Vertigo; Diagnosis, Differential; Dizziness, psychology; Female; Humans; Middle Aged; Migraine Disorders, complications, diagnosis; Physical Therapy Modalities; Vertigo, diagnosis, psychology, rehabilitation}, pmid = {23042066} }
Kozak, H.H., Dündar, M.A., Uca, A.U., Uğuz, F., Turgut, K., Altaş, M., Tekin, G. and Aziz, S.K.	Anxiety, Mood, and Personality Disorders in Patients with Benign Paroxysmal Positional Vertigo. [Abstract] [BibTeX]	2018	Noro psikiyatri arsivi Vol. 55(1), pp. 49-53	article	DOI
Abstract: This study presents the current prevalence of anxiety, mood, and personality disorders as well as factors associated with the existence of psychiatric disorders in patients with benign paroxysmal positional vertigo (BPPV). The study sample comprised 46 patients with BPPV and 74 control subjects. Anxiety and mood disorders were ascertained via the Structured Clinical Interview for the Diagnostic and Statistical Manual (DSM) of Mental Disorders, Fourth Edition/Clinical Version. Personality disorders were diagnosed via the Structured Clinical Interview for DSM, Revised Third Edition, Personality Disorders. Of the 46 patients, 18 (39.1%) had at least one mood or anxiety disorder and 13 (28.3%) had at least one personality disorder. The most common Axis I and Axis II disorders in the patient group were major depression in 8 (17.4%) and obsessive-compulsive personality disorder in 10 (21.7%) patients, respectively. It was found that major depression (p=0.021), generalized anxiety disorder (p=0.026) and obsessive- compulsive personality disorder (p=0.001) were more prevalent in the BPPV group compared with the control group. Results suggest that psychiatric disturbances should be carefully checked in patients with BPPV due to the relatively high rate of comorbidity.
BibTeX: @article{Kozak2018, author = {Kozak, Hasan Hüseyin and Dündar, Mehmet Akif and Uca, Ali Ulvi and Uğuz, Faruk and Turgut, Keziban and Altaş, Mustafa and Tekin, Gonca and Aziz, Suhayb Kuria}, title = {Anxiety, Mood, and Personality Disorders in Patients with Benign Paroxysmal Positional Vertigo.}, journal = {Noro psikiyatri arsivi}, year = {2018}, volume = {55}, issue = {1}, pages = {49--53}, doi = {https://doi.org/10.5152/npa.2016.18143}, keywords = {Benign paroxysmal positional vertigo; anxiety; depression; personality disorders; psychiatric disorders}, pmid = {30042641} }
Jung, H.J., Koo, J.-W., Kim, C.S., Kim, J.S. and Song, J.-J.	Anxiolytics reduce residual dizziness after successful canalith repositioning maneuvers in benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2012	Acta oto-laryngologica Vol. 132(3), pp. 277-284	article	DOI
Abstract: This study suggests that adjuvant anti-anxiety medication may be helpful for patients with benign paroxysmal positional vertigo (BPPV) even after a successful canalith repositioning procedure (CRP). Although the CRP is an effective treatment for BPPV, many patients suffer from persistent dizziness despite successful CRPs. The aim of this study was to evaluate the effect of adjuvant anxiolytic medication on residual dizziness after successful CRP. Between January 2011 and March 2011, 73 patients were diagnosed with BPPV and they underwent successful treatment with CRPs. The patients were randomly assigned to either the medication group or the control group. The patients in the medication group were prescribed low dose etizolam for 2 weeks whereas the patients in the control group were not prescribed any medication. All patients were scheduled to return 2 weeks after evaluation of subjective visual vertical. Subjective symptoms before and after CRP were measured using the Dizziness Handicap Inventory (DHI) and the Activities-specific Balance Confidence (ABC) scale. Both groups demonstrated a significant improvement in DHI scores. However, the medication group showed significantly greater decrease in the functional (p = 0.018) and emotional (p = 0.030) subscale scores, as well as in the total DHI (p = 0.038) score.
BibTeX: @article{Jung2012, author = {Jung, Hahn Jin and Koo, Ja-Won and Kim, Chong Sun and Kim, Ji Soo and Song, Jae-Jin}, title = {Anxiolytics reduce residual dizziness after successful canalith repositioning maneuvers in benign paroxysmal positional vertigo.}, journal = {Acta oto-laryngologica}, year = {2012}, volume = {132}, issue = {3}, pages = {277--284}, doi = {https://doi.org/10.3109/00016489.2011.637179}, keywords = {Adult; Aged; Anti-Anxiety Agents, therapeutic use; Benign Paroxysmal Positional Vertigo; Dizziness, drug therapy, etiology; Female; Humans; Male; Middle Aged; Vertigo, complications, therapy}, pmid = {22201336} }
Kim, H.-A., Yi, H.-A. and Lee, H.	Apogeotropic central positional nystagmus as a sole sign of nodular infarction. [Abstract] [BibTeX]	2012	Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology Vol. 33(5), pp. 1189-1191	article	DOI
Abstract: Positional vertigo and nystagmus without associated neurological symptoms and signs are characteristic features of benign paroxysmal positional vertigo (BPPV). Although positional nystagmus may occur with caudal cerebellar infarction including the nodulus, positional nystagmus is usually associated with other neurological signs such as spontaneous or gaze-evoked nystagmus, perverted head-shaking nystagmus, cerebellar dysmetria, or severe gait ataxia with falling. We present a patient with nodular infarction who had positional vertigo with nystagmus as a sole manifestation. Video-oculography showed apogeotropic positional horizontal nystagmus during head turning while supine, which was consistent with apogeotropic BPPV involving the horizontal canal. MRI disclosed acute infarct in the nodulus. Nodulus infarction should be considered in a patient with positional nystagmus, especially when the presenting symptoms and signs are consistent with BPPV involving the horizontal canal.
BibTeX: @article{Kim2012c, author = {Kim, Hyun-Ah and Yi, Hyon-Ah and Lee, Hyung}, title = {Apogeotropic central positional nystagmus as a sole sign of nodular infarction.}, journal = {Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology}, year = {2012}, volume = {33}, issue = {5}, pages = {1189--1191}, doi = {https://doi.org/10.1007/s10072-011-0884-x}, keywords = {Cerebral Infarction, complications; Female; Humans; Nystagmus, Pathologic, etiology; Vertigo, etiology}, pmid = {22187336} }
Vannucchi, P., Pecci, R., Giannoni, B., Di Giustino, F., Santimone, R. and Mengucci, A.	Apogeotropic Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo: Some Clinical and Therapeutic Considerations. [Abstract] [BibTeX]	2015	Audiology research Vol. 5(1), pp. 130	article	DOI
Abstract: We lately reported the cases of patients complaining positional vertigo whose nystagmic pattern was that of a peripheral torsional vertical positional down beating nystagmus originating from a lithiasis of the non-ampullary arm of the posterior semicircular canal (PSC). We considered this particular pathological picture the apogeotropic variant of PSC benign paroxysmal positional vertigo (BPPV). Since the description of the pilot cases we observed more than 150 patients showing the same clinical sign and course of symptoms. In this paper we describe, in detail, both nystagmus of apogeotropic PSC BPPV (A-PSC BPPV) and symptoms reported by patients trying to give a reasonable explanation for these clinical features. Moreover we developed two specific physical therapies directed to cure A-PSC BPPV. Preliminary results of these techniques are related.
BibTeX: @article{Vannucchi2015, author = {Vannucchi, Paolo and Pecci, Rudi and Giannoni, Beatrice and Di Giustino, Fabio and Santimone, Rossana and Mengucci, Arianna}, title = {Apogeotropic Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo: Some Clinical and Therapeutic Considerations.}, journal = {Audiology research}, year = {2015}, volume = {5}, issue = {1}, pages = {130}, doi = {https://doi.org/10.4081/audiores.2015.130}, keywords = {45° forced prolonged position; apogeotropic variant; demi Semont; down beating nystagmus; positional vertigo}, pmid = {26557364} }
Riga, M., Korres, S., Korres, G. and Danielides, V.	Apogeotropic variant of lateral semicircular canal benign paroxysmal positional vertigo: is there a correlation between clinical findings, underlying pathophysiologic mechanisms and the effectiveness of repositioning maneuvers? [Abstract] [BibTeX]	2013	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 34(6), pp. 1155-1164	article	DOI
Abstract: The apogeotropic variant of horizontal semicircular canal (h-SCC) benign paroxysmal positional vertigo (BPPV) is attributed to canalithiasis of the anterior arm or cupulolithiasis. This study is an attempt to distinguish the most effective maneuvers for each case, by investigating any correlation, between the clinical findings or the treatment options and the possible location of the displaced debris. A review of the literature (1990-2012) was conducted via the PubMed database with the search terms "apogeotropic nystagmus and benign paroxysmal positional vertigo." Articles on central nervous system lesions were excluded. The studies included in the analysis provided detailed diagnostic and therapeutic protocols, supported by the resolution of the signs and symptoms through repositioning maneuvers. Descriptive statistics were used to summarize the findings. Intergroup and intragroup comparisons were performed through Pearson's χ or Fischer's exact test. Protocols vary considerably among studies. Nystagmus from seated to supine position is the best studied secondary clinical sign and possibly a clinical indication of cupulolithiasis. In patients with symmetrical responses in the head yaw test, no significant differences can be detected in the occurrence of secondary signs of lateralization compared to patients with asymmetrical responses. The Gufoni maneuver seems to be effective in all pathophysiologic types of apogeotropic h-SCC BPPV. The Barbeque and Vannucchi-Asprella maneuvers mainly target at lithiasis of the anterior ampullary arm. The results of this analysis may imply that different clinical subgroups of h-SCC BPPV may regard to different pathophysiologic and therapeutical mechanisms.
BibTeX: @article{Riga2013, author = {Riga, Maria and Korres, Stavros and Korres, George and Danielides, Vasilios}, title = {Apogeotropic variant of lateral semicircular canal benign paroxysmal positional vertigo: is there a correlation between clinical findings, underlying pathophysiologic mechanisms and the effectiveness of repositioning maneuvers?}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2013}, volume = {34}, issue = {6}, pages = {1155--1164}, doi = {https://doi.org/10.1097/MAO.0b013e318280db3a}, keywords = {Benign Paroxysmal Positional Vertigo; Humans; Lithiasis, complications, pathology; Nystagmus, Physiologic, physiology; Otologic Surgical Procedures; Posture, physiology; Semicircular Canals, physiopathology; Treatment Outcome; Vertigo, diagnosis, etiology, physiopathology}, pmid = {23512075} }
Cohen, H.S., Kimball, K.T. and Adams, A.S.	Application of the vestibular disorders activities of daily living scale. [Abstract] [BibTeX]	2000	The Laryngoscope Vol. 110(7), pp. 1204-1209	article	DOI
Abstract: Existing scales of functional performance are either insufficiently sensitive or omit some important daily life tasks. This paper demonstrates that a new scale of self-perceived disablement in the vestibularly impaired population-the Vestibular Disorders Activities of Daily Living Scale (VADL)-differentiates between disabled and healthy persons and evaluates the associations of this assessment with other measures of vestibular disorders. Prospective. Subjects were 1) asymptomatic, healthy adults, 2) patients with benign paroxysmal positional vertigo, 3) patients with chronic vestibulopathy excluding Meniere's disease, postsurgical vertigo, and postconcussion vertigo, and 4) family members. Patient were assessed on the VADL, the Dizziness Handicap Inventory, level of vertigo, and computerized dynamic posturography. Healthy subjects and family members completed the VADL. The VADL differentiates healthy persons from patients but does not differentiate between patient groups. Patients perceived themselves as more independent than their spouses perceived them to be. Scores are weakly correlated with vertigo frequency and posturography scores for conditions with unreliable kinesthesia and absent or unreliable vision. The VADL is more responsive to higher levels of impairment than the Dizziness Handicap Inventory. This well-normed, self-administered scale of self-perceived disablement is useful for evaluating the functional status of patients with peripheral vestibular disorders. Perceptions of patients and significant others vary, but scores are moderately correlated with some standard measures of vestibular function. As it assesses a different domain of function than do standard diagnostic tests, the VADL will augment these tests during initial evaluation and may be useful for assessing posttreatment change.
BibTeX: @article{Cohen2000, author = {Cohen, H S and Kimball, K T and Adams, A S}, title = {Application of the vestibular disorders activities of daily living scale.}, journal = {The Laryngoscope}, year = {2000}, volume = {110}, issue = {7}, pages = {1204--1209}, doi = {https://doi.org/10.1097/00005537-200007000-00026}, keywords = {Activities of Daily Living; Adult; Aged; Chronic Disease; Female; Humans; Male; Middle Aged; Posture; Prospective Studies; Surveys and Questionnaires; Vertigo, diagnosis, etiology; Vestibular Diseases, complications, diagnosis}, pmid = {10892697} }
Haslwanter, T. and Ong, J.	Applying knowledge--challenges in bringing scientific advances to dizzy patients. [Abstract] [BibTeX]	2009	Annals of the New York Academy of Sciences Vol. 1164, pp. 309-315	article	DOI
Abstract: Simple diagnostic or therapeutic procedures can produce tremendous benefits for dizzy patients. To see how new ideas in the laboratory evolve into benefits for patients, an attempt to analyze how the corresponding information is distributed was made. To quantify that flow of information, a number of new scientific publications, citation numbers, and a number of new books on relevant subjects were looked at. For vertigo, this approach was facilitated by the fact that the diagnostic procedures for benign paroxysmal positioning vertigo (BPPV) and for canal paresis can be traced back to seminal publications. Results indicate that the current way of disseminating new information used here is working well, and that new ideas on diagnosis and treatment are readily available to practitioners. However, the application of new methods is limited by the availability of the required technology. It is conjectured that the technological requirements have become more complex over time, leading to a slower uptake of new technology.
BibTeX: @article{Haslwanter2009, author = {Haslwanter, Thomas and Ong, James}, title = {Applying knowledge--challenges in bringing scientific advances to dizzy patients.}, journal = {Annals of the New York Academy of Sciences}, year = {2009}, volume = {1164}, pages = {309--315}, doi = {https://doi.org/10.1111/j.1749-6632.2008.03716.x}, keywords = {Diffusion of Innovation; Dizziness, diagnosis, physiopathology; Eye Movements; Humans}, pmid = {19645917} }
Lea, P., Kushnir, M., Shpirer, Y., Zomer, Y. and Flechter, S.	Approach to benign paroxysmal positional vertigo in old age. [Abstract] [BibTeX]	2005	The Israel Medical Association journal : IMAJ Vol. 7(7), pp. 447-450	article
Abstract: Benign paroxysmal positional vertigo is a common and treatable vestibular disorder characterized by attacks of positional vertigo. Although elderly patients often complain about unsteadiness, the symptom of positional vertigo is seldom reported. Several studies on BPPV in the elderly reveal a low success rate in the treatment of this entity. To assess the clinical characteristics and treatment outcome of BPPV in elderly patients and to compare them with those of the general population treated at our dizziness clinic. We reviewed the medical records of 23 patients above age 75 who were treated at our dizziness clinic for BPPV during the years 1998-2004. Their clinical data, BPPV characteristics and treatment outcome were compared with the data of 30 consecutive BPPV patients who represented the general population. No differences in gender distribution, duration of BPPV, treatment responsiveness or recurrence rate were found between elderly patients as compared to the general population. The duration of the last attack of positional vertigo was found to be longer in the elderly, probably due to the delay in recognition of symptoms and accessibility of a dizziness clinic. Our study shows that BPPV characteristics and treatment effectiveness, as measured by negative Dix-Hallpike maneuver, are not age-dependent and there is no need for a special approach or cautiousness in prognosis prediction. It is important to search actively for this condition since treatment leads to amelioration of unsteadiness and improved well-being in these patients.
BibTeX: @article{Lea2005, author = {Lea, Pollak and Kushnir, Mark and Shpirer, Yizchak and Zomer, Yaacov and Flechter, Shlomo}, title = {Approach to benign paroxysmal positional vertigo in old age.}, journal = {The Israel Medical Association journal : IMAJ}, year = {2005}, volume = {7}, issue = {7}, pages = {447--450}, keywords = {Adult; Age Factors; Aged; Aged, 80 and over; Dizziness, etiology; Female; Humans; Male; Middle Aged; Nystagmus, Physiologic; Physical Therapy Modalities; Posture; Prognosis; Recurrence; Retrospective Studies; Treatment Outcome; Vertigo, etiology, physiopathology, therapy}, pmid = {16011061} }
Pollak, L., Stryjer, R., Kushnir, M. and Flechter, S.	Approach to bilateral benign paroxysmal positioning vertigo. [Abstract] [BibTeX]	2006	American journal of otolaryngology Vol. 27(2), pp. 91-95	article	DOI
Abstract: Bilateral benign paroxysmal positioning vertigo (bBPPV) is rather rare, accounting for up to 10% in the reported benign paroxysmal positioning vertigo (BPPV) series. Inappropriate head positioning during testing in unilateral BPPV causes the otolith debris in the uppermost ear to move toward the cupula, resulting in an inhibitory nystagmus and mimicking bBPPV. We analyzed the clinical data of patients with bilaterally positive Dix-Hallpike maneuver and compared them with the characteristics of patients with unilateral BPPV. We further tried to propose a simple schematic approach to the treatment of patients with bilaterally positive Dix-Hallpike maneuver. Medical records of 232 patients treated for BPPV at our dizziness clinic during 1999 to 2003 were reviewed. An algorithm used for the treatment of patients with bilaterally positive BPPV is discussed. Twenty-eight patients with bilaterally positive Dix-Hallpike test were found. Sixteen were diagnosed with bBPPV, and 12 were diagnosed with unilateral mimicking bBPPV. Thirty patients with unilateral posterior canal BPPV served as control subjects. No difference in age, sex distribution, duration of symptoms, number of treatments per ear, and recurrence was found between bBPPV and unilateral BPPV. The female sex appeared to be predisposed for more treatments. The total duration of BPPV symptoms obtained by history was found to correlate with the number of recurrences after treatment. We conclude that bBPPV can be readily distinguished from unilateral mimicking bBPPV. Patients with bBPPV do not differ from patients with unilateral BPPV in clinical characteristics. The mechanism of otolith debris dislodgment appears to be the main cause of bilaterality, trauma being a more common trigger than other known causes of BPPV.
BibTeX: @article{Pollak2006, author = {Pollak, Lea and Stryjer, Rafael and Kushnir, Mark and Flechter, Shlomo}, title = {Approach to bilateral benign paroxysmal positioning vertigo.}, journal = {American journal of otolaryngology}, year = {2006}, volume = {27}, issue = {2}, pages = {91--95}, doi = {https://doi.org/10.1016/j.amjoto.2005.07.012}, keywords = {Adult; Aged; Aged, 80 and over; Algorithms; Analysis of Variance; Chi-Square Distribution; Female; Humans; Male; Middle Aged; Nystagmus, Physiologic, physiology; Posture, physiology; Statistics, Nonparametric; Vertigo, physiopathology, therapy; Vestibule, Labyrinth, physiopathology}, pmid = {16500470} }
Devaraja, K.	Approach to cervicogenic dizziness: a comprehensive review of its aetiopathology and management. [Abstract] [BibTeX]	2018	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 275(10), pp. 2421-2433	article	DOI
Abstract: Though there is abundant literature on cervicogenic dizziness with at least half a dozen of review articles, the condition remains to be enigmatic for clinicians dealing with the dizzy patients. However, most of these studies have studied the cervicogenic dizziness in general without separating the constitute conditions. Since the aetiopathological mechanism of dizziness varies between these cervicogenic causes, one cannot rely on the universal conclusions of these studies unless the constitute conditions of cervicogenic dizziness are separated and contrasted against each other. This narrative review of recent literature revisits the pathophysiology and the management guidelines of various conditions causing the cervicogenic dizziness, with an objective to formulate a practical algorithm that could be of clinical utility. The structured discussion on each of the causes of the cervicogenic dizziness not only enhances the readers' understanding of the topic in depth but also enables further research by identifying the potential areas of interest and the missing links. Certain peculiar features of each condition have been discussed with an emphasis on the recent experimental and clinical studies. A simple aetiopathological classification and a sensible management algorithm have been proposed by the author, to enable the identification of the most appropriate underlying cause for the cervicogenic dizziness in any given case. However, further clinical studies are required to validate this algorithm. So far, no single clinical study, either epidemiological or interventional, has incorporated and isolated all the constitute conditions of cervicogenic dizziness. There is a need for such studies in the future to validate either the reliability of a clinical test or the efficacy of an intervention in cervicogenic dizziness.
BibTeX: @article{Devaraja2018, author = {Devaraja, K}, title = {Approach to cervicogenic dizziness: a comprehensive review of its aetiopathology and management.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2018}, volume = {275}, issue = {10}, pages = {2421--2433}, doi = {https://doi.org/10.1007/s00405-018-5088-z}, keywords = {Algorithms; Cervical Vertebrae; Dizziness, classification, etiology, therapy; Humans; Myofascial Pain Syndromes, complications, diagnosis; Posterior Cervical Sympathetic Syndrome, complications, diagnosis; Spondylosis, complications, diagnosis; Vertebral Artery Dissection, complications, diagnosis; Vertebrobasilar Insufficiency, complications, diagnosis; Whiplash Injuries, complications, diagnosis; Barre–Lieou syndrome; Benign paroxysmal positional vertigo; Bow hunter’s syndrome; Cervical vertigo; Cervicogenic dizziness; Whiplash-associated disorder}, pmid = {30094486} }
Jung, I. and Kim, J.-S.	Approach to dizziness in the emergency department. [Abstract] [BibTeX]	2015	Clinical and experimental emergency medicine Vol. 2(2), pp. 75-88	article	DOI
Abstract: Acute dizziness/vertigo is among the most common causes for visiting the emergency department. The traditional approach to dizziness starts with categorizing dizziness into four types: vertigo, presyncope, disequilibrium, and nonspecific dizziness. However, a recently proposed approach begins with classifying dizziness/vertigo as acute prolonged spontaneous dizziness/vertigo, recurrent spontaneous dizziness/vertigo, recurrent positional vertigo, or chronic persistent dizziness and imbalance. Vestibular neuritis and stroke are key disorders causing acute prolonged spontaneous dizziness/vertigo, but the diagnosis of isolated vascular vertigo has increased by virtue of developments in clinical neurotology and neuroimaging. However, a well-organized bedside examination appears more sensitive than brain imaging in diagnosing strokes presenting with acute dizziness/vertigo. A detailed history is vital to diagnose recurrent spontaneous dizziness/vertigo since confirmatory diagnostic tests are usually unavailable. Isolated positional vertigo is usually caused by benign paroxysmal positional vertigo, which can be treated at the bedside. In recent years, marked progress has occurred in the evaluation/management of acute dizziness/vertigo. However, even with developments in imaging technology, the diagnosis of acute dizziness/vertigo largely relies on bedside examination.
BibTeX: @article{Jung2015, author = {Jung, Ileok and Kim, Ji-Soo}, title = {Approach to dizziness in the emergency department.}, journal = {Clinical and experimental emergency medicine}, year = {2015}, volume = {2}, issue = {2}, pages = {75--88}, doi = {https://doi.org/10.15441/ceem.15.026}, keywords = {Benign paroxysmal positional vertigo; Dizziness; Emergency service, hospital; Stroke; Vertigo}, pmid = {27752577} }
Stewart, K.E., Whelan, D.M. and Banerjee, A.	Are Cervical Collars a Necessary Postprocedure Restriction in Patients With Benign Paroxysmal Positional Vertigo Treated With Particle Repositioning Maneuvers? [Abstract] [BibTeX]	2017	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 38(6), pp. 860-864	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is managed with particle repositioning maneuvers (PRM), following which patients are advised of activity restrictions to prevent recurrence. This can include wearing a cervical collar. Does the use of BPPV postprocedure restriction with a cervical collar impact on the number of PRMs required to resolve a patient's symptoms? Combination of retrospective and prospective review of 624 patients treated in a tertiary UK hospital. All were diagnosed with posterior canal BPPV and received a modified Epley maneuver (PRM). The "with cervical collar" (WC) retrospective group 2002 to 2009 (n = 263) were advised to wear a cervical collar for 48 hours postprocedure, and the "no cervical collar" (NC) prospective group 2010 to 2014 (n = 361) were not. The main outcome measure was the resolution of patient symptoms following a PRM for BPPV. Quantitative and statistical analysis using χ test was undertaken. In the WC group, 84% (n = 221) had resolution of symptoms after the first PRM, versus 82.8% (n = 299) in the NC group. After the second PRM 11% (n = 29) resolved, versus 13.6% (n = 49) in the NC group. After the third PRM 4.9% (n = 13) resolved, versus 3.6% (n = 13) in the NC group. Both clinically and statistically there was no significant difference in outcome between groups. Our review of 624 patients is the largest study in this subject and the results demonstrate that wearing a cervical collar following PRM for BPPV concedes no significant benefit. Excluding this from postprocedure guidance allows patients to manage without the inconvenience of wearing a cervical collar, and allows departments to update clinical guidance.
BibTeX: @article{Stewart2017, author = {Stewart, Kirsten E and Whelan, Darren M and Banerjee, Anirvan}, title = {Are Cervical Collars a Necessary Postprocedure Restriction in Patients With Benign Paroxysmal Positional Vertigo Treated With Particle Repositioning Maneuvers?}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2017}, volume = {38}, issue = {6}, pages = {860--864}, doi = {https://doi.org/10.1097/MAO.0000000000001406}, keywords = {Adult; Benign Paroxysmal Positional Vertigo, therapy; Braces; Female; Humans; Male; Middle Aged; Patient Positioning, methods; Prospective Studies; Recurrence; Retrospective Studies}, pmid = {28595257} }
Bashir, K., Qotb, M.A., Alkahky, S., Fathi, A.M., Mohamed, M.A. and Cameron, P.A.	Are emergency physicians and paramedics providing canalith repositioning manoeuvre for benign paroxysmal positional vertigo? [BibTeX]	2015	Emergency medicine Australasia : EMA Vol. 27(2), pp. 179-180	article	DOI
BibTeX: @article{Bashir2015a, author = {Bashir, Khalid and Qotb, Mohamed Abdelkader and Alkahky, Sherif and Fathi, Ahmed Mohamed and Mohamed, Mona Ahmed and Cameron, Peter A}, title = {Are emergency physicians and paramedics providing canalith repositioning manoeuvre for benign paroxysmal positional vertigo?}, journal = {Emergency medicine Australasia : EMA}, year = {2015}, volume = {27}, issue = {2}, pages = {179--180}, doi = {https://doi.org/10.1111/1742-6723.12362}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis, therapy; Emergency Medical Services; Emergency Medical Technicians; Emergency Service, Hospital; Humans; Patient Positioning, methods; Practice Patterns, Physicians', statistics & numerical data; Semicircular Canals}, pmid = {25651159} }
Fyrmpas, G., Rachovitsas, D., Haidich, A.B., Constantinidis, J., Triaridis, S., Vital, V. and Tsalighopoulos, M.	Are postural restrictions after an Epley maneuver unnecessary? First results of a controlled study and review of the literature. [Abstract] [BibTeX]	2009	Auris, nasus, larynx Vol. 36(6), pp. 637-643	article	DOI
Abstract: Postural restrictions after canalith repositioning maneuvers (CRM) for benign paroxysmal positional vertigo of the posterior semicircular canal (p-BPPV) have no proven value and therefore most physicians regard them as unnecessary. The aim of this study was to assess the short-term efficacy of head and body movement limitations after a single Epley maneuver. A review of the literature was performed to assess the current level of evidence for the efficacy of postural restrictions. Sixty-four patients, median age 59 years (range 37-82 years), with p-BPPV, were allocated either to instructions for movement restrictions or free movements for 48 h after a single Epley maneuver. The minimization method was used for allocation to treatment. This procedure 'minimizes' the differences in the distribution of pre-specified prognostic factors (e.g. sex and age) between the two groups of treatment. Minimization was preferred over randomization which is not as effective in balancing baseline characteristics when the number of participants is small. Outcome was assessed by physician and patient reported measures (Dix-Hallpike test, subjective vertigo intensity in a 10-point scale, patient's assessment of improvement) within 1 week after treatment by an independent investigator. The level of statistical significance was 0.05. More patients with movement restrictions reported a subjective improvement after treatment (p=0.007). Ninety percent of patients with movement restrictions and 74.2% of patients with free movements had a negative follow up Dix-Hallpike test but the difference was not significant (p=0.108). The mean pre-treatment vertigo intensity was reduced from 6.07 and 5.97 to 1.18 and 2.86, respectively but the difference was not significant (p=0.122). Postural restrictions do not increase the efficacy of the canal-repositioning maneuver despite the fact that patients report a subjective improvement after post-procedural instructions. In the review of the literature, all studies except one conclude that postural restrictions are unnecessary. However, a number of methodological issues such as inadequate sample size are not addressed and more conclusive evidence is required. Based on current evidence, the use of postural restrictions after the canal-repositioning maneuver is unjustified.
BibTeX: @article{Fyrmpas2009, author = {Fyrmpas, Georgios and Rachovitsas, Demitrios and Haidich, Anna Bettina and Constantinidis, Jiannis and Triaridis, Stefanos and Vital, Victor and Tsalighopoulos, Meltiadis}, title = {Are postural restrictions after an Epley maneuver unnecessary? First results of a controlled study and review of the literature.}, journal = {Auris, nasus, larynx}, year = {2009}, volume = {36}, issue = {6}, pages = {637--643}, doi = {https://doi.org/10.1016/j.anl.2009.04.004}, keywords = {Adult; Aged; Aged, 80 and over; Female; Head Movements, physiology; Humans; Immobilization; Male; Middle Aged; Otolithic Membrane, physiopathology; Posture, physiology; Prognosis; Prospective Studies; Semicircular Canals, physiopathology; Treatment Outcome; Vertigo, physiopathology, therapy}, pmid = {19410397} }
De Stefano, A., Dispenza, F., Citraro, L., Petrucci, A.G., Di Giovanni, P., Kulamarva, G., Mathur, N. and Croce, A.	Are postural restrictions necessary for management of posterior canal benign paroxysmal positional vertigo? [Abstract] [BibTeX]	2011	The Annals of otology, rhinology, and laryngology Vol. 120(7), pp. 460-464	article	DOI
Abstract: An important component of management of benign paroxysmal positional vertigo (BPPV) has been the application of postural restrictions after use of a canalith repositioning maneuver (CRM) to prevent the return of otolithic debris into the posterior semicircular canal (PSC). This study was designed to explore the effectiveness of postural restrictions in patients with BPPV caused by otolithic debris in the PSC. Seventy-four adult patients with unilateral PSC BPPV were enrolled into this study. All patients were managed with a CRM--either the modified Epley maneuver or the Semont maneuver. The patients were divided randomly into 2 groups: group A, with postural restrictions, and group B, without postural restrictions. The statistical analysis was performed with X2 tests and t-tests. No patients in either group showed positional nystagmus in the posttreatment evaluation under infrared videonystagmoscopy. No patients had symptoms of vertigo after the therapy. The results of follow-up vestibular tests were normal in both groups. In our experience, postural restrictions do not enhance the beneficial effect of the CRMs. They do not seem to have any protective role and therefore should not be recommended as an adjunct to the treatment of PSC BPPV.
BibTeX: @article{DeStefano2011, author = {De Stefano, Alessandro and Dispenza, Francesco and Citraro, Leonardo and Petrucci, Anna Grazia and Di Giovanni, Pamela and Kulamarva, Gautham and Mathur, Navneet and Croce, Adelchi}, title = {Are postural restrictions necessary for management of posterior canal benign paroxysmal positional vertigo?}, journal = {The Annals of otology, rhinology, and laryngology}, year = {2011}, volume = {120}, issue = {7}, pages = {460--464}, doi = {https://doi.org/10.1177/000348941112000707}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Female; Humans; Male; Middle Aged; Posture; Prospective Studies; Recurrence; Treatment Outcome; Vertigo, prevention & control, therapy; Young Adult}, pmid = {21859055} }
Soto-Varela, A., Santos-Perez, S., Rossi-Izquierdo, M. and Sanchez-Sellero, I.	Are the three canals equally susceptible to benign paroxysmal positional vertigo? [Abstract] [BibTeX]	2013	Audiology & neuro-otology Vol. 18(5), pp. 327-334	article	DOI
Abstract: A prospective study of patients diagnosed with 'single-canal' benign paroxysmal positional vertigo (BPPV) was performed. Demographic, etiological and prognostic differences between patients with posterior, horizontal and superior canal BPPV were studied. A total of 614 patients diagnosed in a period of 11 years and with a follow-up period of at least 1 year were included in the study. The posterior semicircular canal was affected in 543 casas (88.4%), the horizontal in 39 (6.4%) and the superior canal in 32 (5.2%). Final status at the end of the follow-up period was better in posterior canal BPPV (95% cure) than in horizontal or superior canal BPPV (87% cure in both cases). This may be explained by two facts: a poorer initial response to repositioning maneuvers in anterior canal BPPV than in BPPV involving the other two canals, and a poorer response to maneuvers in recurrences of horizontal canal BPPV.
BibTeX: @article{Soto-Varela2013, author = {Soto-Varela, Andrés and Santos-Perez, Sofia and Rossi-Izquierdo, Marcos and Sanchez-Sellero, Ines}, title = {Are the three canals equally susceptible to benign paroxysmal positional vertigo?}, journal = {Audiology & neuro-otology}, year = {2013}, volume = {18}, issue = {5}, pages = {327--334}, doi = {https://doi.org/10.1159/000354649}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Female; Head Movements, physiology; Humans; Male; Middle Aged; Patient Positioning; Posture, physiology; Prospective Studies; Semicircular Canals, physiopathology; Vertigo, physiopathology, therapy; Vestibular Function Tests}, pmid = {24080713} }
Burston, A., Mossman, S. and Weatherall, M.	Are there diurnal variations in the results of the Dix-Hallpike manoeuvre? [Abstract] [BibTeX]	2012	Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia Vol. 19(3), pp. 415-417	article	DOI
Abstract: This study examines diurnal variation in the result of the Dix-Hallpike manoeuvre when testing for benign paroxysmal positional vertigo in a randomised crossover study of the order of diagnostic testing in a community out-reach clinic for a tertiary neurological centre in Wellington, New Zealand. Study participants were adults referred for physiotherapy treatment. Dix-Hallpike manoeuvres were performed to both ears, and groups were randomly allocated to have a morning, then afternoon, sequence of testing or vice versa. The results of the Dix-Hallpike manoeuvres were digitally recorded and reviewed by a second blinded assessor. A total of 27 of 50 participants (54%) tested positive on at least one of the days, six of 27 (22%) had discordant results. The difference in marginal proportions was 0% (95% confidence interval: -9.6 to 9.6), p=1.0. The time of day is not a factor in false negative Dix-Hallpike manoeuvres, although 22% of those with positive results tested negative on one of the two measurements.
BibTeX: @article{Burston2012, author = {Burston, Anne and Mossman, Stuart and Weatherall, Mark}, title = {Are there diurnal variations in the results of the Dix-Hallpike manoeuvre?}, journal = {Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia}, year = {2012}, volume = {19}, issue = {3}, pages = {415--417}, doi = {https://doi.org/10.1016/j.jocn.2011.08.011}, keywords = {Aged; Benign Paroxysmal Positional Vertigo; Circadian Rhythm, physiology; Cross-Over Studies; Data Interpretation, Statistical; Dizziness, diagnosis; Double-Blind Method; False Positive Reactions; Female; Humans; Male; Middle Aged; Neurologic Examination, methods; Reproducibility of Results; Treatment Outcome; Vertigo, diagnosis}, pmid = {22249017} }
Nomura, Y.	Argon laser irradiation of the semicircular canal in two patients with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2002	The Journal of laryngology and otology Vol. 116(9), pp. 723-725	article	DOI
Abstract: The results of long-term follow-up after surgical treatment of two patients with intractable benign paroxysmal positional vertigo are reported. Argon laser irradiation of the blue-lined posterior and lateral semicircular canals in one patient, and of only the posterior canal in the other was performed seven and six years ago, respectively. Argon laser irradiation was carried out 10 times in succession three mm along the canal to occlude it. The power applied each time was 1.5 W on the dial of the laser device for 0.5 sec. Relief of vertigo was noted on the second post-irradiation day. There has been no recurrence of vertigo in these patients.
BibTeX: @article{Nomura2002, author = {Nomura, Yasuya}, title = {Argon laser irradiation of the semicircular canal in two patients with benign paroxysmal positional vertigo.}, journal = {The Journal of laryngology and otology}, year = {2002}, volume = {116}, issue = {9}, pages = {723--725}, doi = {https://doi.org/10.1258/002221502760238046}, keywords = {Aged; Argon; Female; Follow-Up Studies; Humans; Laser Therapy, methods; Middle Aged; Semicircular Canals, surgery; Vertigo, surgery; Wounds, Penetrating, complications}, pmid = {12437810} }
Unal, M. and Bagdatoglu, C.	Arnold-Chiari type I malformation presenting as benign paroxysmal positional vertigo in an adult patient. [Abstract] [BibTeX]	2007	The Journal of laryngology and otology Vol. 121(3), pp. 296-298	article	DOI
Abstract: Arnold-Chiari malformations are a group of congenital hindbrain and spinal cord abnormalities characterized by herniation of the contents of the posterior cranial fossa caudally through the foramen magnum into the upper cervical spine. It is important to recognize Arnold-Chiari type I malformation in the differential diagnosis of adult vertigo cases. We present a 51-year-old patient with Arnold-Chiari type I malformation that was initially diagnosed as posterior semicircular canal benign paroxysmal positional vertigo.
BibTeX: @article{Unal2007, author = {Unal, M and Bagdatoglu, C}, title = {Arnold-Chiari type I malformation presenting as benign paroxysmal positional vertigo in an adult patient.}, journal = {The Journal of laryngology and otology}, year = {2007}, volume = {121}, issue = {3}, pages = {296--298}, doi = {https://doi.org/10.1017/S0022215106003082}, keywords = {Arnold-Chiari Malformation, complications, diagnosis, surgery; Diagnosis, Differential; Female; Humans; Magnetic Resonance Imaging; Middle Aged; Vertigo, etiology}, pmid = {17166331} }
Wada, M., Naganuma, H., Tokumasu, K., Hashimoto, S.-i., Ito, A. and Okamoto, M.	Arteriosclerotic changes as background factors in patients with peripheral vestibular disorders. [Abstract] [BibTeX]	2008	The international tinnitus journal Vol. 14(2), pp. 131-134	article
Abstract: Symptoms such as vertigo and unsteady gait occur in various diseases and are among the relatively common chief complaints. Even at present, the mechanisms underlying these disorders are unclear. We considered the possibility of peripheral vestibular disorders correlating with lifestyle-related illnesses. Under these circumstances, we assessed correlations of lifestyle-related illness as background factors for peripheral vestibular disorders and associated arteriosclerotic changes. Using carotid ultrasonography, we assessed maximum intima-media thickness (max IMT) and maximum common carotid artery IMT and evaluated biochemical examinations in 85 patients with peripheral vertigo. The patients were divided into two groups: those with benign paroxysmal positional vertigo (BPPV) and those with peripheral vestibular disorders. The frequency of abnormal IMT was significantly higher in those in the BPPV group. Calculating for average age, max IMT was significantly higher in the BPPV group. The correlation coefficient between age and max IMT was 0.343 (p < .001). All other correlation coefficients also reached statistical significance. Our results indicate that cervical ultrasonography is useful for noninvasive examination of arteriosclerotic changes in patients with peripheral vestibular disorders. Our results also indicated that peripheral vestibular disorder patients show progression of arteriosclerotic changes.
BibTeX: @article{Wada2008, author = {Wada, Masaoki and Naganuma, Hideaki and Tokumasu, Koji and Hashimoto, Shin-ichiro and Ito, Akihiko and Okamoto, Makito}, title = {Arteriosclerotic changes as background factors in patients with peripheral vestibular disorders.}, journal = {The international tinnitus journal}, year = {2008}, volume = {14}, issue = {2}, pages = {131--134}, keywords = {Age Factors; Aged; Carotid Artery Diseases, complications, diagnostic imaging; Carotid Artery, Common, diagnostic imaging; Carotid Artery, Internal, diagnostic imaging; Female; Humans; Life Style; Male; Meniere Disease, diagnostic imaging, etiology; Middle Aged; Risk Factors; Tunica Intima, diagnostic imaging; Tunica Media, diagnostic imaging; Ultrasonography; Vertigo, diagnostic imaging, etiology; Vestibular Neuronitis, diagnostic imaging, etiology}, pmid = {19205164} }
Lindell, E., Finizia, C., Johansson, M., Karlsson, T., Nilson, J. and Magnusson, M.	Asking about dizziness when turning in bed predicts examination findings for benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2018	Journal of vestibular research : equilibrium & orientation Vol. 28(3-4), pp. 339-347	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is the single most common cause of vestibular vertigo and is characterised by short episodes of rotational vertigo precipitated by changes in head positions like lying down or turning in bed. This study aims to assess useful questions when suspecting benign paroxysmal positional vertigo (BPPV) caused dizziness as well as identifying if a single question can be useful in identify or distinguish patients with BPPV from other dizziness aetiology. A total of 149 patients admitted due to dizziness were included. Patients answered a questionnaire and were investigated for BPPV with diagnostic manoeuvres. Two of the 15 questions were of diagnostic importance. Dizziness when laying down or turning in bed, increased likelihood of BPPV by an odds ratio (95% confidence interval) of 60 (7.47-481.70). Continuous dizziness duration as opposed to lasting seconds decreased likelihood of BPPV with an odds ratio of 0.06 (0.01-0.27). Vertiginous attacks by turning or laying down in bed together with dizziness <1 minute, are important questions and strongly related to BPPV. Such questions are important when taking a medical history and may help to early identify BPPV, also for non-medical staff, as well as reduce the need of further investigations.
BibTeX: @article{Lindell2018, author = {Lindell, Ellen and Finizia, Caterina and Johansson, Mia and Karlsson, Therese and Nilson, Jerker and Magnusson, Måns}, title = {Asking about dizziness when turning in bed predicts examination findings for benign paroxysmal positional vertigo.}, journal = {Journal of vestibular research : equilibrium & orientation}, year = {2018}, volume = {28}, issue = {3-4}, pages = {339--347}, doi = {https://doi.org/10.3233/VES-180637}, keywords = {BPPV; diagnosis; dizziness; prevalence; vertigo}, pmid = {30149484} }
Childs, L.A.	Assessing vestibular dysfunction. Exploring treatments of a complex condition. [Abstract] [BibTeX]	2010	Rehab management Vol. 23(6), pp. 24-25	article
Abstract: In summary, patients with BPPV can be treated with the canalith repositioning maneuver. Patients with unilateral vestibular hypofunction can be treated using adaptation, substitution, and/or habituation exercises. Patients with motion sensitivity can demonstrate improved tolerance to motion after performing habituation exercises. Patients with bilateral vestibular loss will benefit from substitution and adaptation exercises. Each patient requires a treatment regime that is individualized and appropriate to address their impairments. Often the treatment is determined through the evaluation process. The task that causes the patient's complaints, whether it be dizziness, imbalance, and/or issues with eye-head coordination, often becomes the treatment of choice, gradually increasing difficulty as appropriate and safe. Patients with TBI who have concomitant vestibular dysfunction are a challenging population to treat. One has to be cognizant of cognitive deficits that may interfere with or prolong treatment as well as the many other neurological deficits that may be present because of the brain injury. For example, attempting to perform the canalith repositioning maneuver on a patient status post TBI when they are not able to comprehend the reasoning behind the treatment can lead to agitation or behavioral issues. Communication with the patient's primary doctor is a necessity so that the team is always on the same page about the approach to treatment. Vestibular evaluation and rehabilitation are a necessity for patients who have experienced a TBI. The sooner the problems are identified, the sooner treatment can be initiated with the goal of helping patients recover their maximal functional level of independence and safety. Also, treating patients with TBI and vestibular impairments can require increased treatment time in comparison to treatment of a patient with only vestibular dysfunction, so the sooner the treatment for vestibular dysfunction can be started, the better for the patient with TBI.
BibTeX: @article{Childs2010, author = {Childs, Lisa A}, title = {Assessing vestibular dysfunction. Exploring treatments of a complex condition.}, journal = {Rehab management}, year = {2010}, volume = {23}, issue = {6}, pages = {24--25}, keywords = {Brain Injuries, rehabilitation; Humans; Vertigo, rehabilitation; Vestibular Diseases, rehabilitation; Vestibular Function Tests}, pmid = {20614769} }
Abbott, J., Tomassen, S., Lane, L., Bishop, K. and Thomas, N.	Assessment for benign paroxysmal positional vertigo in medical patients admitted with falls in a district general hospital. [Abstract] [BibTeX]	2016	Clinical medicine (London, England) Vol. 16(4), pp. 335-338	article	DOI
Abstract: Having benign paroxysmal positional vertigo (BPPV) puts patients at a significantly higher risk of falling. It is poorly recognised and diagnosis is frequently delayed. BPPV has been studied in outpatient settings, but there have been no studies looking at the prevalence in patients admitted with falls. This study aims to establish how common BPPV is in these patients.For a 4-month period, patients admitted on an unselected medical take were screened for an admission precipitated by a fall. Patients who consented were assessed for BPPV using the Dix-Hallpike manoeuvre. Patients who tested positive were treated using the Epley manoeuvre. The assessments were carried out by specialist physiotherapists who were experienced at assessing and diagnosing patients with peripheral vestibular disorders. Out of the 111 patients initially identified, 37 (33%) were considered to be appropriate and consented to be part of the study. Of these, 20 patients (54%) had a positive Dix-Hallpike manoeuvre.Of the patients included in the study, over half tested positive for BPPV. This merits further study. Potentially, there is a proportion of patients admitted with falls who have an easily treatable contributing factor that is not being identified with standard practice.
BibTeX: @article{Abbott2016, author = {Abbott, Joel and Tomassen, Sylvia and Lane, Laura and Bishop, Katie and Thomas, Nibu}, title = {Assessment for benign paroxysmal positional vertigo in medical patients admitted with falls in a district general hospital.}, journal = {Clinical medicine (London, England)}, year = {2016}, volume = {16}, issue = {4}, pages = {335--338}, doi = {https://doi.org/10.7861/clinmedicine.16-4-335}, keywords = {Accidental Falls, prevention & control; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, diagnosis, physiopathology; Female; Hospitals, General; Humans; Inpatients; Male; Patient Admission; Prospective Studies; BPPV; Falls; vertigo}, pmid = {27481376} }
Chancellor, A.M.	Assessment for benign paroxysmal positioning vertigo in medical patients admitted with falls in a district general hospital. [BibTeX]	2016	Clinical medicine (London, England) Vol. 16(6), pp. 607	article	DOI
BibTeX: @article{Chancellor2016, author = {Chancellor, Andrew M}, title = {Assessment for benign paroxysmal positioning vertigo in medical patients admitted with falls in a district general hospital.}, journal = {Clinical medicine (London, England)}, year = {2016}, volume = {16}, issue = {6}, pages = {607}, doi = {https://doi.org/10.7861/clinmedicine.16-6-607a}, keywords = {Accidental Falls; Benign Paroxysmal Positional Vertigo; Hospitalization; Hospitals, District; Hospitals, General; Humans}, pmid = {27927836} }
Britt, C.J., Ward, B.K., Owusu, Y., Friedland, D., Russell, J.O. and Weinreich, H.M.	Assessment of a Statistical Algorithm for the Prediction of Benign Paroxysmal Positional Vertigo. [Abstract] [BibTeX]	2018	JAMA otolaryngology-- head & neck surgery Vol. 144(10), pp. 883-886	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is an otologic pathologic condition defined as a sensation of spinning triggered by changes in head position relative to gravity and caused by an entrapment of fragmented endolymph debris most commonly in the posterior semicircular canal. Confirmation of diagnosis requires experience with procedures that are poorly known by those other than practitioners with advanced otologic training. The complexity in the diagnosis of BPPV inspired the design of a questionnaire-based algorithm that would be useful for determining a vestibular diagnosis and treatment options. To assess a statistical algorithm for the diagnosis of BPPV in a busy tertiary care setting, with the long-term goal of implementing a clinical pathway to efficiently diagnose and treat patients with dizziness. In this retrospective case series, 200 patients who visited the Department of Otolaryngology-Head and Neck Surgery at Johns Hopkins University School of Medicine for their initial vertigo symptoms from September 1, 2016, to December 31, 2016, were assessed. Use of a validated patient questionnaire as a tool to differentiate patients with dizziness in an electronic medical record review. Linear predictor (LP) value based on the questionnaire for the diagnosis of BPPV. Of the 200 patient visits reviewed (132 [66%] female), 106 (53.0%; 68 [64%] female) had the information necessary to calculate the LP value and had a confirmed final diagnosis. On the basis of an LP value of 0.2 or greater, the sensitivity for a diagnosis of BPPV was 0.75 and the specificity was 1.0. The positive predictive value was 1.0, whereas the negative predictive value was 0.96. Patients with BPPV had a statistically significantly different LP value (odds ratio, 5.92; 95% CI, 2.73-12.83) than did patients without BPPV. The findings of this study suggest that the algorithm is efficient for the diagnosis of BPPV in a clinical care setting.
BibTeX: @article{Britt2018, author = {Britt, Christopher J and Ward, Bryan K and Owusu, Yaw and Friedland, David and Russell, Jonathon O and Weinreich, Heather M}, title = {Assessment of a Statistical Algorithm for the Prediction of Benign Paroxysmal Positional Vertigo.}, journal = {JAMA otolaryngology-- head & neck surgery}, year = {2018}, volume = {144}, issue = {10}, pages = {883--886}, doi = {https://doi.org/10.1001/jamaoto.2018.1657}, pmid = {30178063} }
Dawoud, E.A.E., Ismail, E.I., Eltoukhy, S.A.-G. and El-Sharabasy, A.E.-S.	Assessment of auditory and vestibular functions in vitiligo patients. [Abstract] [BibTeX]	2017	Journal of otology Vol. 12(3), pp. 143-149	article	DOI
Abstract: To evaluate audiological and vestibular functions via basic audiological evaluation, otoacoustic emissions and videonystagmography (VNG) in vitiligo patients. 30 vitiligo patients (8 acrofacial and 22 mixed types) as the study group and 30 normal healthy adults as the control group were included in the study. All participants were submitted to basic audiological evaluation, transient and distortion product otoacoustic emmisions (TEOAEs and DPOAEs), vestibular assessment including history taking, office tests and videonystagmography (VNG) and dermatological assessment to determine type, percent of body surface area involvement and duration of vitiligo. This study showed statistically significant difference between control and study groups in pure tone audiometry (PTA) and otoacoustic emissions results. Fifty percent of vitiligo patients had peripheral vestibular disorders (10 vestibular neuritis and 5 posterior canal benign paroxysmal positional vertigo. The results in this study showed that 50% of vitiligo patients suffered from peripheral vestibular disorders in addition to auditory affection. Vitiligo patients require routine monitoring for auditory and vestibular functions for early identification and monitoring of changes as the disease progress.
BibTeX: @article{Dawoud2017, author = {Dawoud, Eman Abd Elmohsin and Ismail, Elshahat Ibrahem and Eltoukhy, Soheir Abdel-Gaber and El-Sharabasy, Ayman El-Saeed}, title = {Assessment of auditory and vestibular functions in vitiligo patients.}, journal = {Journal of otology}, year = {2017}, volume = {12}, issue = {3}, pages = {143--149}, doi = {https://doi.org/10.1016/j.joto.2017.07.001}, keywords = {Otoacoustic emissions; Videonystagmography; Vitiligo}, pmid = {29937850} }
Wu, Y., Fan, Z., Jin, H., Guan, Q., Zhou, M., Lu, X., Li, L., Yan, W., Gu, C., Chen, C. and Han, W.	Assessment of Bone Metabolism in Male Patients With Benign Paroxysmal Positional Vertigo. [Abstract] [BibTeX]	2018	Frontiers in neurology Vol. 9, pp. 742	article	DOI
Abstract: Several studies have suggested a probable association between benign paroxysmal positional vertigo (BPPV) and both reduction of bone mineral density (BMD) and serum vitamin D levels, but none of these studies have explored their findings by examining bone turnover markers (BTM) in male idiopathic BPPV patients. This study aimed to evaluate the relationship between BMD and serum 25-hydroxyvitamin D (25(OH) D), with the occurrence of BPPV along with the characteristics of bone metabolism in male idiopathic BPPV patients. This retrospective study comprised 60 male idiopathic BPPV patients and 92 age-matched healthy controls referred to Ningbo No.2 Hospital during the period of February 2016 to February 2018. All subjects' serum levels of 25(OH) D, bone formation marker amino-terminal propeptide of type I procollagen (PINP), and bone resorption marker β-isomerized carboxy-terminal telopeptide of type I collagen (β-CTX) were measured. BMD was determined by dual energy X-ray absorption at the lumbar spine and hip. Among male patients with BPPV, the prevalence of BMD reduction was 35.0%, which was similar to that of 27.2% in healthy controls. There were significant differences in the mean serum 25(OH) D level and prevalence of vitamin D deficiency between the two groups, with -values of 0.049 and 0.009, respectively. The bone turnover markers of PINP and β-CTX in BPPV patients were lower than those in healthy controls. Logistic regression showed that vitamin D deficiency were associated with BPPV with an odds ratio of 3.8 (95% confidence interval = 1.25-11.73). Our study found that decreased serum vitamin D may be a risk factor for BPPV in male patients. The level of bone turnover among male patients with BPPV was lower than that among healthy controls.
BibTeX: @article{Wu2018a, author = {Wu, Yunqin and Fan, Zhenyi and Jin, Hang and Guan, Qiongfeng and Zhou, Min and Lu, Xiaoxiong and Li, Li and Yan, Wang and Gu, Chengyao and Chen, Caijing and Han, Weiwei}, title = {Assessment of Bone Metabolism in Male Patients With Benign Paroxysmal Positional Vertigo.}, journal = {Frontiers in neurology}, year = {2018}, volume = {9}, pages = {742}, doi = {https://doi.org/10.3389/fneur.2018.00742}, keywords = {25-hydroxyvitamin D; benign paroxysmal positional vertigo; bone mineral density; bone turnover markers; vitamin D deficiency}, pmid = {30233488} }
Dunlap, P.M., Khoja, S.S., Whitney, S.L. and Freburger, J.K.	Assessment of Physician Adherence to Guidelines for the Diagnosis and Treatment of Benign Paroxysmal Positional Vertigo in Ambulatory Care Settings. [BibTeX]	2018	JAMA otolaryngology-- head & neck surgery Vol. 144(9), pp. 845-846	article	DOI
BibTeX: @article{Dunlap2018, author = {Dunlap, Pamela M and Khoja, Samanaaz S and Whitney, Susan L and Freburger, Janet K}, title = {Assessment of Physician Adherence to Guidelines for the Diagnosis and Treatment of Benign Paroxysmal Positional Vertigo in Ambulatory Care Settings.}, journal = {JAMA otolaryngology-- head & neck surgery}, year = {2018}, volume = {144}, issue = {9}, pages = {845--846}, doi = {https://doi.org/10.1001/jamaoto.2018.1859}, pmid = {30128474} }
Wang, Y., Xia, F., Wang, W. and Hu, W.	Assessment of sleep quality in benign paroxysmal positional vertigo recurrence. [Abstract] [BibTeX]	2018	The International journal of neuroscience, pp. 1-7	article	DOI
Abstract: Despite the availability of highly effective treatments, there is a significant recurrence rate of benign paroxysmal positional vertigo (BPPV). This study is aimed to quantitatively measure sleep quality in BPPV patients and correlate it with the recurrence of BPPV. In this longitudinal cohort study, the clinical records of 67 elderly or middle-aged adult patients who were diagnosed with BPPV at Neurology Clinic, Beijing Chaoyang Hospital affiliated to Capital Medical University between 2013 and 2014. The 'recurrent' and 'non-recurrent' BPPV were respectively defined. Primary data collection included the medical history, blood test and Pittsburgh Sleep Quality Index measurement. Among the total 67 patients after successful treatment, recurrent BPPV is observed in 37.31% patients (n = 25) within 2 years. Among all 11 variables analyzed between recurrent and non-recurrent groups, only the Pittsburgh Sleep Quality Index (PSQI) scores showed significant difference (p<.001). In details, these differences were also measured in five individual sleep items, including the subjective assessment of sleep quality, sleep latency, sleep duration, the use of sleep-aid medication and daytime dysfunctions (all p<.05). Regression analysis showed patients with higher PSQI score (lower sleep quality) had higher risk of BPPV recurrence [odds ratio (OR)=1.17, 95% confidence interval (CI): 1.04-1.32, p=.0082]. The sleep quality in patients with BPPV recurrence is significantly poorer compared to non-recurrent patients. Our result suggested sleep quality as measured by PSQI is an independent risk factor of BPPV recurrence.
BibTeX: @article{Wang2018e, author = {Wang, Yun and Xia, Fei and Wang, Wei and Hu, Wenli}, title = {Assessment of sleep quality in benign paroxysmal positional vertigo recurrence.}, journal = {The International journal of neuroscience}, year = {2018}, pages = {1--7}, doi = {https://doi.org/10.1080/00207454.2018.1486835}, keywords = {Benign paroxysmal positional vertigo; Pittsburgh Sleep Quality Index; recurrence; sleep quality}, pmid = {29883234} }
Valente, L.M.	Assessment techniques for vestibular evaluation in pediatric patients. [Abstract] [BibTeX]	2011	Otolaryngologic clinics of North America Vol. 44(2), pp. 273-90, vii	article	DOI
Abstract: In this article the author describes in detail the adaptation of adult vestibular testing techniques to the pediatric population. Assessment tools discussed include video-oculography (VOG), computerized rotary chair (CRC), computerized dynamic posturography (CDP), and vestibular evoked myogenic potentials (VEMPs). As with hearing impairment, the earlier a vestibular disorder is identified, the earlier remediation strategies may begin. Among the most crucial aspects of vestibular testing in pediatric patients are obtaining of pediatric normative data and adapting adult techniques so that younger children may be evaluated.
BibTeX: @article{Valente2011, author = {Valente, L Maureen}, title = {Assessment techniques for vestibular evaluation in pediatric patients.}, journal = {Otolaryngologic clinics of North America}, year = {2011}, volume = {44}, issue = {2}, pages = {273--90, vii}, doi = {https://doi.org/10.1016/j.otc.2011.01.002}, keywords = {Benign Paroxysmal Positional Vertigo; Child; Electronystagmography; Humans; Physical Examination; Vertigo, diagnosis; Vestibular Diseases, diagnosis; Vestibular Evoked Myogenic Potentials; Vestibular Function Tests}, pmid = {21474004} }
Han, C., Lim, Y.-H., Jung, K. and Hong, Y.-C.	Association between ambient particulate matter and disorders of vestibular function. [Abstract] [BibTeX]	2017	Environmental research Vol. 155, pp. 242-248	article	DOI
Abstract: Exposure to environmental chemicals has been suggested to alter the physiologic state of the inner and middle ear. However, it is unknown if particulate matter exposure is associated with acute vestibular dysfunction. To estimate the effects of particulate matter exposure on the number of hospital visits related to three major diseases of vestibular dysfunction, Meniere's disease (MD), benign paroxysmal positional vertigo (BPPV), and vestibular neuronitis (VN). Our study subject is from Korean National Health Insurance Service-National Sample Cohort, which is dynamic cohort consist of 1 million participants representing the Korean population. Among total cohort participants, we used the hospital visit data of 210,000 individuals who resided in Seoul from 2007 to 2010. Time series analysis using the Poisson generalized additive model and case-crossover analysis using conditional logistic regression were used to investigate the association between daily particulate matter levels (PM , particulate matter <2.5μg/m ; PM , particulate matter <10μg/m ; PM , PM - PM ) and number of MD, BPPV, and VN hospital visits. Time series analysis showed that an interquartile range (IQR) increase in PM and PM on lag day 1 was associated with an increased risk of MD hospital visits [relative risk (RR), 95% confidence interval (CI), PM : 1.09 (1.02-1.15); PM : 1.06 (1.02-1.10)]. In addition, elderly individuals (≥60 years old) showed an increased risk of MD hospital visits after particulate matter exposure when compared to younger individuals. An IQR increase in particulate matter on lag day 1 was associated with a marginally significant increase in VN hospital visits [RR (95%CI), PM : 1.11 (0.98-1.25); PM : 1.07 (0.99-1.15); PM : 1.04 (0.99-1.09)]. However, no association between particulate matter exposure and BPPV hospital visits was noted. Case-crossover analyses showed similar results to the time-series analysis across all three diseases. MD hospital visits were associated with ambient particulate matter exposure. Elderly individuals, in particular, were more susceptible to particulate matter exposure than younger individuals.
BibTeX: @article{Han2017, author = {Han, Changwoo and Lim, Youn-Hee and Jung, Kweon and Hong, Yun-Chul}, title = {Association between ambient particulate matter and disorders of vestibular function.}, journal = {Environmental research}, year = {2017}, volume = {155}, pages = {242--248}, doi = {https://doi.org/10.1016/j.envres.2017.02.013}, keywords = {Air Pollutants, analysis; Benign Paroxysmal Positional Vertigo, epidemiology; Environmental Monitoring; Female; Hospitalization, statistics & numerical data; Humans; Male; Meniere Disease, epidemiology; Middle Aged; Particulate Matter, analysis; Risk; Seoul, epidemiology; Vestibular Neuronitis, epidemiology; Benign paroxysmal positional vertigo; Meniere's disease; Particulate matter; Time series; Vestibular neuronitis}, pmid = {28236785} }
Papi, G., Corsello, S.M., Milite, M.T., Zanni, M., Ciardullo, A.V., Donato, C.D.I. and Pontecorvi, A.	Association between benign paroxysmal positional vertigo and autoimmune chronic thyroiditis. [BibTeX]	2009	Clinical endocrinology Vol. 70(1), pp. 169-170	article	DOI
BibTeX: @article{Papi2009, author = {Papi, Giampaolo and Corsello, Salvatore Maria and Milite, Maria Teresa and Zanni, Massimo and Ciardullo, Anna Vittoria and Donato, Carlo D I and Pontecorvi, Alfredo}, title = {Association between benign paroxysmal positional vertigo and autoimmune chronic thyroiditis.}, journal = {Clinical endocrinology}, year = {2009}, volume = {70}, issue = {1}, pages = {169--170}, doi = {https://doi.org/10.1111/j.1365-2265.2008.03311.x}, keywords = {Adolescent; Adult; Case-Control Studies; Female; Humans; Iodide Peroxidase, immunology; Male; Middle Aged; Thyroglobulin, immunology; Thyroiditis, Autoimmune, complications; Thyrotropin, blood; Thyroxine, blood; Vertigo, complications}, pmid = {18547341} }
Lin, Y.-T., Lin, H.-W., Huang, Y.-C., Ho, W.-T., Li, Y.-C. and Chen, T.-J.	Association between gout and vertigo in a Taiwanese population. [Abstract] [BibTeX]	2013	Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia Vol. 20(6), pp. 857-861	article	DOI
Abstract: There are reports of an association between benign paroxysmal positional vertigo and hyperuricemia. We sought to determine the risk of vertigo among patients with gout compared with the general population, using a nationwide Taiwanese population-based claims database. Our study cohort consisted of patients with a diagnosis of gout disorders in 2004 (N = 18773). Four age- and gender-matched controls for every patient in the study cohort were selected using random sampling as the comparison cohort (N = 75092). All subjects were followed from the date of cohort entry until they developed vertigo or to the end of 2006. Cox proportional hazard regressions were performed to evaluate the 3-year vertigo-free survival rates. Of the total sample, 2563 (incidence, 10.09 per 1000 person-years) had vertigo during the 3-year follow-up period: 570 (incidence, 11.78 per 1000 person-years) from the study cohort and 1993 (incidence, 9.69 per 1000 person-years) from the comparison cohort. The adjusted hazard ratios (HR) of peripheral and central vertigo in patients with gout compared with controls during the 2-3-year follow-up were 1.17 (95% confidence interval [CI] = 1.05-1.29, p = 0.003) and 1.08 (95% CI = 0.86-1.36, p = 0.53), respectively. This is the first population-based study performed to suggest that patients with gout may have an increased risk of peripheral vertigo but not central vertigo. Benign paroxysmal positional vertigo may be the reason for the observed association; however, future studies are required to further ascertain the relationship between gout and the various causes of peripheral vertigo.
BibTeX: @article{Lin2013, author = {Lin, Yu-Ting and Lin, Hui-Wen and Huang, Yu-Chen and Ho, Wen-Tsao and Li, Yu-Chuan and Chen, Ting-Jui}, title = {Association between gout and vertigo in a Taiwanese population.}, journal = {Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia}, year = {2013}, volume = {20}, issue = {6}, pages = {857--861}, doi = {https://doi.org/10.1016/j.jocn.2012.05.036}, keywords = {Adult; Age Factors; Aged; Cohort Studies; Female; Gout, diagnosis, epidemiology; Humans; Incidence; Kaplan-Meier Estimate; Male; Middle Aged; Proportional Hazards Models; Risk Factors; Sex Factors; Taiwan; Vertigo, diagnosis, epidemiology; Young Adult}, pmid = {23394876} }
Kim, S.K., Hong, S.M., Park, I.-S. and Choi, H.G.	Association Between Migraine and Benign Paroxysmal Positional Vertigo Among Adults in South Korea. [Abstract] [BibTeX]	2019	JAMA otolaryngology-- head & neck surgery	article	DOI
Abstract: Patients with migraine often experience various types of vertigo, and several studies have suggested an epidemiologic and physiologic association of migraine and vertigo with vestibule. However, few researchers have investigated the association between migraine and benign paroxysmal positional vertigo (BPPV). To determine the incidence of BPPV in individuals with migraine in a large national population-based sample. This cohort study obtained data from the Korean Health Insurance Review and Assessment Service covering the period January 1, 2002, through December 31, 2013. These data included personal information, health insurance claim codes, diagnostic codes, death records, socioeconomic data, and medical examination data for each individual in the database. A 1:4 matching method was used to select individuals for the migraine group (n = 40 682) and the control group (n = 162 728). Individuals who had a history of BPPV before the index date, for whom a match could not be identified, and who received a migraine diagnosis before age 20 years were excluded from the analysis. Data analysis was conducted from September 1, 2015, to December 31, 2017. The crude and adjusted (by age, sex, income, region of residence, and medical history [hypertension, diabetes, or dyslipidemia]) hazard ratios for migraine and BPPV were analyzed using the Cox proportional hazards regression model. Of the 40 682 individuals in the migraine group, 10 381 (25.5%) were male and 30 301 (74.5%) were female. Of the 162 728 controls, 41 524 (25.5%) were male and 121 204 (74.5%) were female. The incidence of BPPV was statistically significantly higher in the migraine group than in the control group (2431 [6.0%] vs 3677 [2.3%]). Migraine increased the risk of BPPV (adjusted hazard ratio, 2.54; 95% CI, 2.41-2.68). In a subgroup analysis, the incidence of BPPV in all age groups and in both men and women was statistically significantly higher in the migraine group than in the control group. The incidence of BPPV was the highest in men younger than 40 years (adjusted hazard ratio, 4.49; 95% CI, 3.05-6.62), and the HR decreased in both men and women as age increased. Migraine appeared to be statistically significantly associated with higher incidence of BPPV; future studies are needed to determine the association between BPPV and specific factors related to migraine.
BibTeX: @article{Kim2019, author = {Kim, Sung Kyun and Hong, Seok Min and Park, Il-Seok and Choi, Hyo Geun}, title = {Association Between Migraine and Benign Paroxysmal Positional Vertigo Among Adults in South Korea.}, journal = {JAMA otolaryngology-- head & neck surgery}, year = {2019}, doi = {https://doi.org/10.1001/jamaoto.2018.4016}, pmid = {30676633} }
Yu, S., Liu, F., Cheng, Z. and Wang, Q.	Association between osteoporosis and benign paroxysmal positional vertigo: a systematic review. [Abstract] [BibTeX]	2014	BMC neurology Vol. 14, pp. 110	article	DOI
Abstract: Increasing recent evidence has implicated osteoporosis as a risk factor for benign paroxysmal positional vertigo (BPPV). We conducted a systematic review to examine the association between osteoporosis and BPPV. Four electronic databases (PubMed, EMBASE, Cochrane Library, and the China Network Knowledge Infrastructure) were searched to identify all papers, published in either English or Chinese, examining the association between osteoporosis (osteopenia) and BPPV. Seven studies were eligible for analysis, though these studies included some weaknesses. Most of the studies demonstrated a correlation between osteoporosis (osteopenia) and the occurrence and recurrence of BPPV, especially in older women. Patients with osteoporosis may require more canalith-repositioning procedures. This systematic review provides insight into currently available evidence and elucidates the possible existence of an association between BPPV and osteoporosis (osteopenia). However, the evidence supporting that conclusion is not strong, and further studies are needed to clarify the association between these conditions.
BibTeX: @article{Yu2014, author = {Yu, Shudong and Liu, Fenye and Cheng, Zhixin and Wang, Qirong}, title = {Association between osteoporosis and benign paroxysmal positional vertigo: a systematic review.}, journal = {BMC neurology}, year = {2014}, volume = {14}, pages = {110}, doi = {https://doi.org/10.1186/1471-2377-14-110}, keywords = {Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Osteoporosis, complications; Vertigo, complications; Young Adult}, pmid = {24886504} }
Yoda, S., Cureoglu, S., Yildirim-Baylan, M., Morita, N., Fukushima, H., Harada, T. and Paparella, M.M.	Association between type 1 diabetes mellitus and deposits in the semicircular canals. [Abstract] [BibTeX]	2011	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 145(3), pp. 458-462	article	DOI
Abstract: To compare the prevalence of cupular and free-floating deposits in the semicircular canals between temporal bones of type 1 diabetes mellitus patients and normal controls. Case-control histopathologic human temporal bone study. Otopathology laboratory in a tertiary academic medical center. Twenty-eight temporal bones from 14 patients with type 1 diabetes mellitus and 56 normal temporal bones from 28 age-matched individuals were histopathologically examined. The cupula and lumina of the semicircular canals were examined for evidence of deposits. The prevalence of cupular and free-floating deposits in the lateral and posterior semicircular canals was significantly higher in type 1 diabetes mellitus patients compared with normal temporal bones (lateral, cupular deposits, odds ratio [OR], 5.47; 95% confidence interval [CI], 1.43 to 21.02; free-floating deposits, OR, 8.25; 95% CI, 2.42 to 27.85; posterior, cupular deposits, OR, 41.73; 95% CI, 5.96 to 275.50; free-floating deposits, OR, 7.44; 95% CI, 1.91 to 28.53). The prevalence of these deposits was associated with the duration of disease rather than with aging. The findings suggest that type 1 diabetes mellitus is associated with cupular and free-floating deposits in the semicircular canals. The patients with type 1 diabetes mellitus with a longer duration of disease have an increased probability of suffering from benign paroxysmal positional vertigo.
BibTeX: @article{Yoda2011, author = {Yoda, Shigetoshi and Cureoglu, Sebahattin and Yildirim-Baylan, Muzeyyen and Morita, Norimasa and Fukushima, Hisaki and Harada, Tamotsu and Paparella, Michael M}, title = {Association between type 1 diabetes mellitus and deposits in the semicircular canals.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2011}, volume = {145}, issue = {3}, pages = {458--462}, doi = {https://doi.org/10.1177/0194599811407610}, keywords = {Adolescent; Adult; Aged; Benign Paroxysmal Positional Vertigo; Cadaver; Calcinosis, epidemiology, pathology; Case-Control Studies; Comorbidity; Confidence Intervals; Crystallization; Diabetes Mellitus, Type 1, epidemiology; Female; Foreign Bodies, diagnosis, epidemiology; Humans; Male; Middle Aged; Odds Ratio; Otolithic Membrane, pathology; Prevalence; Reference Values; Risk Assessment; Semicircular Canals, pathology; Temporal Bone, pathology; Time Factors; Vertigo, diagnosis, epidemiology, pathology; Young Adult}, pmid = {21572081} }
Karataş, A., Acar Yüceant, G., Yüce, T., Hacı, C., Cebi, I.T. and Salviz, M.	Association of Benign Paroxysmal Positional Vertigo with Osteoporosis and Vitamin D Deficiency: A Case Controlled Study. [Abstract] [BibTeX]	2017	The journal of international advanced otology Vol. 13(2), pp. 259-265	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is a common type of vertigo caused by the peripheral vestibular system. The majority of cases are accepted as idiopathic. Calcium metabolism also plays a primary role in the synthesis/absorption of otoconia made of calcium carbonate and thus might be an etiological factor in the onset of BPPV. In this study, we aimed to investigate the role of osteoporosis and vitamin D in the etiology of BPPV by comparing BPPV patients with hospital-based controls. This is a case-control study comparing the prevalence of osteoporosis and vitamin D deficiency in 78 BPPV patients and 78 hospital-based controls. The mean T-scores and serum vitamin D levels were compared. The risk factors of osteoporosis, physical activity, diabetes mellitus, body mass index, and blood pressure were all compared between the groups. To avoid selection bias, the groups were stratified as subgroups according to age, sex, and menopausal status. In this study, the rates of osteoporosis and vitamin D deficiency detected in BPPV patients were reasonably high. But there was no significant difference in mean T-scores and vitamin D levels, osteoporosis, and vitamin D deficiency prevalence between the BPPV group and controls. The prevalence of osteoporosis and vitamin D deficiency is reasonably high in the general population. Unlike the general tendencies in the literature, our study suggests that osteoporosis and vitamin D deficiency are not risk factors for BPPV; we conclude that the coexistence of BPPV with osteoporosis and vitamin D deficiency is coincidental.
BibTeX: @article{Karatas2017, author = {Karataş, Abdullah and Acar Yüceant, Gülşah and Yüce, Turgut and Hacı, Cemal and Cebi, Işıl Taylan and Salviz, Mehti}, title = {Association of Benign Paroxysmal Positional Vertigo with Osteoporosis and Vitamin D Deficiency: A Case Controlled Study.}, journal = {The journal of international advanced otology}, year = {2017}, volume = {13}, issue = {2}, pages = {259--265}, doi = {https://doi.org/10.5152/iao.2016.2640}, keywords = {Benign Paroxysmal Positional Vertigo, complications; Case-Control Studies; Female; Humans; Male; Middle Aged; Osteoporosis, diagnosis; Prevalence; Vitamin D, blood; Vitamin D Deficiency, diagnosis}, pmid = {28274898} }
AlGarni, M.A., Mirza, A.A., Althobaiti, A.A., Al-Nemari, H.H. and Bakhsh, L.S.	Association of benign paroxysmal positional vertigo with vitamin D deficiency: a systematic review and meta-analysis. [Abstract] [BibTeX]	2018	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 275(11), pp. 2705-2711	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is an idiopathic recurrent inner ear illness that is caused most often by an imbalance in the metabolism of calcium carbonate crystals (otoconia) inside the semicircular canals, in which the otoconia begin to circulate freely after being dislodged from the basic structure. The underlying etiology of this imbalance has not yet been well established; however, a few recent articles have revealed that vitamin D level abnormality in these patients might play a role. Therefore, we conducted the current systematic review analysis to explore potential associations of vitamin D level with the occurrence as well as the recurrence of BPPV disease. A comprehensive literature search was conducted using different databases to retrieve all of the articles that have evaluated possible associations, irrespective of the study design. Then, we reported different vitamin D3 levels from BPPV groups and control groups to estimate the standardized mean difference (SMD) between the BPPV and control groups. We also calculated the effect size of each study under the random effects statistical model. Of the 703 studies that we identified, only 37 studies were found to be potential for our analysis, and of these, only seven met our predetermined criteria. Two meta-analyses were conducted with respect to the occurrence and the recurrence of BPPV. When the BPPV cases were compared to the controls (free of BPPV disease), there was an insignificant reduction in vitamin D level among the diseased groups (SMD = - 2.20; 95% CI - 6.66 to 2.26). In contrast, when the recurrent BPPV groups were compared with the non-recurrent BPPV groups, the statistical analysis showed significantly lower level of vitamin D among the recurrence BPPV groups (SMD = - 4.47; 95% CI - 7.55 to - 1.29). Although a negative vitamin D imbalance has been reported among some BPPV patients, this review analysis failed to establish a relationship between the occurrence of BPPV and low vitamin D level. However, low vitamin D level was significantly evident among patients with recurrent episodes of BPPV.
BibTeX: @article{AlGarni2018, author = {AlGarni, Mohammed A and Mirza, Ahmad A and Althobaiti, Awwadh A and Al-Nemari, Hanan H and Bakhsh, Lamees S}, title = {Association of benign paroxysmal positional vertigo with vitamin D deficiency: a systematic review and meta-analysis.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2018}, volume = {275}, issue = {11}, pages = {2705--2711}, doi = {https://doi.org/10.1007/s00405-018-5146-6}, keywords = {Benign Paroxysmal Positional Vertigo, complications; Humans; Recurrence; Vitamin D Deficiency, complications; Benign positional paroxysmal vertigo; Meta-analysis; Systematic review; Vitamin D deficiency}, pmid = {30302575} }
Lo, M.-H., Lin, C.-L., Chuang, E., Chuang, T.-Y. and Kao, C.-H.	Association of dementia in patients with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2017	Acta neurologica Scandinavica Vol. 135(2), pp. 197-203	article	DOI
Abstract: We conducted a cohort study to investigate whether benign paroxysmal positional vertigo (BPPV) is correlated with an increased risk of dementia. We established a case cohort comprising 7818 patients aged over 20 years who were diagnosed with BPPV from 2000 to 2010. In addition, we formed a control cohort by randomly selecting 31,272 people without BPPV and matched them with the BPPV patients according to gender, age, and index year. Cox proportional hazard regressions were performed to compute the hazard ratio (HR) of dementia after we adjusted for demographic characteristics and comorbidity. The prevalence of comorbidity was higher among patients with BPPV than among those without BPPV. In addition, patients with BPPV exhibited a 1.24-fold (95% confidence interval, CI 1.09-1.40; P < 0.001) higher risk of dementia than those without BPPV after we adjusted for age, gender, and comorbidity. An analysis stratified according to demographic factors revealed that women with BPPV exhibited a 1.36-fold (95% CI 1.16-1.59; P < 0.001) higher risk of dementia. Patients with BPPV aged over 65 years exhibited a significantly higher risk of dementia (adjusted HR: 1.26; 95% CI 1.10-1.43; P < 0.001) than those without BPPV. Patients with BPPV exhibited a higher risk of dementia than those without BPPV.
BibTeX: @article{Lo2017, author = {Lo, M-H and Lin, C-L and Chuang, E and Chuang, T-Y and Kao, C-H}, title = {Association of dementia in patients with benign paroxysmal positional vertigo.}, journal = {Acta neurologica Scandinavica}, year = {2017}, volume = {135}, issue = {2}, pages = {197--203}, doi = {https://doi.org/10.1111/ane.12581}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo, diagnosis, epidemiology; Cohort Studies; Comorbidity; Dementia, diagnosis, epidemiology; Female; Follow-Up Studies; Humans; Male; Middle Aged; Prevalence; Random Allocation; atherosclerosis; benign paroxysmal positional vertigo; dementia}, pmid = {26932875} }
Winchester, S., Singh, P.K. and Mikati, M.A.	Ataxia. [Abstract] [BibTeX]	2013	Handbook of clinical neurology Vol. 112, pp. 1213-1217	article	DOI
Abstract: The approach to the child with ataxia requires a detailed history and careful general and neurological examination as well as selected blood work and brain imaging and increasingly available genetic testing for inherited ataxias that usually have an episodic or progressive presentation. The differential of acute and recurring ataxia covered in this chapter includes intoxication (e.g., antiepileptics, lead, alcohol), postinfectious cerebellitis, hemorrhage, ischemic stroke, tumor (posterior fossa or cerebellum), brainstem encephalitis, occult neuroblastoma, Miller Fisher syndrome, conversion reaction, multiple sclerosis, epileptic pseudoataxia, vasculitis (e.g., Kawasaki), metabolic etiologies (e.g., maple syrup urine disease, pyruvate dehydrogenase deficiency, ornithine transcarbamylase deficiency, biotinidase deficiency, Hartnup disease, and argininosuccinic aciduria), migraine, migraine equivalents (benign paroxysmal positional vertigo), autosomal dominant episodic ataxias (with seven types currently identified), and hypothyroidism. Cooperation with therapists and providers from other specialties including ophthalmology and genetics and metabolism is essential to caring for these children and their families.
BibTeX: @article{Winchester2013, author = {Winchester, Sara and Singh, Piyush K and Mikati, Mohamad A}, title = {Ataxia.}, journal = {Handbook of clinical neurology}, year = {2013}, volume = {112}, pages = {1213--1217}, doi = {https://doi.org/10.1016/B978-0-444-52910-7.00043-X}, keywords = {Ataxia, diagnosis, pathology, therapy; Brain, pathology; Child; Humans; Physical Examination; Prognosis}, pmid = {23622331} }
Agus, G., Puxeddu, R., Demontis, G.P. and Puxeddu, P.	Atypical "reversed" paroxysmal positioning nystagmus in benign paroxysmal positional vertigo. [Abstract] [BibTeX]	1995	Acta oto-laryngologica. Supplementum Vol. 520 Pt 1, pp. 143-147	article
Abstract: An atypical paroxysmal positioning nystagmus (PPNy), "reversed" in its directional components, is a rare finding in patients suffering from benign paroxysmal positioning vertigo (BPPV). It poses problems of pathophysiogenetic interpretation, differential diagnosis with a CNS lesion and therapeutic strategy. Such a finding was observed in 7 patients (out of a total of 450 BPPV) and took on the typical PPNy pattern after repeated diagnostic manoeuvres. These aspects are incompatible with the "heavy cupula" mechanism (cupulolithiasis) and are better explained by the presence of "free endolymph aggregates" (canalolithiasis) within the posterior semicircular canal (p.s.c). Moreover, canalolithiasis would also permit a more convincing interpretation of all the clinical findings observed in typical p.s.c.-BPPV.
BibTeX: @article{Agus1995, author = {Agus, G and Puxeddu, R and Demontis, G P and Puxeddu, P}, title = {Atypical "reversed" paroxysmal positioning nystagmus in benign paroxysmal positional vertigo.}, journal = {Acta oto-laryngologica. Supplementum}, year = {1995}, volume = {520 Pt 1}, pages = {143--147}, keywords = {Adult; Aged; Calculi, diagnosis, physiopathology; Dominance, Cerebral, physiology; Electronystagmography; Endolymph, physiology; Female; Humans; Male; Meniere Disease, diagnosis, physiopathology; Middle Aged; Nystagmus, Pathologic, diagnosis, physiopathology; Orientation, physiology; Reflex, Vestibulo-Ocular, physiology; Semicircular Canals, innervation; Vestibular Function Tests; Vestibular Nerve, physiopathology}, pmid = {8749104} }
Smouha, E.E. and Roussos, C.	Atypical forms of paroxysmal positional nystagmus. [Abstract] [BibTeX]	1995	Ear, nose, & throat journal Vol. 74(9), pp. 649-656	article
Abstract: Benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo, and has a typical constellation of physical findings. Atypical forms of paroxysmal positional nystagmus (APPN) also exist, and are thought to represent conditions which are in fact not "benign". We studied 100 consecutive patients with positional vertigo in order to learn whether APPN differed from classic BPPV in etiology or clinical fate, and to learn the incidence of central nervous system (CNS) disorders in these patients. APPN was present in 38% of these patients with diverse causes. One-fourth had CNS disorders or vascular insufficiency, the remainder, otogenic or idiopathic. APPN was more likely than BPPV to have a prolonged (persistent or recurring) clinical course. Although most cases eventually resolved, duration of symptoms tended to be longer, regardless of etiology. We conclude that APPN has a less favorable prognosis than typical BPPV, and that a CNS etiology should be suspected in prolonged cases.
BibTeX: @article{Smouha1995, author = {Smouha, E E and Roussos, C}, title = {Atypical forms of paroxysmal positional nystagmus.}, journal = {Ear, nose, & throat journal}, year = {1995}, volume = {74}, issue = {9}, pages = {649--656}, keywords = {Adult; Aged; Diagnosis, Differential; Eye Movements; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, diagnosis, etiology, physiopathology; Posture; Prognosis; Vertigo, diagnosis, etiology, physiopathology}, pmid = {8565867} }
Moreno, N.S. and André, A.P.d.R.	Audiologic features of elderly with Benign Paroxysmal Positional Vertigo. [Abstract] [BibTeX]	2009	Brazilian journal of otorhinolaryngology Vol. 75(2), pp. 300-304	article
Abstract: Benign Paroxysmal Positional Vertigo (BPPV) is one of the most common causes of dizziness; it constitutes the most common vestibular disorder in the elderly with vertigo. Its characteristic clinical aspect is dizziness at head movement, with not hearing alteration. This paper aims at studying the audiologic characteristics of elderly with BPPV of the posterior semicircular canal. We carried out a retrospective analysis of threshold tonal audiometry exams of 37 senior citizens with posterior semicircular canal BPPV and also of 37 elderly without complaints of dizziness and/or vertigo, and we studied the audiologic characteristics of the two groups. Both groups had high rates of hearing loss, especially the descending curve sensorineural type, and there was no statistically significant difference between the groups. Having such data, we can conclude that posterior semicircular canal BPPV has no impact on the hearing loss features of senior citizens; nonetheless, because of the spontaneous degeneration of the vestibulocochlear system, such population has a prevalence of hearing loss.
BibTeX: @article{Moreno2009a, author = {Moreno, Nathali Singaretti and André, Ana Paula do Rego}, title = {Audiologic features of elderly with Benign Paroxysmal Positional Vertigo.}, journal = {Brazilian journal of otorhinolaryngology}, year = {2009}, volume = {75}, issue = {2}, pages = {300--304}, keywords = {Aged; Aged, 80 and over; Aging, physiology; Audiometry, Pure-Tone; Female; Hearing Loss, Sensorineural, etiology; Humans; Male; Middle Aged; Retrospective Studies; Semicircular Canals, physiopathology; Vertigo, etiology, physiopathology}, pmid = {19575120} }
Grayeli, A.B., Sterkers, O. and Toupet, M.	Audiovestibular function in patients with otosclerosis and balance disorders. [Abstract] [BibTeX]	2009	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 30(8), pp. 1085-1091	article	DOI
Abstract: The aim of this study was to investigate the clinical aspects of balance disorders and to assess the audiovestibular functions of patients with otosclerosis. Among 13,800 patients examined for balance disorders between 2002 and 2006, 98 (0.7%) presented with otosclerosis. Seventy-three patients (28 treated nonoperatively, 27 operated on unilaterally, and 18 operated on bilaterally for otosclerosis) with an audiovestibular assessment were included in this retrospective study. Complaints were dizziness in 42 patients (56%), benign paroxysmal positional vertigo in 37 patients (51%), and rotatory vertigo in 21 patients (29%), with no difference between patients operated on and those treated nonoperatively. In patients treated nonoperatively, despite the absence of correlation for hearing loss between the right and left ears, a strong correlation was observed for the bithermic caloric response (BCR; Y = 2.54 + 0.73X, Y = left, X = right, R2 = 0.71, n = 26, p < 0.0001, analysis of variance). In contrast, the correlation between the ipsilateral and contralateral ears in BCR was weak in patients operated on 1 side (Y = 15.1 + 0.66X, Y = contralateral, X = ipsilateral, n = 27, R2 = 0.20, p < 0.05), and this was associated to a caloric paresis suggesting a surgery-induced deficit. There was no correlation between hearing thresholds and the BCR. The proportion of patients with otosclerosis among those with balance disorders was similar to the estimated prevalence of otosclerosis in the general population. Despite the asymmetric hearing loss, BCR was symmetrical in patients treated nonoperatively. In contrast, the loss of vestibular function symmetry in patients suggested a surgery-induced vestibular trauma.
BibTeX: @article{Grayeli2009, author = {Grayeli, Alexis Bozorg and Sterkers, Olivier and Toupet, Michel}, title = {Audiovestibular function in patients with otosclerosis and balance disorders.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2009}, volume = {30}, issue = {8}, pages = {1085--1091}, doi = {https://doi.org/10.1097/MAO.0b013e3181b0fd5d}, keywords = {Adult; Aged; Aged, 80 and over; Audiometry; Caloric Tests; Cochlear Implantation; Dizziness, etiology; Female; Follow-Up Studies; Functional Laterality, physiology; Hearing Loss, etiology; Humans; Male; Meniere Disease, etiology; Middle Aged; Otosclerosis, complications, physiopathology, therapy; Postural Balance, physiology; Retrospective Studies; Stapes Surgery; Tinnitus, etiology; Vertigo, etiology; Vestibular Diseases, complications, physiopathology, therapy; Vestibular Function Tests; Vestibule, Labyrinth, physiopathology}, pmid = {19638946} }
Rabelo, M.B. and Corona, A.P.	Auditory and vestibular dysfunctions in systemic sclerosis: literature review. [Abstract] [BibTeX]	2014	CoDAS Vol. 26(5), pp. 337-342	article
Abstract: To describe the prevalence of auditory and vestibular dysfunction in individuals with systemic sclerosis (SS) and the hypotheses to explain these changes. We performed a systematic review without meta-analysis from PubMed, LILACS, Web of Science, SciELO and SCOPUS databases, using a combination of keywords "systemic sclerosis AND balance OR vestibular" and "systemic sclerosis AND hearing OR auditory." We included articles published in Portuguese, Spanish, or English until December 2011 and reviews, letters, and editorials were excluded. We found 254 articles, out of which 10 were selected. The study design was described, and the characteristics and frequency of the auditory and vestibular dysfunctions in these individuals were listed. Afterwards, we investigated the hypothesis built by the authors to explain the auditory and vestibular dysfunctions in SS. Hearing loss was the most common finding, with prevalence ranging from 20 to 77%, being bilateral sensorineural the most frequent type. It is hypothesized that the hearing impairment in SS is due to vascular changes in the cochlea. The prevalence of vestibular disorders ranged from 11 to 63%, and the most frequent findings were changes in caloric testing, positional nystagmus, impaired oculocephalic response, changes in clinical tests of sensory interaction, and benign paroxysmal positional vertigo. High prevalence of auditory and vestibular dysfunctions in patients with SS was observed. Conducting further research can assist in early identification of these abnormalities, provide resources for professionals who work with these patients, and contribute to improving the quality of life of these individuals.
BibTeX: @article{Rabelo2014, author = {Rabelo, Maysa Bastos and Corona, Ana Paula}, title = {Auditory and vestibular dysfunctions in systemic sclerosis: literature review.}, journal = {CoDAS}, year = {2014}, volume = {26}, issue = {5}, pages = {337--342}, keywords = {Female; Hearing Loss, etiology; Humans; Male; Quality of Life; Scleroderma, Systemic, complications; Vertigo, etiology, physiopathology; Vestibular Diseases, etiology, physiopathology; Vestibule, Labyrinth, physiopathology}, pmid = {25388064} }
Caruana, P., Hughes, A.R., Lea, R.A. and Lueck, C.J.	Australian driving restrictions: how well do neurologists know them? [Abstract] [BibTeX]	2018	Internal medicine journal Vol. 48(9), pp. 1144-1149	article	DOI
Abstract: Driving regulations are complex, particularly for neurological conditions, but accurate application of restrictions is important. This study was designed to investigate knowledge of the Austroads guidelines in medical students, neurological trainees and consultant neurologists using a questionnaire addressing both private and commercial licence restrictions related to five common neurological conditions, namely transient ischaemic attack (TIA), vasovagal episode, unwitnessed blackout, first epileptic seizure and benign paroxysmal positional vertigo. In total, 118 of the 120 returned responses could be analysed. Overall, 50% of all responses were correct. Respondents performed better for private than commercial licences, and consultants performed better than trainees and students. The highest proportion of correct answers was seen for vasovagal attack, and the lowest for TIA. In summary, knowledge of driving restrictions was relatively poor, and regular consultation of the guidelines is recommended. A larger study is warranted and increased education at both medical school and postgraduate levels should be considered.
BibTeX: @article{Caruana2018, author = {Caruana, Patricia and Hughes, Andrew R and Lea, Rodney A and Lueck, Christian J}, title = {Australian driving restrictions: how well do neurologists know them?}, journal = {Internal medicine journal}, year = {2018}, volume = {48}, issue = {9}, pages = {1144--1149}, doi = {https://doi.org/10.1111/imj.14026}, keywords = {Australia; Automobile Driving, legislation & jurisprudence; Benign Paroxysmal Positional Vertigo; Epilepsy; Health Knowledge, Attitudes, Practice; Humans; Ischemic Attack, Transient; Neurologists; Neurology; Seizures; Students, Medical; Surveys and Questionnaires; Syncope, Vasovagal; TIA; blackout; driving; epilepsy; syncope; vertigo}, pmid = {30182392} }
Liu, X., Treister, R., Yan, Y., Wang, H. and Li, X.	Automated Mechanical Repositioning Treatment for Posterior Canal Benign Paroxysmal Positional Vertigo: A Single-Center Experience and Literature Review. [Abstract] [BibTeX]	2017	European neurology Vol. 78(5-6), pp. 240-246	article	DOI
Abstract: To evaluate the feasibility and effectiveness of automated mechanical repositioning treatment (AMRT) for posterior canal benign paroxysmal positional vertigo -(PC-BPPV). We reviewed all PC-BPPV patients admitted to our department between January and -December 2016. The inclusion criteria mainly required conducting a diagnosis for PC-BPPV by using the Dix-Hallpike test, a PC-BPPV history within 1 month, no intake of medications for the last 48 h. Compared with the cases who received classical manual repositioning treatment (CMRT), the proportion of patients who underwent AMRT with a resolution within the 1-week follow-up session after initial treatment and a recurrence during the 6-month follow-up were evaluated. A total of182 patients who underwent AMRT and 152 patients who underwent CMRT were included. Compared with the CMRT group, the AMRT group had a higher rate of complete or partial resolution and positional nystagmus at the 1 week follow-up (92.6 vs. 86.2%; p = 0.004). AMRT with less treatment cycles was more effective than CMRT (1.5 vs. 1.9; p < 0.001). After 6 months of follow-up, the cumulative recurrence rate of the AMRT group was significantly lower than that of the CMRT group (3.0 vs. 8.9%; p = 0.037). AMRT is a feasible and effective procedure for the resolution of PC-BPPV.
BibTeX: @article{Liu2017a, author = {Liu, Xiaolei and Treister, Roi and Yan, Yinan and Wang, Hailong and Li, Xinyi}, title = {Automated Mechanical Repositioning Treatment for Posterior Canal Benign Paroxysmal Positional Vertigo: A Single-Center Experience and Literature Review.}, journal = {European neurology}, year = {2017}, volume = {78}, issue = {5-6}, pages = {240--246}, doi = {https://doi.org/10.1159/000480429}, keywords = {Adult; Aged; Automation, instrumentation, methods; Benign Paroxysmal Positional Vertigo, therapy; Case-Control Studies; Female; Humans; Male; Middle Aged; Patient Positioning, methods; Posture; Retrospective Studies; Automated mechanical repositioning; Dix-Hallpike test; Epley maneuver; Posterior canal; Treatment; Vertigo}, pmid = {28942452} }
Adelsberger, R., Valko, Y., Straumann, D. and Tröster, G.	Automated Romberg testing in patients with benign paroxysmal positional vertigo and healthy subjects. [Abstract] [BibTeX]	2015	IEEE transactions on bio-medical engineering Vol. 62(1), pp. 373-381	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most common cause of dizziness. The underlying pathomechanism responsible for the recurrent vertigo attacks has been elucidated in detail and highly effective treatment strategies (liberation maneuvers) have been developed. However, many BPPV patients complain about problems of balance especially following liberation maneuvers. To objectively demonstrate differences in balance performance in BPPV patients compared to healthy subjects both prior and after BPPV liberation maneuvers. Seven patients with BPPV of the posterior semicircular canal and nine healthy subjects participated. To assess balance while standing, we analyzed the location and temporal stability of the center of pressure recorded by pressure-sensitive electronic soles during Romberg testing (on stable ground and on foam) and tandem stand. To assess regularity of gait, we analyzed the step frequency during walking of 50 m. All tests were performed prior and after liberation maneuvers in both groups. Healthy subjects and patients differ significantly in their balance performance and use different stabilization strategies both prior and after liberation maneuvers. Both Romberg tests indicated poorer balance in BPPV patients (mean COP shifted towards toes), especially in posttreatment tests, while tandem stand appeared unaltered. We did not observe differences in escorted (by an experimenter) walking regularities between patients and healthy subjects and between pre- and post-maneuver testing. Our findings confirm the typical clinical observation of a further posttreatment deterioration of already impaired postural performance in BPPV patients. While the etiology and the time course of this peculiar problem warrants further studies, the treating physician should be familiar with this transient side effect of therapeutic maneuvers to provide adequate counseling of patients. Finally, we successully demonstrated the pressure-sensitive electronic soles as a new and potentially useful tool for both clinical and research purposes.
BibTeX: @article{Adelsberger2015, author = {Adelsberger, Rolf and Valko, Yulia and Straumann, Dominik and Tröster, Gerhard}, title = {Automated Romberg testing in patients with benign paroxysmal positional vertigo and healthy subjects.}, journal = {IEEE transactions on bio-medical engineering}, year = {2015}, volume = {62}, issue = {1}, pages = {373--381}, doi = {https://doi.org/10.1109/TBME.2014.2354053}, keywords = {Adult; Algorithms; Artificial Intelligence; Benign Paroxysmal Positional Vertigo, diagnosis; Diagnosis, Computer-Assisted, instrumentation, methods; Equipment Design; Equipment Failure Analysis; Humans; Male; Middle Aged; Pattern Recognition, Automated, methods; Reference Values; Reproducibility of Results; Sensitivity and Specificity; Vestibular Function Tests, instrumentation, methods}, pmid = {25203981} }
Kim, H.-A. and Lee, H.	Autonomic dysfunction as a possible cause of residual dizziness after successful treatment in benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2014	Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology Vol. 125(3), pp. 608-614	article	DOI
Abstract: To investigate whether residual dizziness after successful treatment in patients with benign paroxysmal positional vertigo (BPPV) was associated with autonomic dysfunction. Fifty-eight consecutive patients with BPPV who had successful canal repositioning procedures (CRPs) and showed no nystagmus or positional vertigo at the next follow-up visit were enrolled and divided into two groups with and without residual dizziness. We performed a standardized autonomic function test. Of the 58 patients, 25 (43%) complained of residual dizziness after successful CRPs, in which postural lightheadedness when righting from sitting, or short-lasting nonspecific dizziness that occurred during head movement or walking were common complaints. Orthostatic hypotension (OH) occurred in 11 patients (19%). Incidence of OH was significantly higher in patients with residual dizziness at the next follow-up than those without residual dizziness (40% and 3%, p=0.000). Compared to patients without residual dizziness, patients with residual dizziness had larger falls in systolic BP during the valsalva maneuver and head-up tilt test. However, cardiovagal parasympathetic function was not different between the patients with and without residual dizziness. In BPPV, residual dizziness after successful treatment may be associated with sympathoneural autonomic dysfunction. This investigation could be useful in understanding the mechanism of residual dizziness in patients with BPPV.
BibTeX: @article{Kim2014e, author = {Kim, Hyun-Ah and Lee, Hyung}, title = {Autonomic dysfunction as a possible cause of residual dizziness after successful treatment in benign paroxysmal positional vertigo.}, journal = {Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology}, year = {2014}, volume = {125}, issue = {3}, pages = {608--614}, doi = {https://doi.org/10.1016/j.clinph.2013.08.008}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo; Dizziness, etiology; Female; Humans; Hypotension, Orthostatic, complications; Male; Middle Aged; Posture, physiology; Tilt-Table Test; Vertigo, therapy; Walking; Autonomic dysfunction; BPPV; Residual dizziness}, pmid = {24045026} }
Pollak, L.	Awareness of benign paroxysmal positional vertigo in central Israel. [Abstract] [BibTeX]	2009	BMC neurology Vol. 9, pp. 17	article	DOI
Abstract: Despite its frequent occurrence and effective treatment options, benign paroxysmal positional vertigo (BPPV) still remains under-estimated in the community. We reviewed referral letters and medical records of 120 patients who were treated for BPPV at our Dizziness Clinic during the years 2006-2008 and searched for factors that possibly contribute to missing this entity. The referral diagnosis could be clustered into four groups: BPPV (25.6%), further unspecified vertigo (36.6%), dizziness (27.5%) and other (10%). BPPV was recognized more frequently by ENT doctors than by other specialists.Patients referred with the correct diagnosis of BPPV were significantly younger and the duration of their symptoms shorter than in other referral groups. Patients in the distinct referral groups did not differ in the presence of autonomic symptoms or a history of another serious disease. A history typical of BPPV could be obtained in all but 11 patients, but position dependence was noted by the referring physician only in 55 patients, 31 of them correctly assigned as possible BPPV. Only in two patients was the Dix-Hallpike test performed. Thirty two patients were diagnosed with BPPV in the past, but this did not influence the recognition of the recurrence of this clinical entity. About 40% of patients had an audiogram and/or brainstem auditory evoked potentials. Electronystagmography was performed in 7.5% and brain imaging in 14% of patients before referral. Our results show that BPPV is still an under-recognized entity.Education and the demand on specialists to learn how to treat BPPV, could improve the situation.
BibTeX: @article{Pollak2009, author = {Pollak, Lea}, title = {Awareness of benign paroxysmal positional vertigo in central Israel.}, journal = {BMC neurology}, year = {2009}, volume = {9}, pages = {17}, doi = {https://doi.org/10.1186/1471-2377-9-17}, keywords = {Brain, diagnostic imaging; Electronystagmography; Evoked Potentials, Auditory, Brain Stem; Female; Humans; Israel, epidemiology; Male; Middle Aged; Radiography; Recurrence; Referral and Consultation, statistics & numerical data; Vertigo, diagnosis, epidemiology}, pmid = {19386117} }
Chang, W.-C., Hsu, L.-C., Yang, Y.-R. and Wang, R.-Y.	Balance ability in patients with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2006	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 135(4), pp. 534-540	article	DOI
Abstract: The purpose of the study was to investigate the balance ability of the patients with benign paroxysmal positional vertigo (BPPV). Twenty-three patients (63.3 +/- 9.2 years of age) with a diagnosis of unilateral posterior semicircular canal BPPV were recruited. Static balance was measured in 4 conditions with eyes open and eyes closed: stance on firm surface, stance on foam surface, left leg stance, and right leg stance. Dynamic balance was measured in tandem walk test. Data of the patients with BPPV were compared to age-matched norm values of the healthy adults. The patients with BPPV demonstrated greater sway velocity in stance on foam surface with eyes closed (P < 0.05), in single leg stance with eyes closed (P < 0.001), and in tandem walk test (P < 0.05) compared to the healthy adults. Patients with BPPV demonstrated impaired static and dynamic balance ability particularly when depriving visual and changing proprioceptive inputs. Clinically, in addition to canalith repositioning maneuver, balance retraining on different conditions may be a useful adjunct to treatment for patients with BPPV.
BibTeX: @article{Chang2006, author = {Chang, Wen-Ching and Hsu, Li-Chi and Yang, Yea-Ru and Wang, Ray-Yau}, title = {Balance ability in patients with benign paroxysmal positional vertigo.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2006}, volume = {135}, issue = {4}, pages = {534--540}, doi = {https://doi.org/10.1016/j.otohns.2005.10.001}, keywords = {Aged; Female; Humans; Male; Middle Aged; Postural Balance; Prospective Studies; Vertigo, physiopathology}, pmid = {17011413} }
Sommerfleck, P.A., González Macchi, M.E., Weinschelbaum, R., De Bagge, M.D., Bernáldez, P. and Carmona, S.	Balance disorders in childhood: Main etiologies according to age. Usefulness of the video head impulse test. [Abstract] [BibTeX]	2016	International journal of pediatric otorhinolaryngology Vol. 87, pp. 148-153	article	DOI
Abstract: Balance disorders are common in adult patients but less usual in the pediatric population. When this symptomatology appears in children it is a cause for concern, both for parents and health-care professionals. To explain the balance disorders in children describing a case series and to discuss the main etiologies found according to age. A retrospective, observational, descriptive, and cross-sectional study was conducted. Patients aged 1-18 years who consulted because of balance disorders at the otolaryngology department of a pediatric tertiary-care hospital between March 2012 and July 2015. Two hundred and six patients were included in the study. Median age was 10 years. The most common diagnoses were vestibular migraine in 21.8% of the children, ataxia in 9.22%, benign paroxysmal vertigo of childhood in 7.77%, and post-traumatic vertigo in 6.31%.Overall, 61 videonystagmographies- of which 46 were normal - and 55 video head impulse tests - which were normal in 45 and showed abnormalities in the vestibulo-ocular reflex gain in 10 - were performed. In a child with balance disorders, the medical history and neurotological examination are essential. Vestibular migraine is the most commonly found disorder in every age group, and most of the patients have a family history of migraine. Ancillary studies, especially the video head-impulse test, provide important data to confirm the diagnosis.
BibTeX: @article{Sommerfleck2016, author = {Sommerfleck, Patricia Alejandra and González Macchi, María Emilia and Weinschelbaum, Romina and De Bagge, Maximiliano Damián and Bernáldez, Patricia and Carmona, Sergio}, title = {Balance disorders in childhood: Main etiologies according to age. Usefulness of the video head impulse test.}, journal = {International journal of pediatric otorhinolaryngology}, year = {2016}, volume = {87}, pages = {148--153}, doi = {https://doi.org/10.1016/j.ijporl.2016.06.020}, keywords = {Adolescent; Ataxia, complications, physiopathology; Benign Paroxysmal Positional Vertigo, complications, physiopathology; Central Nervous System Neoplasms, complications, physiopathology; Child; Child, Preschool; Cross-Sectional Studies; Female; Head Impulse Test; Humans; Infant; Labyrinthitis, complications, physiopathology; Male; Migraine Disorders, complications, physiopathology; Otitis Media with Effusion, complications, physiopathology; Postural Balance; Reflex, Vestibulo-Ocular; Retrospective Studies; Sensation Disorders, etiology, physiopathology; Vertigo, complications, physiopathology; Vestibular Diseases; Vestibular Function Tests; Balance-disorder; Childhood; Video-head-impulse-test}, pmid = {27368464} }
Chang, W.-C., Yang, Y.-R., Hsu, L.-C., Chern, C.-M. and Wang, R.-Y.	Balance improvement in patients with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2008	Clinical rehabilitation Vol. 22(4), pp. 338-347	article	DOI
Abstract: To investigate the effect of an additional vestibular stimulated exercise programme on balance for patients with benign paroxysmal positional vertigo. Randomized controlled trial. Medical centre. Twenty-six subjects with benign paroxysmal positional vertigo involving the unilateral posterior semicircular canal. Subjects were randomized into experimental or control groups. Thirteen subjects in the experimental group received the canalith repositioning manoeuvre and vestibular stimulated exercise training three times a week for four weeks. Thirteen subjects in the control group received only the canalith repositioning manoeuvre. Static balance tests, tandem walk test, Dynamic Gait Index and subjective rating of the intensity of vertigo were measured at baseline, two-week and four-week assessments. Compared with the control group, subjects in the experimental group demonstrated a statistically significant improvement in single leg stance with eyes closed at the two-week assessment (P<0.05). Furthermore, stance on foam surface with eyes closed, single-leg stance with eyes closed, and Dynamic Gait Index at the four-week assessment were also significantly improved (P<0.05). The present study demonstrated that additional exercise training, which emphasizes vestibular stimulation, can improve balance ability and functional gait performance among patients with benign paroxysmal positional vertigo who had already undergone the canalith repositioning manoeuvre.
BibTeX: @article{Chang2008, author = {Chang, Wen-Ching and Yang, Yea-Ru and Hsu, Li-Chi and Chern, Chang-Ming and Wang, Ray-Yau}, title = {Balance improvement in patients with benign paroxysmal positional vertigo.}, journal = {Clinical rehabilitation}, year = {2008}, volume = {22}, issue = {4}, pages = {338--347}, doi = {https://doi.org/10.1177/0269215507082741}, keywords = {Adult; Aged; Aged, 80 and over; Exercise Therapy, methods; Female; Gait, physiology; Humans; Male; Middle Aged; Oculomotor Muscles, physiology; Postural Balance, physiology; Semicircular Canals, physiopathology; Treatment Outcome; Vertigo, physiopathology, rehabilitation; Vestibule, Labyrinth, physiology}, pmid = {18390977} }
Celebisoy, N., Bayam, E., Güleç, F., Köse, T. and Akyürekli, O.	Balance in posterior and horizontal canal type benign paroxysmal positional vertigo before and after canalith repositioning maneuvers. [Abstract] [BibTeX]	2009	Gait & posture Vol. 29(3), pp. 520-523	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is characterized by acute, brief and rotatory vertigo attacks provoked by changes in head position. Most patients complain of a loss of equilibrium and unstable gait during and between the vertigo attacks. Canalith repositioning maneuvers (CRM) relieve attacks and improve postural stability. In this study balance ability of 32 patients with PC BPPV and 12 patients with HC BPPV before and after treatment with CRM was investigated. 50 healthy volunteers served as the control group. Static balance was measured as mean center of gravity sway velocity recorded in four different conditions: on a static platform and on foam with eyes open and closed. Dynamic balance was measured in tandem walk test. PC BPPV patients demonstrated greater sway velocity in stance on foam with eyes closed. After CRM the velocity decreased significantly. The results of the HC BPPV patients were not different from the healthy volunteers all through the four test conditions. Walking speed of the patients both with PC BPPV and HC BPPV was significantly low. It increased after treatment in both groups. In conclusion, patients with PC BPPV had impaired static balance ability due to a clot in the affected canal. Dynamic balance ability measured by walking speed was impaired both in PC and HC BPPV patients. Static and dynamic deficits improved significantly after CRM.
BibTeX: @article{Celebisoy2009, author = {Celebisoy, Neşe and Bayam, Ece and Güleç, Feray and Köse, Timur and Akyürekli, Onder}, title = {Balance in posterior and horizontal canal type benign paroxysmal positional vertigo before and after canalith repositioning maneuvers.}, journal = {Gait & posture}, year = {2009}, volume = {29}, issue = {3}, pages = {520--523}, doi = {https://doi.org/10.1016/j.gaitpost.2008.12.002}, keywords = {Adult; Aged; Humans; Middle Aged; Otolithic Membrane; Postural Balance, physiology; Semicircular Canals; Vertigo, etiology, physiopathology, therapy}, pmid = {19138524} }
Monteiro, S.R.G., Ganança, M.M., Ganança, F.F., Ganança, C.F. and Caovilla, H.H.	Balance Rehabilitation Unit (BRU™) posturography in benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2012	Brazilian journal of otorhinolaryngology Vol. 78(3), pp. 98-104	article
Abstract: Posturography has been used in the evaluation of patients with vestibular disorders. To evaluate balance control with the Balance Rehabilitation Unit (BRU™) posturography in patients with Benign Paroxysmal Positional Vertigo. Prospective case-control. A cross-sectional controlled study was carried out in 45 patients with BPPV, and a homogeneous control group consisting of 45 healthy individuals. Patients were submitted to a balance function evaluation by means of the Balance Rehabilitation Unit (BRU™) posturography. The mean values of the ellipse area and the sway velocity in a firm surface and saccadic stimulation (p = 0.060). The Balance Rehabilitation Unit (BRU™) posturography enables to identify postural control abnormalities in patients with BPPV.
BibTeX: @article{Monteiro2012, author = {Monteiro, Silvia Roberta Gesteira and Ganança, Maurício Malavasi and Ganança, Fernando Freitas and Ganança, Cristina Freitas and Caovilla, Heloisa Helena}, title = {Balance Rehabilitation Unit (BRU™) posturography in benign paroxysmal positional vertigo.}, journal = {Brazilian journal of otorhinolaryngology}, year = {2012}, volume = {78}, issue = {3}, pages = {98--104}, keywords = {Benign Paroxysmal Positional Vertigo; Case-Control Studies; Female; Humans; Male; Middle Aged; Postural Balance, physiology; Prospective Studies; Vertigo, physiopathology; Vestibular Function Tests, methods}, pmid = {22714854} }
Kerber, K.A., Forman, J., Damschroder, L., Telian, S.A., Fagerlin, A., Johnson, P., Brown, D.L., An, L.C., Morgenstern, L.B. and Meurer, W.J.	Barriers and facilitators to ED physician use of the test and treatment for BPPV. [Abstract] [BibTeX]	2017	Neurology. Clinical practice Vol. 7(3), pp. 214-224	article	DOI
Abstract: The test and treatment for benign paroxysmal positional vertigo (BPPV) are evidence-based practices supported by clinical guideline statements. Yet these practices are underutilized in the emergency department (ED) and interventions to promote their use are needed. To inform the development of an intervention, we interviewed ED physicians to explore barriers and facilitators to the current use of the Dix-Hallpike test (DHT) and the canalith repositioning maneuver (CRM). We conducted semi-structured in-person interviews with ED physicians who were recruited at annual ED society meetings in the United States. We analyzed data thematically using qualitative content analysis methods. Based on 50 interviews with ED physicians, barriers that contributed to infrequent use of DHT/CRM that emerged were (1) prior negative experiences or forgetting how to perform them and (2) reliance on the history of present illness to identify BPPV, or using the DHT but misattributing patterns of nystagmus. Based on participants' responses, the principal facilitator of DHT/CRM use was prior positive experiences using these, even if infrequent. When asked which clinical supports would facilitate more frequent use of DHT/CRM, participants agreed supports needed to be brief, readily accessible, and easy to use, and to include well-annotated video examples. Interventions to promote the use of the DHT/CRM in the ED need to overcome prior negative experiences with the DHT/CRM, overreliance on the history of present illness, and the underuse and misattribution of patterns of nystagmus. Future resources need to be sensitive to provider preferences for succinct information and video examples.
BibTeX: @article{Kerber2017a, author = {Kerber, Kevin A and Forman, Jane and Damschroder, Laura and Telian, Steven A and Fagerlin, Angela and Johnson, Patricia and Brown, Devin L and An, Lawrence C and Morgenstern, Lewis B and Meurer, William J}, title = {Barriers and facilitators to ED physician use of the test and treatment for BPPV.}, journal = {Neurology. Clinical practice}, year = {2017}, volume = {7}, issue = {3}, pages = {214--224}, doi = {https://doi.org/10.1212/CPJ.0000000000000366}, pmid = {28680765} }
Boleas-Aguirre, M.S., Pérez, N. and Batuecas-Caletrío, A.	Bedside therapeutic experiences with horizontal canal benign paroxysmal positional vertigo (cupulolithiasis). [Abstract] [BibTeX]	2009	Acta oto-laryngologica Vol. 129(11), pp. 1217-1221	article	DOI
Abstract: After forced prolonged position type one (FPP-one) and the appropriate repositioning maneuvers, or FPP-two, 95.45% of patients with cupulolithiasis of the horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV).were symptom-free. To treat patients with cupulolithiasis of the HSC-BPPV. This was a prospective study including 22 subjects with HSC-BPPV (cupulolithiasis) based on apogeotropic direction-changing positional nystagmus (apo-DCPN). Patients adopted FPP-one, which means lying down on the side of the weaker nystagmus during nightly rest for 2 weeks. If apo-DCPN persisted, subjects adopted type two FPP (FPP-two), which means lying on the strongest nystagmus side during nightly rest for 2 weeks. No vertigo or nystagmus was observed in 15 subjects after FPP-one. One subject experienced geotropic DCPN (geo-DCPN), two subjects had posterior BPPV, and another had superior BPPV. Three subjects had persistent apo-DCPN and they were subjected to FPP-two. After that, no vertigo or nystagmus was detected in two subjects. Apo-DCPN persisted in the other remaining subject after FPP-two.
BibTeX: @article{Boleas-Aguirre2009, author = {Boleas-Aguirre, María Soledad and Pérez, Nicolás and Batuecas-Caletrío, Angel}, title = {Bedside therapeutic experiences with horizontal canal benign paroxysmal positional vertigo (cupulolithiasis).}, journal = {Acta oto-laryngologica}, year = {2009}, volume = {129}, issue = {11}, pages = {1217--1221}, doi = {https://doi.org/10.3109/00016480802631958}, keywords = {Adult; Aged; Aged, 80 and over; Caloric Tests; Electronystagmography; Female; Follow-Up Studies; Humans; Male; Middle Aged; Moving and Lifting Patients; Otolithic Membrane, physiopathology; Posture, physiology; Prospective Studies; Retreatment; Semicircular Canals, physiopathology; Treatment Outcome; Vertigo, physiopathology, therapy; Vestibular Nerve, physiopathology; Video Recording; Young Adult}, pmid = {19863314} }
Zuma e Maia, F.C., Albernaz, P.L.M. and Cal, R.V.	Behavior of the Posterior Semicircular Canal After Dix-Hallpike Maneuver. [Abstract] [BibTeX]	2016	Audiology research Vol. 6(1), pp. 140	article	DOI
Abstract: The objective of the present study is to analyze the quantitative vestibulo-ocular responses in a group of patients with benign paroxysmal positional vertigo (BPPV) canalolithiasis and compare these data with the data of the tridimensional biomechanical model. This study was conducted on 70 patients that presented idiopathic posterior semicircular canal canalolithiasis. The diagnosis was obtained by Dix-Hallpike maneuvers recorded by videonystagmograph. The present study demonstrates that there is a significant correlation between the intensity of the nystagmus and its latency in cases of BPPV-idiopathic posterior semicircular canal canalolithiasis type. These findings are in agreement with those obtained in a tridimensional biomechanical model and are not related to the patients' age.
BibTeX: @article{ZumaeMaia2016a, author = {Zuma e Maia, Francisco Carlos and Albernaz, Pedro Luiz Mangabeira and Cal, Renato Valério}, title = {Behavior of the Posterior Semicircular Canal After Dix-Hallpike Maneuver.}, journal = {Audiology research}, year = {2016}, volume = {6}, issue = {1}, pages = {140}, doi = {https://doi.org/10.4081/audiores.2016.140}, keywords = {Benign paroxysmal positional vertigo; Dix-Hallpike maneuver}, pmid = {27588161} }
Pollak, L., Segal, P., Stryjer, R. and Stern, H.G.	Beliefs and emotional reactions in patients with benign paroxysmal positional vertigo: a longitudinal study. [Abstract] [BibTeX]	2012	American journal of otolaryngology Vol. 33(2), pp. 221-225	article	DOI
Abstract: Psychologic studies in patients with benign paroxysmal positional vertigo (BPPV) are scarce, considering the high frequency of the disorder. We performed a repeated-measures design questionnaire study in a cohort of patients with BPPV before and after treatment to investigate the dynamics of the psychologic findings and possible treatment consequences. Thirty-seven consecutive patients with idiopathic BPPV participated in the study. During the first visit and 2 to 3 months after therapy, the patients completed 4 questionnaires: the Dizziness Handicap Inventory, the Illness Perception Questionnaire-Revised, the Intolerance of Uncertainty Scale, and the State-Trait Anxiety Inventory. The scores for all questioned items did not change before and after treatment except for the physical handicap scores. Correlation was found between the grade of functional and emotional impact of the disease and belief in consequences as well as anxiety levels of the patients. Moreover, uncertainty scores were in correlation with emotional impact, anxiety levels, and perceived consequences of the disease. The belief in personal control of the condition was correlated with the belief in treatment control and understanding of the disease. The main finding in this study is the lack of a significant change in beliefs and emotional reactions in patients with BPPV after treatment of their condition. Physicians dealing with BPPV should be aware that the disease is not solely a somatic condition but has a serious impact on the patient's mental state. Selected patients might benefit from anxiolytic medication.
BibTeX: @article{Pollak2012, author = {Pollak, Lea and Segal, Perri and Stryjer, Rafael and Stern, Hadassah Goldberg}, title = {Beliefs and emotional reactions in patients with benign paroxysmal positional vertigo: a longitudinal study.}, journal = {American journal of otolaryngology}, year = {2012}, volume = {33}, issue = {2}, pages = {221--225}, doi = {https://doi.org/10.1016/j.amjoto.2011.07.002}, keywords = {Benign Paroxysmal Positional Vertigo; Culture; Dizziness, ethnology, etiology, psychology; Emotions; Female; Follow-Up Studies; Humans; Incidence; Israel, epidemiology; Male; Middle Aged; Psychometrics, methods; Retrospective Studies; Surveys and Questionnaires; Time Factors; Vertigo, complications, ethnology, psychology}, pmid = {21872359} }
Brodsky, J., Kaur, K., Shoshany, T., Lipson, S. and Zhou, G.	Benign paroxysmal migraine variants of infancy and childhood: Transitions and clinical features. [Abstract] [BibTeX]	2018	European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society Vol. 22(4), pp. 667-673	article	DOI
Abstract: Migraine variant disorders of childhood include benign paroxysmal torticollis of infancy (BPTI) and benign paroxysmal vertigo of childhood (BPVC). This study aimed to review our experience with BPTI and BPVC and determine the incidence of children transitioning between each of these disorders and to vestibular migraine (VM). We retrospectively reviewed the medical records of patients seen at the Balance and Vestibular Program at Boston Children's Hospital between January 2012 and December 2016 who were diagnosed with BPTI, BPVC, and/or VM. Fourteen patients were diagnosed with BPTI, 39 with BPVC, and 100 with VM. Abnormal rotary chair testing was associated with progression from BPTI to BPVC (n = 8, p = 0.045). Eight (57.1%) patients with BPTI and 11 (28.2%) with BPVC had motor delay. Eleven (78.6%) patients with BPTI and 21 (53.8%) with BPVC had balance impairment. Six BPTI patients developed BPVC (42.9%), six BPVC patients developed VM (15.4%), and two patients progressed through all three disorders (2%). One BPTI patient progressed directly to VM. Most patients with BPTI will experience complete resolution in early childhood, but some will progress to BPVC, and similarly many patients with BPVC will progress to VM. Parents of children with these disorders should be made aware of this phenomenon, which we refer to as "the vestibular march." Children with BPTI and BPVC should also be screened for hearing loss, otitis media, and motor delay.
BibTeX: @article{Brodsky2018a, author = {Brodsky, Jacob and Kaur, Karampreet and Shoshany, Talia and Lipson, Sophie and Zhou, Guangwei}, title = {Benign paroxysmal migraine variants of infancy and childhood: Transitions and clinical features.}, journal = {European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society}, year = {2018}, volume = {22}, issue = {4}, pages = {667--673}, doi = {https://doi.org/10.1016/j.ejpn.2018.03.008}, keywords = {Benign Paroxysmal Positional Vertigo, epidemiology; Child; Child, Preschool; Disease Progression; Female; Humans; Male; Migraine Disorders, complications, epidemiology; Retrospective Studies; Torticollis, complications, epidemiology; Benign paroxysmal torticollis of infancy; Benign paroxysmal vertigo of childhood; Benign recurrent vertigo; Migraine associated vertigo; Migrainous vertigo; Vestibular migraine}, pmid = {29656928} }
Black, F.O., Pesznecker, S.C., Homer, L. and Stallings, V.	Benign paroxysmal positional nystagmus in hospitalized subjects receiving ototoxic medications. [Abstract] [BibTeX]	2004	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 25(3), pp. 353-358	article
Abstract: To investigate the occurrence of benign paroxysmal positional nystagmus in subjects undergoing treatment with potentially ototoxic medications. Prospective and retrospective record reviews. Tertiary referral neurotology clinic; clinical research and technology center. Ninety-nine hospitalized subjects undergoing treatment of infectious disease or carcinoma with potentially ototoxic medications. Records review, tests of vestibular function. Results of Hallpike positional tests for benign paroxysmal positional nystagmus (electro-oculography). Forty-one (41%) of 99 subjects were female and 58 (59%) were male. Age range was 15 to 73 years (mean, 47 years). Forty-nine (50%) of 99 subjects had an unequivocally positive Hallpike test for benign paroxysmal positional nystagmus in one or both ears. The occurrence of benign paroxysmal positional nystagmus in the Hallpike-positive population was distributed equally across age decades. Of the 49 subjects with benign paroxysmal positional nystagmus, 22 (44%) were female and 27 (56%) were male. Benign paroxysmal positional nystagmus is the most common cause of vertigo in the general population, including subjects receiving ototoxic drugs. Complaints of vertigo in subjects receiving ototoxic drugs therefore may or may not indicate onset of ototoxicity. Occurrence of benign paroxysmal positional nystagmus in subjects receiving ototoxic drugs was independent of gender or age. The high occurrence rate of benign paroxysmal positional nystagmus in subjects receiving potentially ototoxic medications is consistent with the observation that benign paroxysmal positional nystagmus occurs in combination with many pathologic conditions. Benign paroxysmal positional nystagmus presenting in subjects receiving ototoxic drugs may complicate the clinical identification of ototoxicity and obfuscate clinical decision-making processes.
BibTeX: @article{Black2004, author = {Black, F Owen and Pesznecker, Susan C and Homer, Louis and Stallings, Valerie}, title = {Benign paroxysmal positional nystagmus in hospitalized subjects receiving ototoxic medications.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2004}, volume = {25}, issue = {3}, pages = {353--358}, note = {Grant numbers: NASA NAG5-6329.}, keywords = {Adolescent; Adult; Aged; Aminoglycosides, adverse effects; Anti-Infective Agents, adverse effects; Antineoplastic Agents, adverse effects; Cisplatin, adverse effects; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, chemically induced, complications; Prospective Studies; Retrospective Studies; Vertigo, etiology; Vestibular Function Tests; NASA Discipline Neuroscience; Non-NASA Center}, pmid = {15129117} }
Burrows, L. and Price, R.	Benign paroxysmal positional vertigo (BPPV) diagnosis and treatment in an elite professional football (soccer) player. [Abstract] [BibTeX]	2017	BMJ case reports Vol. 2017	article	DOI
Abstract: A 33-year-old male professional football player suffered from acute-onset dizziness following a lower limb soft tissue treatment in prone lying. Symptoms included spinning vertigo lasting for 30's, headache, visual vertigo and disorientation. Clinical examination of balance and vestibular systems confirmed a left posterior canalithiasis benign paroxysmal positional vertigo (BPPV) and excluded other central and peripheral causes of dizziness. Two cycles of a left Epley manoeuvre were performed. An Epley manoeuvre abolished the BPPV and negated the need for medication. The player was able to return to play without dizziness within 24 hours completely symptom free. BPPV can be successfully identified and treated in elite football players and they can see a return to training and games within 24 hours. There are no epidemiology studies for this group of elite athletes either male or female despite increased occupational risk factors.
BibTeX: @article{Burrows2017, author = {Burrows, Lisa and Price, Rob}, title = {Benign paroxysmal positional vertigo (BPPV) diagnosis and treatment in an elite professional football (soccer) player.}, journal = {BMJ case reports}, year = {2017}, volume = {2017}, doi = {https://doi.org/10.1136/bcr-2017-220000}, keywords = {Adult; Benign Paroxysmal Positional Vertigo, complications, diagnosis, therapy; Confusion, diagnosis, etiology; Dizziness, diagnosis, etiology; Ear, Inner, pathology; Headache, diagnosis, etiology; Humans; Lithiasis, complications, diagnosis; Male; Physical Examination; Physical Therapy Modalities; Postural Balance; Prone Position; Return to Sport; Risk Factors; Soccer; ear, nose and throat/otolaryngology; physiotherapy (rehabilitation); sports and exercise medicine}, pmid = {28739612} }
Brodsky, J.R., Lipson, S., Wilber, J. and Zhou, G.	Benign Paroxysmal Positional Vertigo (BPPV) in Children and Adolescents: Clinical Features and Response to Therapy in 110 Pediatric Patients. [Abstract] [BibTeX]	2018	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 39(3), pp. 344-350	article	DOI
Abstract: This study aimed to characterize the clinical features and outcomes of benign paroxysmal positional vertigo (BPPV) in the pediatric population. Retrospective case review. Tertiary care center. One hundred ten patients, aged 5 to 19 years old, diagnosed with BPPV. Patient demographics, comorbidities, canal involvement, response to treatment, and incidence of recurrence. BPPV was diagnosed in 19.8% of patients seen for dizziness during the study period. Patient age ranged 5 to 19 years old (mean =13.4 ± 3.4 yr). Female:male ratio was 3:2. The most prevalent comorbidities were concussion (n = 42, 38.2%) and migraine disorders (n = 33, 30.0%). Average time to diagnosis from symptom onset was 178.2 ± 190.8 days. The posterior canal was most frequently affected (n = 80, 72.7%), followed by the lateral canal (n = 37, 33.6%) and superior canal (n = 21, 19.1%), and 36.4% (n = 40) of patients had multiple canals affected. Treatment requiring more than or equal to five maneuvers to achieve resolution was observed in 11.8% of cases (n = 13). Recurrence was observed in 18.2% of cases. A logistic regression analysis demonstrated that patients with vestibular migraine or benign paroxysmal vertigo of childhood had five times higher odds of recurrence of BPPV, p = 0.003, 95% [1.735, 15.342], than those who did not have either. BPPV is a relatively common cause of dizziness in the pediatric population. Children and adolescents with BPPV can be successfully treated with repositioning maneuvers but may be at risk for treatment resistance and recurrence. Increased awareness of BPPV in pediatric patients may reduce delays in identification and treatment.
BibTeX: @article{Brodsky2018b, author = {Brodsky, Jacob R and Lipson, Sophie and Wilber, Jared and Zhou, Guangwei}, title = {Benign Paroxysmal Positional Vertigo (BPPV) in Children and Adolescents: Clinical Features and Response to Therapy in 110 Pediatric Patients.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2018}, volume = {39}, issue = {3}, pages = {344--350}, doi = {https://doi.org/10.1097/MAO.0000000000001673}, pmid = {29287036} }
Gordon, A.G.	Benign paroxysmal positional vertigo (BPPV) or bubble provoked positional vertigo? [BibTeX]	1992	Journal of the neurological sciences Vol. 111(2), pp. 229-233	article
BibTeX: @article{Gordon1992, author = {Gordon, A G}, title = {Benign paroxysmal positional vertigo (BPPV) or bubble provoked positional vertigo?}, journal = {Journal of the neurological sciences}, year = {1992}, volume = {111}, issue = {2}, pages = {229--233}, keywords = {Air; Craniocerebral Trauma, complications; Ear, Inner, physiopathology; Gravitation; Humans; Models, Biological; Nystagmus, Pathologic, physiopathology; Perilymph; Posture; Stress, Mechanical; Vertigo, etiology, physiopathology}, pmid = {1431992} }
Damman, W., Kuhweide, R. and Dehaene, I.	Benign paroxysmal positional vertigo (BPPV) predominantly affects the right labyrinth. [BibTeX]	2005	Journal of neurology, neurosurgery, and psychiatry Vol. 76(9), pp. 1307-1308	article	DOI
BibTeX: @article{Damman2005, author = {Damman, W and Kuhweide, R and Dehaene, I}, title = {Benign paroxysmal positional vertigo (BPPV) predominantly affects the right labyrinth.}, journal = {Journal of neurology, neurosurgery, and psychiatry}, year = {2005}, volume = {76}, issue = {9}, pages = {1307--1308}, doi = {https://doi.org/10.1136/jnnp.2005.065912}, keywords = {Functional Laterality; Humans; Labyrinth Diseases, complications, pathology; Retrospective Studies; Vertigo, etiology, pathology}, pmid = {16107378} }
Hornibrook, J.	Benign Paroxysmal Positional Vertigo (BPPV): History, Pathophysiology, Office Treatment and Future Directions. [Abstract] [BibTeX]	2011	International journal of otolaryngology Vol. 2011, pp. 835671	article	DOI
Abstract: BPPV is the most common cause of vertigo. It most often occurs spontaneously in the 50 to 70 year age group. In younger individuals it is the commonest cause of vertigo following head injury. There is a wide spectrum of severity from inconsistent positional vertigo to continuous vertigo provoked by any head movement. It is likely to be a cause of falls and other morbidity in the elderly. Misdiagnosis can result in unnecessary tests. The cardinal features and a diagnostic test were clarified in 1952 by Dix and Hallpike. Subsequently, it has been established that the symptoms are attributable to detached otoconia in any of the semicircular canals. BPPV symptoms can resolve spontaneously but can last for days, weeks, months, and years. Unusual patterns of nystagmus and nonrepsonse to treatment may suggest central pathology. Diagnostic strategies and the simplest "office" treatment techniques are described. Future directions for research are discussed.
BibTeX: @article{Hornibrook2011, author = {Hornibrook, Jeremy}, title = {Benign Paroxysmal Positional Vertigo (BPPV): History, Pathophysiology, Office Treatment and Future Directions.}, journal = {International journal of otolaryngology}, year = {2011}, volume = {2011}, pages = {835671}, doi = {https://doi.org/10.1155/2011/835671}, pmid = {21808648} }
Katsarkas, A.	Benign paroxysmal positional vertigo (BPPV): idiopathic versus post-traumatic. [Abstract] [BibTeX]	1999	Acta oto-laryngologica Vol. 119(7), pp. 745-749	article
Abstract: Between October 1974 and August 1997 in our Dizziness Clinic (n = 15,233), 2,523 patients were found to suffer from BPPV. All patients were assessed and followed up by the author. Patients (n = 337) having other ear or neurological diseases were excluded from this retrospective study. In 1644/2186 (75.21%) patients, the type of nystagmus was clinically identified in two opposite directions of gaze in the provocative head position. These patients were divided into two groups: i) idiopathic (n = 1,490) (no apparent cause); ii) post-traumatic (n = 154) (time of onset related to accident). It was found that in the idiopathic group men were older than women; women were more affected than men (2.3:1), and in the post-traumatic group there was no age difference between men and women; women and men were equally affected (1:1). In addition: i) patients were older in the idiopathic than the post-traumatic group. ii) BPPV of the posterior (PSC) was by far more prevalent than BPPV of the horizontal semicircular canal (HSC) in both groups, although there was no difference in prevalence between the two groups. iii) Bilateral involvement was more prevalent in the post-traumatic group. iv) All bilateral cases in both groups suffered from BPPV of the PSC. It is concluded that despite similarities, these two groups differ in a number of parameters. Thus the pathophysiology and the course of idiopathic vs post-traumatic BPPV may also be different.
BibTeX: @article{Katsarkas1999, author = {Katsarkas, A}, title = {Benign paroxysmal positional vertigo (BPPV): idiopathic versus post-traumatic.}, journal = {Acta oto-laryngologica}, year = {1999}, volume = {119}, issue = {7}, pages = {745--749}, keywords = {Adult; Age Distribution; Aged; Craniocerebral Trauma, complications; Eye Movements, physiology; Female; Head, physiology; Humans; Male; Middle Aged; Nystagmus, Pathologic, physiopathology; Posture, physiology; Prevalence; Retrospective Studies; Semicircular Canals, physiopathology; Sex Factors; Vertigo, epidemiology, etiology, physiopathology}, pmid = {10687929} }
Maslovara, S., Soldo, S.B., Puksec, M., Balaban, B. and Penavic, I.P.	Benign paroxysmal positional vertigo (BPPV): influence of pharmacotherapy and rehabilitation therapy on patients' recovery rate and life quality. [Abstract] [BibTeX]	2012	NeuroRehabilitation Vol. 31(4), pp. 435-441	article	DOI
Abstract: This prospective clinical study includes 96 BPPV patients with the results of DHI testing ≥ 40 points. They were segregated to be taken into this study and randomly divided into two therapy groups: 48 patients in Group I were treated pharmacotherapeutically with Betahistine Chloride (BC) and 48 patients in Group II underwent a rehabilitation treatment by performing an Epley maneuver. Total study duration was eight weeks, during which the patients were first examined upon arrival, checked after one, and rechecked after eight weeks. The tests included otoneurological examination and VNG, as well as completing three questionnaires: DHI, SF-36®, and HADS®. During the first checkup after one week, 86.96% of patients in Group I and 93.33% in Group II had negative results at the Dix-Hallpike test. During the second checkup after an eight weeks' treatment, 95.65% in Group I and 97.78% patients in Group II had a negative result. At the beginning of the study, the values of patients' physical, emotional, and functional health (QoL) were equally distributed in both therapy groups, compared to standardized values of healthy population. During the first checkup, the values were significantly higher and by the second checkup, reached the statistic average, which corresponds with the healthy population. There was an obviously faster and more complete recovery of the patients in Group II, who underwent a rehabilitation treatment.
BibTeX: @article{Maslovara2012, author = {Maslovara, Sinisa and Soldo, Silva Butkovic and Puksec, Mirjana and Balaban, Branka and Penavic, Ivana Pajic}, title = {Benign paroxysmal positional vertigo (BPPV): influence of pharmacotherapy and rehabilitation therapy on patients' recovery rate and life quality.}, journal = {NeuroRehabilitation}, year = {2012}, volume = {31}, issue = {4}, pages = {435--441}, doi = {https://doi.org/10.3233/NRE-2012-00814}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Betahistine, therapeutic use; Female; Histamine Agonists, therapeutic use; Humans; Male; Middle Aged; Neurologic Examination; Patient Positioning, methods; Patient Satisfaction; Quality of Life; Recovery of Function, physiology; Surveys and Questionnaires; Treatment Outcome; Vertigo, drug therapy, rehabilitation, therapy}, pmid = {23232168} }
Giannini, S., Signorini, L., Bonanome, L., Severino, M., Corpaci, F. and Cielo, A.	Benign paroxysmal positional vertigo (BPPV): it may occur after dental implantology. A mini topical review. [Abstract] [BibTeX]	2015	European review for medical and pharmacological sciences Vol. 19(19), pp. 3543-3547	article
Abstract: Benign Paroxysmal Positional Vertigo (BPPV) is one of the most frequent vestibular disorders. BPPV as a complication of Osteotome Sinus Floor Elevation (OSFE) is a complication that rarely occurs. The aim of this paper is to better understand the mechanisms underlying the BPPV after SFE with the osteotomes. This could be important for all the dental and maxillofacial surgeons that should know and manage this clinical occurrence. The osteotome sinus floor elevation (OSFE), firstly described by Summers requires the use of a surgical mallet for striking the bone, until the optimal depth is reached. The surgical mallet develops a mechanical trauma, even if the striking is performed with a gentle percussion. The recent literature describes an average occurrence of OSFE-induced BPPV quite low, but the symptoms show to be unpleasant and severe, often able to alter the patient's daily life. A successful remission of BPPV following treatment with a particle repositioning maneuver will be necessary and relatively urgent for the surgeons who have experienced this clinical complication. The surgeons, therefore, must be aware of these complications and about the ways to manage them.
BibTeX: @article{Giannini2015, author = {Giannini, S and Signorini, L and Bonanome, L and Severino, M and Corpaci, F and Cielo, A}, title = {Benign paroxysmal positional vertigo (BPPV): it may occur after dental implantology. A mini topical review.}, journal = {European review for medical and pharmacological sciences}, year = {2015}, volume = {19}, issue = {19}, pages = {3543--3547}, keywords = {Benign Paroxysmal Positional Vertigo, etiology; Humans; Osteotomy, adverse effects; Patient Positioning; Sinus Floor Augmentation, adverse effects}, pmid = {26502841} }
Bourgeois, P.M. and Dehaene, I.	Benign paroxysmal positional vertigo (BPPV). Clinical features in 34 cases and review of literature. [Abstract] [BibTeX]	1988	Acta neurologica Belgica Vol. 88(2), pp. 65-74	article
Abstract: The clinical features of benign paroxysmal positional vertigo are analysed in 34 patients. These features are detectable by careful examination and are explained by an abnormal stimulation of a posterior semicircular canal of the labyrinth. Cupulolithiasis could be the mechanism which makes this cupula gravity-sensitive.
BibTeX: @article{Bourgeois1988, author = {Bourgeois, P M and Dehaene, I}, title = {Benign paroxysmal positional vertigo (BPPV). Clinical features in 34 cases and review of literature.}, journal = {Acta neurologica Belgica}, year = {1988}, volume = {88}, issue = {2}, pages = {65--74}, keywords = {Adult; Aged; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, etiology, physiopathology; Posture; Reaction Time; Semicircular Canals, physiopathology; Vertigo, etiology, physiopathology}, pmid = {3389075} }
Kim, M.-B. and Ban, J.H.	Benign paroxysmal positional vertigo accompanied by sudden sensorineural hearing loss: a comparative study with idiopathic benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2012	The Laryngoscope Vol. 122(12), pp. 2832-2836	article	DOI
Abstract: To investigate the clinical characteristics of benign paroxysmal positional vertigo (BPPV) associated with idiopathic sudden sensorineural hearing loss (ISSHL) and to compare them with the characteristics of idiopathic BPPV (i-BPPV). Retrospective case series. We retrospectively analyzed 519 patients with ISSHL and 597 patients with i-BPPV. The ISSHL patients with recent vertigo history before or after admission were tested with video-nystagmography that included the caloric test. BPPV with same-side ISSHL was identified and categorized as secondary BPPV (s-BPPV) using the roll or Dix-Hallpike test. All members of the s-BPPV and i-BPPV groups underwent a daily canalith repositioning procedure (CRP) during the admission periods. We investigated the clinical characteristics, including the number of CRPs performed to achieve successful reposition, canal involvement type, and effect of canal paresis and made comparisons between the s-BPPV and i-BPPV groups. Of the 519 ISSHL patients, 63 (12.1%) were identified as having s-BPPV. Multicanal involvement was more frequent in s-BPPV than i-BPPV patients (P < .001). The mean number of CRPs needed to achieve successful reposition was 4.28 in s-BPPV and 1.34 in i-BPPV (P < .001). The presence of canal paresis was also associated with a greater number of CRPs required for s-BPPV (P < .02). In about 12% of ISSHL patients, s-BPPV was concurrent. More CRPs were required for successful repositioning in patients with s-BPPV than in patients with i-BPPV. Also, the presence of canal paresis in s-BPPV was associated with a greater number of required CRPs.
BibTeX: @article{Kim2012, author = {Kim, Min-Beom and Ban, Jae Ho}, title = {Benign paroxysmal positional vertigo accompanied by sudden sensorineural hearing loss: a comparative study with idiopathic benign paroxysmal positional vertigo.}, journal = {The Laryngoscope}, year = {2012}, volume = {122}, issue = {12}, pages = {2832--2836}, doi = {https://doi.org/10.1002/lary.23607}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Audiometry; Benign Paroxysmal Positional Vertigo; Child; Female; Hearing Loss, Sensorineural, complications, epidemiology, physiopathology; Hearing Loss, Sudden, classification, epidemiology, physiopathology; Humans; Incidence; Male; Middle Aged; Posture; Prognosis; Republic of Korea, epidemiology; Retrospective Studies; Risk Factors; Semicircular Canals, physiopathology; Vertigo, complications, epidemiology, physiopathology; Young Adult}, pmid = {22915291} }
Dan-Goor, E., Eden, J.C.P., Wilson, S.J., Dangoor, J. and Wilson, B.R.	Benign paroxysmal positional vertigo after decompression sickness: a first case report and review of the literature. [Abstract] [BibTeX]	2010	American journal of otolaryngology Vol. 31(6), pp. 476-478	article	DOI
Abstract: Benign paroxysmal positional vertigo is a common cause of vertigo. We describe a previously unreported case of this clinical entity in a young, fit recreational water diver, having experienced decompression illness. Full recovery occurred after hyperbaric recompression therapy, and he remained symptom free on 6-week follow-up. We review the literature and discuss the pathogenesis of benign paroxysmal positional vertigo, proposing that semicircular canal nitrogen bubble formation could have been the primary etiological event leading to this condition.
BibTeX: @article{Dan-Goor2010, author = {Dan-Goor, Eric and Eden, Julian C P and Wilson, Simon J and Dangoor, Joseph and Wilson, Benjamin R}, title = {Benign paroxysmal positional vertigo after decompression sickness: a first case report and review of the literature.}, journal = {American journal of otolaryngology}, year = {2010}, volume = {31}, issue = {6}, pages = {476--478}, doi = {https://doi.org/10.1016/j.amjoto.2009.07.001}, keywords = {Adult; Benign Paroxysmal Positional Vertigo; Decompression Sickness, complications, therapy; Diving, adverse effects; Humans; Hyperbaric Oxygenation; Male; Nitrogen; Semicircular Canals; Vertigo, etiology, therapy}, pmid = {20015792} }
Chang, T.-P., Lin, Y.-W., Sung, P.-Y., Chuang, H.-Y., Chung, H.-Y. and Liao, W.-L.	Benign Paroxysmal Positional Vertigo after Dental Procedures: A Population-Based Case-Control Study. [Abstract] [BibTeX]	2016	PloS one Vol. 11(4), pp. e0153092	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV), the most common type of vertigo in the general population, is thought to be caused by dislodgement of otoliths from otolithic organs into the semicircular canals. In most cases, however, the cause behind the otolith dislodgement is unknown. Dental procedures, one of the most common medical treatments, are considered to be a possible cause of BPPV, although this has yet to be proven. This study is the first nationwide population-based case-control study conducted to investigate the correlation between BPPV and dental manipulation. Patients diagnosed with BPPV between January 1, 2007 and December 31, 2012 were recruited from the National Health Insurance Research Database in Taiwan. We further identified those who had undergone dental procedures within 1 month and within 3 months before the first diagnosis date of BPPV. We also identified the comorbidities of the patients with BPPV, including head trauma, osteoporosis, migraine, hypertension, diabetes, hyperlipidemia and stroke. These variables were then compared to those in age- and gender-matched controls. In total, 768 patients with BPPV and 1536 age- and gender-matched controls were recruited. In the BPPV group, 9.2% of the patients had undergone dental procedures within 1 month before the diagnosis of BPPV. In contrast, only 5.5% of the controls had undergone dental treatment within 1 month before the date at which they were identified (P = 0.001). After adjustments for demographic factors and comorbidities, recent exposure to dental procedures was positively associated with BPPV (adjusted odds ratio 1.77; 95% confidence interval 1.27-2.47). This association was still significant if we expanded the time period from 1 month to 3 months (adjusted odds ratio 1.77; 95% confidence interval 1.39-2.26). Our results demonstrated a correlation between dental procedures and BPPV. The specialists who treat patients with BPPV should consider dental procedures to be a risk factor, and dentists should recognize BPPV as a possible complication of dental treatment.
BibTeX: @article{Chang2016, author = {Chang, Tzu-Pu and Lin, Yueh-Wen and Sung, Pi-Yu and Chuang, Hsun-Yang and Chung, Hsien-Yang and Liao, Wen-Ling}, title = {Benign Paroxysmal Positional Vertigo after Dental Procedures: A Population-Based Case-Control Study.}, journal = {PloS one}, year = {2016}, volume = {11}, issue = {4}, pages = {e0153092}, doi = {https://doi.org/10.1371/journal.pone.0153092}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo, epidemiology, etiology; Case-Control Studies; Comorbidity; Female; Humans; Male; Middle Aged; Odds Ratio; Population Surveillance; Prosthodontics; Risk Factors; Taiwan, epidemiology}, pmid = {27044009} }
Chiarella, G., Leopardi, G., De Fazio, L., Chiarella, R. and Cassandro, E.	Benign paroxysmal positional vertigo after dental surgery. [Abstract] [BibTeX]	2008	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 265(1), pp. 119-122	article	DOI
Abstract: We investigated the relationship between dental and maxillofacial surgery and benign paroxysmal positional vertigo (BPPV). BPPV represents the most frequent cause of vertigo of labyrinthine origin. BPPV has been reported following surgical trauma from various surgical interventions, regarding anatomical site and technical execution. A surgical origin is, in many cases, supported by the temporal relation to the surgical intervention as well as by the clinical picture. We considered eight BPPV cases of suspected iatrogenic origin focusing our attention on dental surgery with particular reference to surgical extraction of included teeth through rotating tools. The cases taken into account had no other inner ear disease and BPPV risk indicator. We conclude that dental surgery is a risk factor for BPPV.
BibTeX: @article{Chiarella2008, author = {Chiarella, Giuseppe and Leopardi, Gianluca and De Fazio, Luca and Chiarella, Rosarita and Cassandro, Ettore}, title = {Benign paroxysmal positional vertigo after dental surgery.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2008}, volume = {265}, issue = {1}, pages = {119--122}, doi = {https://doi.org/10.1007/s00405-007-0397-7}, keywords = {Adult; Female; Humans; Male; Middle Aged; Risk Factors; Tooth Extraction, adverse effects; Vertigo, etiology}, pmid = {17647006} }
Giacomini, P.G., Ferraro, S., Di Girolamo, S., Villanova, I. and Ottaviani, F.	Benign paroxysmal positional vertigo after intense physical activity: a report of nine cases. [Abstract] [BibTeX]	2009	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 266(11), pp. 1831-1835	article	DOI
Abstract: The aim of this study was to report some clinical cases suggesting a possible correlation between benign paroxysmal positional vertigo (BPPV) and intense physical activity. Out of 430 BPPV cases referred to our out-patients clinic, 9 patients, showing symptoms of BPPV arising after an intense period of physical activity, were selected for this study. The posterior semicircular canal was affected in all the nine patients. The canalith repositioning procedure was successful and eliminated vertigo and nystagmus in all patients. During the follow-up period (12 months) all patients continued with the usual physical activity; four of the nine patients showed a recurrence of the BPPV symptoms after a new intense period of exercises: all were successfully treated by a new single Epley repositioning procedure. BPPV due to intense physical activity is a rare condition (9/430) and it may be caused by repeated vibratory vertical accelerations of a minor degree associated with metabolic variations during strenuous exercise.
BibTeX: @article{Giacomini2009, author = {Giacomini, Pier Giorgio and Ferraro, Simona and Di Girolamo, Stefano and Villanova, Irene and Ottaviani, Fabrizio}, title = {Benign paroxysmal positional vertigo after intense physical activity: a report of nine cases.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2009}, volume = {266}, issue = {11}, pages = {1831--1835}, doi = {https://doi.org/10.1007/s00405-009-0938-3}, keywords = {Adolescent; Adult; Exercise; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, etiology, pathology, therapy; Semicircular Canals, pathology; Vertigo, etiology, pathology, therapy; Vestibular Function Tests}, pmid = {19288124} }
Kansu, L., Aydin, E. and Gulsahi, K.	Benign paroxysmal positional vertigo after nonotologic surgery: case series. [Abstract] [BibTeX]	2015	Journal of maxillofacial and oral surgery Vol. 14(Suppl 1), pp. 113-115	article	DOI
Abstract: Benign paroxysmal positional vertigo is one of the most common types of vertigo caused by peripheral vestibular dysfunction. Although head trauma, migraine, long-term bed rest, Ménière disease, viral labyrinthitis, and upper respiratory tract infections are believed to be predisposing factors, most cases of benign paroxysmal positional vertigo are idiopathic. Ear surgery is another cause, but after non-otologic surgery, attacks of benign paroxysmal positional vertigo are rare. We describe three cases of benign paroxysmal positional vertigo attacks after non-otologic surgery (one patient after a nasal septoplasty and two patients after dental endodontic treatment) and discuss the pathophysiological mechanism of benign paroxysmal positional vertigo seen after non-otologic surgery, its diagnosis and treatment.
BibTeX: @article{Kansu2015, author = {Kansu, Leyla and Aydin, Erdinc and Gulsahi, Kamran}, title = {Benign paroxysmal positional vertigo after nonotologic surgery: case series.}, journal = {Journal of maxillofacial and oral surgery}, year = {2015}, volume = {14}, issue = {Suppl 1}, pages = {113--115}, doi = {https://doi.org/10.1007/s12663-012-0356-8}, keywords = {Benign paroxysmal positional vertigo; Dental surgery; Nasal septoplasty}, pmid = {25838683} }
Messina, A.M. and Marini, E.	Benign Paroxysmal Positional Vertigo After Piezosurgical Removal of Osseointegrated Implants. [Abstract] [BibTeX]	2018	The Journal of craniofacial surgery Vol. 29(8), pp. e739-e740	article	DOI
Abstract: With the increasing popularity of dental implants, the explantation of fractured implants has become a major challenge for clinicians. Several tools can be used for the removal of osseointegrated implants; however, few of these have the characteristics of easy control, selective cutting, and rapid healing. We report a case of benign paroxysmal positional vertigo (BPPV) developed immediately after piezosurgical removal of osteointegrated implants.The BPPV may be an unpleasant complication of piezosurgical removal of osseointegrated implants and may cause considerable stress if not identified correctly and managed properly.
BibTeX: @article{Messina2018, author = {Messina, Antonello Maria and Marini, Ettore}, title = {Benign Paroxysmal Positional Vertigo After Piezosurgical Removal of Osseointegrated Implants.}, journal = {The Journal of craniofacial surgery}, year = {2018}, volume = {29}, issue = {8}, pages = {e739--e740}, doi = {https://doi.org/10.1097/SCS.0000000000004649}, keywords = {Benign Paroxysmal Positional Vertigo, etiology; Bone-Anchored Prosthesis; Dental Implants; Device Removal, adverse effects; Female; Humans; Middle Aged; Postoperative Complications}, pmid = {29877981} }
Aydin, E., Akman, K., Yerli, H. and Ozluoglu, L.N.	Benign paroxysmal positional vertigo after radiologic scanning: a case series. [Abstract] [BibTeX]	2008	Journal of medical case reports Vol. 2, pp. 92	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most common type of vertigo. It is frequently seen in elderly patients, and the course of the attack may easily mimic cerebrovascular disease. A BPPV attack after a radiologic examination has not been reported previously. We report the cases of two patients who had BPPV attacks after radiologic imaging. The first patient with headache and tremor was admitted to the radiology department for cranial computed tomography (CT) imaging. During scanning, she was asked to lie in the supine position with no other head movements for approximately 10 minutes. After the cranial CT imaging, she stood up rapidly, and suddenly experienced a vertigo attack and nausea. The second patient was admitted to the radiology department for evaluation of his renal arteries. During the renal magnetic resonance angiography, he was in the supine position for 20 minutes and asked not to move. After the examination, he stood up rapidly with the help of the technician and suddenly experienced a vertigo attack with nausea and vomiting. The results of standard laboratory analyses and their neurologic examinations were within normal limits and Dix-Hallpike tests showed rotatory nystagmus in both cases. An Epley maneuver was performed to the patients. The results of a control Dix-Hallpike tests after 1 Epley maneuver were negative in both patients. Radiologists and clinicians must keep in mind that after radiologic imaging in which the patient is still for some time in the supine position and then helped to stand up rapidly, a BPPV attack may occur.
BibTeX: @article{Aydin2008, author = {Aydin, Erdinc and Akman, Kubra and Yerli, Hasan and Ozluoglu, Levent N}, title = {Benign paroxysmal positional vertigo after radiologic scanning: a case series.}, journal = {Journal of medical case reports}, year = {2008}, volume = {2}, pages = {92}, doi = {https://doi.org/10.1186/1752-1947-2-92}, pmid = {18371218} }
Atacan, E., Sennaroglu, L., Genc, A. and Kaya, S.	Benign paroxysmal positional vertigo after stapedectomy. [Abstract] [BibTeX]	2001	The Laryngoscope Vol. 111(7), pp. 1257-1259	article	DOI
Abstract: To determine the incidence of benign paroxysmal positional vertigo (BPPV) following stapedectomy in a patient group and the efficacy of the Epley maneuver in this group. Prospective study in a university-based tertiary referral system. The patient group comprised 63 patients who had undergone stapedectomy; a control group consisted of normal healthy individuals with no otolaryngological complaints. All individuals underwent the Dix-Hallpike maneuver for the diagnosis of BPPV. Patients who exhibited vertigo, torsional nystagmus (which reverses its direction on return to sitting position) preceded by a latent period, and the fatigability of these findings were considered to have BPPV. If the test result was positive, they underwent the Epley therapeutic maneuver. Four of the patients who had undergone a stapedectomy showed characteristic findings of BPPV. No individual in the control group had BPPV. All patients responded well to the Epley maneuver. Stapedectomy may be regarded as an etiological factor in BPPV. Because the fenestra is located in the posterior part of the stapes footplate, the pathophysiology appears to be related to utricular rather than saccular trauma. Correct measurement of the distance between the incus and stapes footplate is essential in stapedectomy. An Internet survey of the relevant literature in English shows a scarcity of publications on the incidence of BPPV following stapedectomy. In the present study, 63 patients who had undergone a stapedectomy were investigated for the presence of BPPV; all had Dix-Hallpike maneuvers performed for the diagnosis. Sixty-three individuals with no otolaryngological complaints made up the control group. Four of the patients who had undergone stapedectomy showed characteristic findings of BPPV, and no individual in the control group had BPPV; the difference between the two groups was statistically significant. All four of the patients diagnosed with BPPV responded well to the Epley maneuver. The pathophysiology appears to be related to utricular trauma. Correct measurement of the distance between the incus and stapes footplate is essential in stapedectomy.
BibTeX: @article{Atacan2001, author = {Atacan, E and Sennaroglu, L and Genc, A and Kaya, S}, title = {Benign paroxysmal positional vertigo after stapedectomy.}, journal = {The Laryngoscope}, year = {2001}, volume = {111}, issue = {7}, pages = {1257--1259}, doi = {https://doi.org/10.1097/00005537-200107000-00021}, keywords = {Adult; Aged; Female; Humans; Male; Middle Aged; Prospective Studies; Stapes Surgery, adverse effects; Vertigo, diagnosis, etiology, physiopathology, therapy}, pmid = {11568550} }
Park, S.-K., Kim, S.Y., Han, K.-H., Hong, S.K., Kim, J.S. and Koo, J.-W.	Benign paroxysmal positional vertigo after surgical drilling of the temporal bone. [Abstract] [BibTeX]	2013	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 34(8), pp. 1448-1455	article	DOI
Abstract: To present the clinical characteristics of secondary BPPV after surgical drilling of the temporal bone. Retrospective study. Tertiary referral academic medical center. Ten patients who developed BPPV after surgical procedure of temporal bone drilling were identified from 965 subjects who underwent surgical drilling of the temporal bone at Seoul National University Bundang Hospital. The localization and lateralization of BPPV were based on positional test using video eye movement recording system and videonystagmography. Onset of BPPV after surgery, distributions of involved semicircular canals, response to particle repositioning maneuver and factors that may influence the development of secondary BPPV after surgical drilling of the temporal bone. Onset of positional vertigo was mostly within 3 days except 1 case (sixth postoperative day). Postoperative BPPV was usually in the contralateral ear in 9 cases (90%), which occurred predominantly on the contralateral horizontal canal in 8 patients (80%). Positional vertigo was resolved after repositioning maneuvers in every case. None of them showed aggravation of bone conduction threshold. The incidence of BPPV after surgical drilling of the temporal bone was around 1%, and the horizontal semicircular canal of the contralateral ear was predominantly involved. Head position during surgery (head restriction to contralateral ear down) as well as limitation of head movement due to compressive mastoid bandage after surgery seems to be responsible for such predominance.
BibTeX: @article{Park2013, author = {Park, Su-Kyoung and Kim, So Young and Han, Kyu-Hee and Hong, Sung Kwang and Kim, Ji Soo and Koo, Ja-Won}, title = {Benign paroxysmal positional vertigo after surgical drilling of the temporal bone.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2013}, volume = {34}, issue = {8}, pages = {1448--1455}, doi = {https://doi.org/10.1097/MAO.0b013e318299b376}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo; Female; Humans; Male; Middle Aged; Orthopedic Procedures, adverse effects; Patient Positioning; Retrospective Studies; Temporal Bone, surgery; Vertigo, etiology, therapy}, pmid = {24026025} }
Dan-Goor, E. and Samra, M.	Benign paroxysmal positional vertigo after use of noise-canceling headphones. [Abstract] [BibTeX]	2012	American journal of otolaryngology Vol. 33(3), pp. 364-366	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo. We describe a case of a woman presenting acutely with a severe episode of disabling positional vertigo. Although she had no known etiologic risk factors, this attack followed 12 hours of continuously wearing digital noise-canceling headphones. This is the first such reported association between BPPV and the use of this gadget. We also provide a short review of BPPV and speculate on the possible pathogenic mechanisms involved.
BibTeX: @article{Dan-Goor2012, author = {Dan-Goor, Eric and Samra, Monica}, title = {Benign paroxysmal positional vertigo after use of noise-canceling headphones.}, journal = {American journal of otolaryngology}, year = {2012}, volume = {33}, issue = {3}, pages = {364--366}, doi = {https://doi.org/10.1016/j.amjoto.2011.08.012}, keywords = {Audiometry; Benign Paroxysmal Positional Vertigo; Diagnosis, Differential; Female; Hearing Aids, adverse effects; Humans; Middle Aged; Noise; Posture; Vertigo, diagnosis, etiology, physiopathology}, pmid = {21978648} }
Ekvall Hansson, E., Månsson, N.-O. and Håkansson, A.	Benign paroxysmal positional vertigo among elderly patients in primary health care. [Abstract] [BibTeX]	2005	Gerontology Vol. 51(6), pp. 386-389	article	DOI
Abstract: Dizziness influences well-being in old age, and benign paroxysmal positional vertigo (BPPV) is a common cause. The condition is diagnosed using the Hallpike maneuver and treated by the particle-repositioning maneuver or habituation exercises. To identify patients with BPPV among a variety of diagnoses represented by the ICD-10 diagnosis R42 in people 65 aged years and older who visited primary health care because of vertigo and dizziness. Searches were performed in the computerized medical records of 6 different health care centers over the period of 1 year for the ICD-10 diagnosis R42 and the age group 65 years and older. Letters were sent to the patients identified with an invitation for assessment and physical examination by a physiotherapist. Thirty-eight patients responded to the letter and were included in the study. All patients were assessed by physical examination including the Hallpike maneuver. The study group included 13 men and 25 women, 65-94 (median 83) years of age. After physical examination, 15 patients were found to have BPPV (confidence interval 24-55%). In this study, 2 of 5 of the patients with ICD-10 diagnosis R42 (dizziness and giddiness) had BPPV. BPPV is probably an underestimated cause of dizziness/vertigo among elderly patients in primary health care.
BibTeX: @article{EkvallHansson2005, author = {Ekvall Hansson, Eva and Månsson, Nils-Ove and Håkansson, Anders}, title = {Benign paroxysmal positional vertigo among elderly patients in primary health care.}, journal = {Gerontology}, year = {2005}, volume = {51}, issue = {6}, pages = {386--389}, doi = {https://doi.org/10.1159/000088702}, keywords = {Aged; Aged, 80 and over; Aging, physiology; Exercise Therapy; Female; Humans; Male; Primary Health Care; Sweden; Vertigo, diagnosis, physiopathology, therapy; Vestibule, Labyrinth, physiopathology}, pmid = {16299419} }
Dornhoffer, J.L. and Colvin, G.B.	Benign paroxysmal positional vertigo and canalith repositioning: clinical correlations. [Abstract] [BibTeX]	2000	The American journal of otology Vol. 21(2), pp. 230-233	article
Abstract: To correlate patient response and recurrence rate after canalith repositioning to clinical presentation and cause of BPPV. This was a retrospective chart review. This study was performed at a tertiary referral center. The study included patients with a diagnosis of benign paroxysmal positional vertigo based on history and the presence of a positive response to the Dix-Hallpike maneuver (affected ear down) who were treated at the University of Arkansas for Medical Sciences between January 1993 and February 1997 using canalith repositioning. There were 52 patients (13 men, 39 women) with an average age of 63 years. Canalith repositioning was performed without the use of vibration, with the maneuver repeated up to three times as necessary at the initial session until vertigo and nystagmus were abolished. Initial response, defined as complete response (elimination of nystagmus and symptoms), improved response (elimination of nystagmus but with some residual symptoms), or no response (continued nystagmus and symptoms), as well as recurrence rate. Initial complete response was seen in 66% of patients, and 33% showed improved response. This difference was believed to be caused by the pathophysiology. Recurrence rates appeared to be correlated to cause, with higher rates reflecting ongoing inner ear injury, such as with Meniere disease. Canalith repositioning was effective in 99% of patients based on elimination of nystagmus. Partial responders probably experienced resolution naturally over time because of a difference in pathophysiology. Higher recurrence rates can be expected when the cause is thought to involve an ongoing process.
BibTeX: @article{Dornhoffer2000, author = {Dornhoffer, J L and Colvin, G B}, title = {Benign paroxysmal positional vertigo and canalith repositioning: clinical correlations.}, journal = {The American journal of otology}, year = {2000}, volume = {21}, issue = {2}, pages = {230--233}, keywords = {Adult; Aged; Aged, 80 and over; Female; Follow-Up Studies; Humans; Male; Middle Aged; Posture; Retrospective Studies; Treatment Outcome; Vertigo, therapy}, pmid = {10733189} }
Amor-Dorado, J.C., Barreira-Fernández, M.P., Vázquez-Rodríguez, T.R., Miranda-Filloy, J.A., Llorca, J. and González-Gay, M.A.	Benign paroxysmal positional vertigo and clinical test of sensory interaction and balance in ankylosing spondylitis. [Abstract] [BibTeX]	2011	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 32(2), pp. 278-283	article	DOI
Abstract: To assess the frequency and characteristics of benign paroxysmal positional vertigo (BPPV) and clinical test of sensory interaction and balance (CTSIB) abnormalities in patients with ankylosing spondylitis (AS). A series of consecutive patients that fulfilled the modified New York diagnostic criteria for AS and matched controls were studied. The study was performed at the Otolaryngology Division of a tertiary reference center. Fifty-nine patients with AS (47 men [79.6%]) attending hospital outpatient rheumatology clinics between March and October 2008, and 46 controls (34 men [73.9%]) were studied. Dix-Hallpike and cephalic rotational tests and CTSIB were performed in AS patients and age-, sex-, and ethnically frequency-matched controls. Type and frequency of BPPV and CTSIB conditions were assessed. BPPV was diagnosed in 6 patients (10.1%) with AS and in 2 (4.3%) of the controls (p = 0.24). Abnormal caloric test was more commonly observed in patients with AS (n = 15 [25.4%]) than the controls (n = 0) (p < 0.001). Increased frequency of abnormal CTSIB also was observed in patients (19/59 [32%]) compared with the controls (3 [6.5%]) (odds ratio, 6.81 [95% confidence interval, 1.77-38.0]; p = 0.001). Among the abnormal CTSIB patterns, the vestibular loss was the most commonly observed in patients with AS (15/59 [25.4%]). The present study shows an increased frequency of abnormal postural control in CTSIB test of vestibular origin in patients with AS.
BibTeX: @article{Amor-Dorado2011, author = {Amor-Dorado, Juan C and Barreira-Fernández, María P and Vázquez-Rodríguez, Tomas R and Miranda-Filloy, José A and Llorca, Javier and González-Gay, Miguel A}, title = {Benign paroxysmal positional vertigo and clinical test of sensory interaction and balance in ankylosing spondylitis.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2011}, volume = {32}, issue = {2}, pages = {278--283}, doi = {https://doi.org/10.1097/MAO.0b013e3182016534}, keywords = {Adult; Benign Paroxysmal Positional Vertigo; Caloric Tests; Eye Movements, physiology; Female; Head Movements, physiology; Humans; Male; Middle Aged; Nystagmus, Physiologic, physiology; Postural Balance, physiology; Rotation; Semicircular Canals, physiopathology; Spondylitis, Ankylosing, physiopathology; Vertigo, physiopathology; Vestibular Function Tests; Young Adult}, pmid = {21150686} }
Amor-Dorado, J.C., Barreira-Fernandez, M.P., Arias-Nuñez, M.C., Gomez-Acebo, I., Llorca, J. and Gonzalez-Gay, M.A.	Benign paroxysmal positional vertigo and clinical test of sensory interaction and balance in systemic sclerosis. [Abstract] [BibTeX]	2008	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 29(8), pp. 1155-1161	article	DOI
Abstract: To assess the frequency and characteristics of benign paroxysmal positional vertigo (BPPV) and clinical test of sensory interaction and balance (CTSIB) abnormalities in patients with systemic sclerosis (SSc). A series of consecutive patients diagnosed with SSc according to well-established classification criteria and matched controls were studied. The study was performed at the otolaryngology division of a tertiary reference center. Forty-two patients (35 with limited SSc [lSSc] and 7 with diffuse SSc [dSSc]) and 74 controls were studied between January and May 2007. Dix-Hallpike and cephalic rotational tests and CTSIB were performed in SSc patients and age-, sex-, and ethnically frequency-matched controls. Type and frequency of BPPV and CTSIB conditions were assessed. Seven patients (17%) fulfilled the diagnostic criteria for BPPV compared with none of the controls (p < 0.001). It was related to the involvement of the posterior semicircular canal in two lSSc patients and the horizontal semicircular canal in another three patients with lSSc and two with dSSc. A significantly increased frequency of abnormal CTSIB was also observed in SSc patients (20 [48%]) compared to controls (7 [10%]; p < 0.0001; odds ratio, 8.70; 95% confidence interval, 2.97-27.2). It was caused by a vestibular pattern in most patients (p < 0.0001). The present study shows an increased frequency of BPPV and a vestibular pattern in CTSIB in SSc patients.
BibTeX: @article{Amor-Dorado2008, author = {Amor-Dorado, Juan C and Barreira-Fernandez, Maria P and Arias-Nuñez, Maria C and Gomez-Acebo, Ines and Llorca, Javier and Gonzalez-Gay, Miguel A}, title = {Benign paroxysmal positional vertigo and clinical test of sensory interaction and balance in systemic sclerosis.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2008}, volume = {29}, issue = {8}, pages = {1155--1161}, doi = {https://doi.org/10.1097/MAO.0b013e31818a086e}, keywords = {Electronystagmography; Female; Functional Laterality; Hearing Tests; Humans; Labyrinthitis, complications; Male; Nystagmus, Pathologic, etiology; Nystagmus, Physiologic; Patient Selection; Postural Balance, physiology; Posture; Reference Values; Reflex, Vestibulo-Ocular; Scleroderma, Systemic, complications, physiopathology; Touch; Vertigo, etiology, physiopathology; Vestibular Function Tests}, pmid = {18833021} }
Cohen, H.S., Kimball, K.T. and Stewart, M.G.	Benign paroxysmal positional vertigo and comorbid conditions. [Abstract] [BibTeX]	2004	ORL; journal for oto-rhino-laryngology and its related specialties Vol. 66(1), pp. 11-15	article	DOI
Abstract: To determine the prevalence of comorbid disease in patients with benign paroxysmal positional vertigo (BPPV) and the relationship of comorbid disease to symptoms of vertigo, disequilibrium, and anxiety. Patients who had posterior semicircular canal BPPV and who had been referred for vestibular rehabilitation at a tertiary care center completed a health status questionnaire and the Vertigo Symptom Scale, answered questions about level of vertigo, and were tested on computerized dynamic posturography. Subjects had high rates of diabetes, mild head trauma, and probable sinus disease. Balance was generally impaired, worse in diabetics and subjects with significant vestibular weakness. Subjects who smoked or had had mild head trauma had higher levels of anxiety. Comorbid conditions, particularly diabetes, mild head trauma, and sinus disease, are unusually prevalent in BPPV patients. Message: Patients with comorbid disease are at risk for having increased vertigo, anxiety, and disequilibrium compared to other patients.
BibTeX: @article{Cohen2004, author = {Cohen, Helen S and Kimball, Kay T and Stewart, Michael G}, title = {Benign paroxysmal positional vertigo and comorbid conditions.}, journal = {ORL; journal for oto-rhino-laryngology and its related specialties}, year = {2004}, volume = {66}, issue = {1}, pages = {11--15}, doi = {https://doi.org/10.1159/000077227}, keywords = {Adult; Aged; Aged, 80 and over; Anxiety, etiology; Female; Health Status; Humans; Male; Middle Aged; Motor Activity; Postural Balance; Severity of Illness Index; Vertigo, complications, psychology}, pmid = {15103195} }
Shigeno, K., Ogita, H. and Funabiki, K.	Benign paroxysmal positional vertigo and head position during sleep. [Abstract] [BibTeX]	2012	Journal of vestibular research : equilibrium & orientation Vol. 22(4), pp. 197-203	article	DOI
Abstract: To determine whether any particular head positions during sleep are associated with BPPV, head position during sleep was monitored for 3 days in 50 BPPV patients after the disappearance of positional nystagmus and in 25 normal control subjects. A gravity sensor was attached to the center of the subject's forehead at home. The positional angle of the head was measured at 5-second intervals during sleep. In BPPV, the posterior semicircular canal was involved in 40 patients and the lateral semicircular canal in 10 patients. Recurrence was found in 22 of 50 BPPV patients. BPPV patients with recurrence were significantly more likely to sleep in the affected-ear-down 45-degree head position than were patients with no history of recurrence (P< 0.02). When the head is in the affected-ear-down 45-degree head position, the non-ampullated half of the posterior semicircular canal and the non-ampullated half of the lateral semicircular canal are nearly in the earth-vertical position, making it easier for detached otoconia to fall into the posterior or lateral semicircular canal and to agglomerate and attain a certain size in the lowest portion of each semicircular canal. Our findings showed that the affected-ear-down 45-degree head position during sleep could be an etiological factor of BPPV, more particularly in patients with recurrent BPPV.
BibTeX: @article{Shigeno2012, author = {Shigeno, Kohichiro and Ogita, Hideaki and Funabiki, Kazuo}, title = {Benign paroxysmal positional vertigo and head position during sleep.}, journal = {Journal of vestibular research : equilibrium & orientation}, year = {2012}, volume = {22}, issue = {4}, pages = {197--203}, doi = {https://doi.org/10.3233/VES-2012-0457}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Female; Head Movements; Humans; Male; Middle Aged; Nystagmus, Physiologic; Recurrence; Semicircular Canals; Sleep; Vertigo, physiopathology}, pmid = {23142834} }
Korres, S.G., Balatsouras, D.G., Papouliakos, S. and Ferekidis, E.	Benign paroxysmal positional vertigo and its management. [Abstract] [BibTeX]	2007	Medical science monitor : international medical journal of experimental and clinical research Vol. 13(6), pp. CR275-CR282	article
Abstract: Benign paroxysmal positional vertigo (BPPV) is a common peripheral vestibular disorder encountered in primary care and specialist otolaryngology and neurology clinics. It is associated with a characteristic paroxysmal positional nystagmus, which can be elicited with specific diagnostic positional maneuvers. In recent years, specific therapeutic maneuvers have resulted in its effective treatment. In this paper the current knowledge of the pathogenesis, diagnosis, and treatment of BPPV as well as the authors' own clinical experience in treating such patients are presented. A retrospective review of the records of 204 patients with BPPV was performed. Epidemiological data and results from the audiological and neuro-otological work-up were recorded. All patients were treated with an appropriate repositioning maneuver, depending on the type of BPPV. Of the 204 patients, 163 had posterior canal involvement, 19 had horizontal canal involvement, and 6 had the anterior canal variant. Another 11 patients had bilateral posterior canal involvement and 5 had disease of two canals. The canalith repositioning procedure was immediately successful in 165 patients and in 23 more patients proved successful after its repetition in a second session, resulting in a total success rate of 92.1%. Most of the patients with BPPV responded very well to treatment. However, differential diagnosis of the type of BPPV was necessary to apply the appropriate canalith repositioning procedure. The canalith repositioning procedure is easy and safe to perform, is noninvasive, can be repeated if needed, and can provide rapid relief of vertigo.
BibTeX: @article{Korres2007, author = {Korres, Stavros G and Balatsouras, Dimitrios G and Papouliakos, Sotiris and Ferekidis, Eleftherios}, title = {Benign paroxysmal positional vertigo and its management.}, journal = {Medical science monitor : international medical journal of experimental and clinical research}, year = {2007}, volume = {13}, issue = {6}, pages = {CR275--CR282}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Child; Female; Humans; Male; Middle Aged; Retrospective Studies; Semicircular Canals, pathology; Vertigo, pathology, therapy}, pmid = {17534234} }
Nuti, D., Masini, M. and Mandalà, M.	Benign paroxysmal positional vertigo and its variants. [Abstract] [BibTeX]	2016	Handbook of clinical neurology Vol. 137, pp. 241-256	article	DOI
Abstract: Benign paroxysmal positional vertigo is a common labyrinthine disorder caused by a mechanic stimulation of the vestibular receptors within the semicircular canals. It is characterized by positional vertigo and positional nystagmus, both provoked by changes in the position of the head with respect to gravity. The social impact of the disease and its direct and indirect costs to healthcare systems are significant owing to impairment of daily activities and increased risk of falls. The first description of a patient with benign paroxysmal positional vertigo is from Robert Bárány in 1921, but the features of the syndrome and the diagnostic maneuver were well described by Dix and Hallpike in 1952. Since then, the gradually increasing interest of otolaryngologists and neurologists has led to a progressive advance in the knowledge of this labyrinthine disorder with regard to its epidemiologic, pathophysiologic, clinical, and therapeutic aspects. Despite the often effective diagnosis and treatment of most cases of benign paroxysmal positional vertigo, the physiopathologic explanations of the disease are mainly speculative. In this chapter, we describe the epidemiologic, pathophysiologic, clinical, and therapeutic aspects of benign paroxysmal positional vertigo.
BibTeX: @article{Nuti2016, author = {Nuti, D and Masini, M and Mandalà, M}, title = {Benign paroxysmal positional vertigo and its variants.}, journal = {Handbook of clinical neurology}, year = {2016}, volume = {137}, pages = {241--256}, doi = {https://doi.org/10.1016/B978-0-444-63437-5.00018-2}, keywords = {Benign Paroxysmal Positional Vertigo, epidemiology, history, physiopathology, therapy; History, 20th Century; Humans; Semicircular Canals, pathology, physiopathology; anterior semicircular canal; benign paroxysmal positional vertigo; canalolithiasis; cupulolithiasis; downbeat nystagmus; lateral semicircular canal; positional nystagmus; posterior semicircular canal}, pmid = {27638076} }
Faralli, M., Cipriani, L., Del Zompo, M.R., Panichi, R., Calzolaro, L. and Ricci, G.	Benign paroxysmal positional vertigo and migraine: analysis of 186 cases. [Abstract] [BibTeX]	2014	B-ENT Vol. 10(2), pp. 133-139	article
Abstract: This retrospective study assessed several clinical, case history and functional parameters to investigate benign paroxysmal positional vertigo (BPPV) in patients with migraine. Two groups of patients were compared: those affected by BPPV and migraine (group A), as defined by International Headache Society criteria, and those with BPPV without migraine or with another form of headache (group B). The following parameters were investigated: onset of BPPV, recovery time, residual dizziness, recurrence of BPPV, atypical eye movement patterns and Meniere-like vertigo in the inter-critical BPPV period. Mean age at BPPV onset was 39 years +/- 9.2 in Group A and 53 years +/- 7.3 in Group B (p = 0.00). No significant difference emerged in the number of manoeuvres needed to achieve recovery (Group A: 1.7 +/- 0.94; Group B: 1.9 +/- 0.89; p > 0.05). Highly recurrent BPPV (at least 4 documented episodes) was observed in 15 patients from group A (19.4%) and in 8 patients from group B (7.3%). Atypical eyes movements and Meniere-like vertigo were more frequent in migraineurs with highly recurrent BPPV (Chi square = 5.76; p < 0.016). A high prevalence of BPPV and earlier onset in migraine are the main findings of this study. There is a higher incidence of a range of neurotological patterns in the intervals between BPPV episodes in migraineurs with recurrent vertigo. No direct pathophysiological link between migraine and BPPV has yet been established; comorbidity seems to affect clinical features in a sub-population of patients and make BPPV more debilitating.
BibTeX: @article{Faralli2014, author = {Faralli, M and Cipriani, L and Del Zompo, M R and Panichi, R and Calzolaro, L and Ricci, G}, title = {Benign paroxysmal positional vertigo and migraine: analysis of 186 cases.}, journal = {B-ENT}, year = {2014}, volume = {10}, issue = {2}, pages = {133--139}, keywords = {Adult; Benign Paroxysmal Positional Vertigo; Female; Humans; Male; Middle Aged; Migraine Disorders, diagnosis; Retrospective Studies; Vertigo, diagnosis}, pmid = {25090812} }
Pezzoli, M., Garzaro, M., Pecorari, G., Cena, M., Giordano, C. and Albera, R.	Benign paroxysmal positional vertigo and orthostatic hypotension. [Abstract] [BibTeX]	2010	Clinical autonomic research : official journal of the Clinical Autonomic Research Society Vol. 20(1), pp. 27-31	article	DOI
Abstract: The aim of this study was to investigate a possible correlation between post-benign paroxysmal positional vertigo (BPPV) dizziness and orthostatic hypotension (OH) using the head-up tilt test (HUTT). Twenty-nine patients previously affected by BPPV and successfully underwent repositioning maneuvers were tested using the HUTT. Our data do not show a statistically significant relationship between OH and the persistence of balance disorders after recovery from BPPV; anyway the prevalence of OH in the overall sample (34%) and in subjects affected by balance disorders after recovery (40%), was higher than in the general population. it is reasonable to hypothesize that OH plays a role in the genesis of orthostatic dizziness that patients commonly experience after recovery from BPPV. To improve the sensitivity of the HUTT, it would be advisable to use non-invasive continuous blood pressure monitoring. Although we feel that additional data are needed, we believe that the present work underlines the importance of considering anomalies of the autonomic system in the differential diagnosis of dizziness and could offer the basis for further studies about the role of sympathetic reflexes in those cases of persistence of symptoms after recovery from BPPV.
BibTeX: @article{Pezzoli2010, author = {Pezzoli, Matteo and Garzaro, Massimiliano and Pecorari, Giancarlo and Cena, Manuele and Giordano, Carlo and Albera, Roberto}, title = {Benign paroxysmal positional vertigo and orthostatic hypotension.}, journal = {Clinical autonomic research : official journal of the Clinical Autonomic Research Society}, year = {2010}, volume = {20}, issue = {1}, pages = {27--31}, doi = {https://doi.org/10.1007/s10286-009-0032-3}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Blood Pressure, physiology; Dizziness, physiopathology; Female; Humans; Hypotension, Orthostatic, complications, diagnosis, physiopathology; Male; Middle Aged; Posture, physiology; Reflex, physiology; Rotation; Vertigo, complications, physiopathology; Young Adult}, pmid = {19820989} }
Lai, S.-W.	Benign paroxysmal positional vertigo and osteoporosis. [BibTeX]	2019	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 276(1), pp. 279	article	DOI
BibTeX: @article{Lai2019, author = {Lai, Shih-Wei}, title = {Benign paroxysmal positional vertigo and osteoporosis.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2019}, volume = {276}, issue = {1}, pages = {279}, doi = {https://doi.org/10.1007/s00405-018-5255-2}, pmid = {30554357} }
Paparella, M.M.	Benign paroxysmal positional vertigo and other vestibular symptoms in Ménière disease. [BibTeX]	2008	Ear, nose, & throat journal Vol. 87(10), pp. 562	article
BibTeX: @article{Paparella2008, author = {Paparella, Michael M}, title = {Benign paroxysmal positional vertigo and other vestibular symptoms in Ménière disease.}, journal = {Ear, nose, & throat journal}, year = {2008}, volume = {87}, issue = {10}, pages = {562}, keywords = {Humans; Meniere Disease, complications, physiopathology; Vertigo, etiology; Vestibule, Labyrinth, physiopathology}, pmid = {18833531} }
Vrabec, J.T.	Benign paroxysmal positional vertigo and otolith repositioning. [BibTeX]	1998	Archives of otolaryngology--head & neck surgery Vol. 124(2), pp. 223-5; discussion 225-6	article
BibTeX: @article{Vrabec1998, author = {Vrabec, J T}, title = {Benign paroxysmal positional vertigo and otolith repositioning.}, journal = {Archives of otolaryngology--head & neck surgery}, year = {1998}, volume = {124}, issue = {2}, pages = {223--5; discussion 225-6}, keywords = {Cost-Benefit Analysis; Humans; Otolithic Membrane; Posture; Remission, Spontaneous; Vertigo, therapy}, pmid = {9485119} }
Magliulo, G., Bertin, S., Ruggieri, M. and Gagliardi, M.	Benign paroxysmal positional vertigo and post-treatment quality of life. [Abstract] [BibTeX]	2005	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 262(8), pp. 627-630	article	DOI
Abstract: Benign paroxysmal positional vertigo is probably the most common cause of vertigo. It is characterized by acute short-lived episodes of severe vertigo in association with change in the position of the head. This condition is benign, and after the repositioning procedure, the cure rate is between 70 to 80%. Numerous studies describe the association between vertigo and social handicap and emotional disturbance. In our study, we report for the first time the level of anxiety and social consequences, tested with the Hamilton anxiety scale and vertigo handicap questionnaire, in a group of patients who had suffered only from positional vertigo and were clinically cured when the questionnaires and test were administered. The important role played by psychological factors in maintaining or increasing the social consequences and perception of vertigo is revealed in this study.
BibTeX: @article{Magliulo2005a, author = {Magliulo, Giuseppe and Bertin, Serena and Ruggieri, Marzia and Gagliardi, Mario}, title = {Benign paroxysmal positional vertigo and post-treatment quality of life.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2005}, volume = {262}, issue = {8}, pages = {627--630}, doi = {https://doi.org/10.1007/s00405-004-0784-2}, keywords = {Adult; Aged; Aged, 80 and over; Anxiety Disorders, complications; Disability Evaluation; Female; Follow-Up Studies; Humans; Male; Middle Aged; Psychological Tests; Quality of Life, psychology; Retrospective Studies; Severity of Illness Index; Treatment Outcome; Vertigo, psychology, therapy}, pmid = {15666205} }
Ledoux, A. and Vos, J.D.	Benign paroxysmal positional vertigo and rotatory-induced nystagmus. [Abstract] [BibTeX]	1977	Advances in oto-rhino-laryngology Vol. 22, pp. 162-168	article
Abstract: The study of 25 cases of 'benign paroxysmal position vertigo' showed us that irrigation of the ear opposed to the injured side inhibited this nystagmus. In these patients, it is difficult, not to say impossible, to provoke rotatory nystagmus, either by the caloric test (Brünings position II) or by the rotatory test in frontal plane. The significance of these observation is discussed and ascribed to a central compensation system.
BibTeX: @article{Ledoux1977, author = {Ledoux, A and Vos, J D}, title = {Benign paroxysmal positional vertigo and rotatory-induced nystagmus.}, journal = {Advances in oto-rhino-laryngology}, year = {1977}, volume = {22}, pages = {162--168}, keywords = {Eye Movements; Humans; Posture; Rotation; Therapeutic Irrigation; Vestibular Function Tests}, pmid = {868698} }
Barozzi, S., Socci, M., Ginocchio, D., Filipponi, E., Martinazzoli, M.G.T. and Cesarani, A.	Benign paroxysmal positional vertigo and tinnitus. [Abstract] [BibTeX]	2013	The international tinnitus journal Vol. 18(1), pp. 16-19	article	DOI
Abstract: In our clinical experience, some of the patients affected by benign paroxysmal positional vertigo (BPPV) reported the onset of tinnitus shortly before or in association with the positional vertigo. The aim of this study was to describe the prevalence and the clinical patterns of tinnitus episodes which occurred in association with BPPV and to suggest possible interpretative hypotheses. 171 normal hearing patients affected by BPPV (50 males and 122 females; age range: 25-77 years; mean age 60.3 years ± 14.9) underwent pure tone audiometry, immittance test and a clinical vestibular evaluation before and after repositioning manoeuvers. Those suffering from tinnitus were also assessed using visual analogue scales and tinnitus handicap inventory. 19.3% of the patients reported the appearance of tinnitus concurrently with the onset of the positional vertigo. It was mostly unilateral, localized on the same ear as the BPPV, slight in intensity and intermittent. Tinnitus disappeared or decreased in all patients except two, either spontaneously, before performing the therapeutic manoeuvers, or shortly after. A possible vestibular origin of tinnitus determined by the detachment of macular debris into the ductus reuniens and cochlear duct is discussed.
BibTeX: @article{Barozzi2013, author = {Barozzi, Stefania and Socci, Marina and Ginocchio, Daniela and Filipponi, Eliana and Martinazzoli, Maria Grazia Troja and Cesarani, Antonio}, title = {Benign paroxysmal positional vertigo and tinnitus.}, journal = {The international tinnitus journal}, year = {2013}, volume = {18}, issue = {1}, pages = {16--19}, doi = {https://doi.org/10.5935/0946-5448.20130003}, keywords = {Adult; Aged; Audiometry, Pure-Tone; Benign Paroxysmal Positional Vertigo, diagnosis, epidemiology, physiopathology, therapy; Female; Humans; Male; Middle Aged; Otolithic Membrane, physiopathology; Physical Therapy Modalities; Semicircular Canals, physiopathology; Tinnitus, diagnosis, epidemiology, physiopathology, therapy; Vertigo, diagnosis, epidemiology, physiopathology, therapy; Vestibular Function Tests}, pmid = {24995895} }
Peñarrocha, M. and Garcia, A.	Benign paroxysmal positional vertigo as a complication of interventions with osteotome and mallet. [BibTeX]	2006	Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons Vol. 64(8), pp. 1324; author reply 1324	article	DOI
BibTeX: @article{Penarrocha2006, author = {Peñarrocha, Miguel and Garcia, Abel}, title = {Benign paroxysmal positional vertigo as a complication of interventions with osteotome and mallet.}, journal = {Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons}, year = {2006}, volume = {64}, issue = {8}, pages = {1324; author reply 1324}, doi = {https://doi.org/10.1016/j.joms.2006.02.024}, keywords = {Dental Implantation, Endosseous, adverse effects, instrumentation; Humans; Labyrinth Diseases, etiology; Maxillary Sinus, surgery; Osteotomy, adverse effects, instrumentation; Posture; Semicircular Canals, physiopathology; Vertigo, etiology}, pmid = {16860237} }
Beshkar, M., Hasheminasab, M. and Mohammadi, F.	Benign paroxysmal positional vertigo as a complication of orthognathic surgery. [Abstract] [BibTeX]	2013	Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery Vol. 41(1), pp. 59-61	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is a clinical disorder that may develop following surgical trauma to the maxilla, for example as a result of closed sinus lifting with the use of mallet and osteotome during implant surgery. We proposed that BPPV may also occur following maxillary Le Fort osteotomy during orthognathic surgery. In a prospective study of 50 consecutive cases of orthognathic surgery, we observed that one patient developed BPPV in the postoperative period following bimaxillary orthognathic surgery. The patient was a 23-year-old woman who met the strict criteria for a diagnosis of BPPV, including a positive Dix-Hallpike test. We have described BPPV in more detail and have discussed the necessity of increasing awareness and knowledge of surgeons about BPPV as a possible complication of craniomaxillofacial surgery.
BibTeX: @article{Beshkar2013, author = {Beshkar, Majid and Hasheminasab, Mahboobe and Mohammadi, Farnoush}, title = {Benign paroxysmal positional vertigo as a complication of orthognathic surgery.}, journal = {Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery}, year = {2013}, volume = {41}, issue = {1}, pages = {59--61}, doi = {https://doi.org/10.1016/j.jcms.2012.05.012}, keywords = {Benign Paroxysmal Positional Vertigo; Female; Follow-Up Studies; Head Movements; Humans; Male; Orthognathic Surgical Procedures, adverse effects; Osteotomy, Le Fort, adverse effects; Osteotomy, Sagittal Split Ramus, methods; Postoperative Complications; Posture; Prospective Studies; Supine Position; Vertigo, diagnosis, etiology; Young Adult}, pmid = {22819297} }
Peñarrocha, M., Pérez, H., Garciá, A. and Guarinos, J.	Benign paroxysmal positional vertigo as a complication of osteotome expansion of the maxillary alveolar ridge. [BibTeX]	2001	Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons Vol. 59(1), pp. 106-107	article	DOI
BibTeX: @article{Penarrocha2001, author = {Peñarrocha, M and Pérez, H and Garciá, A and Guarinos, J}, title = {Benign paroxysmal positional vertigo as a complication of osteotome expansion of the maxillary alveolar ridge.}, journal = {Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons}, year = {2001}, volume = {59}, issue = {1}, pages = {106--107}, doi = {https://doi.org/10.1053/joms.2001.19307}, keywords = {Alveolar Process, surgery; Dental Implantation, Endosseous, adverse effects, instrumentation; Female; Humans; Jaw, Edentulous, surgery; Maxilla, surgery; Middle Aged; Osteotomy, adverse effects, instrumentation; Posture; Vertigo, etiology}, pmid = {11152180} }
Gyo, K.	Benign paroxysmal positional vertigo as a complication of postoperative bedrest. [Abstract] [BibTeX]	1988	The Laryngoscope Vol. 98(3), pp. 332-333	article	DOI
Abstract: Seven cases of benign paroxysmal positional vertigo (BPPV) after operation were reported, occurring between the fourth and 14th postoperative day. In three of the seven cases, the condition occurred when the patients first arose from bed after 5 to 6 days of postoperative bedrest. In two cases, BPPV occurred when patients moved their head while maintaining strict bedrest. In the other two cases, it occurred 1 to 4 days after patients had been released from bedrest. The cause of BPPV was considered to be postoperative bedrest which might have facilitated the deposition of precipitate on the cupula of the posterior semicircular canal. The prognosis was good, and all the patients recovered within 20 days.
BibTeX: @article{Gyo1988, author = {Gyo, K}, title = {Benign paroxysmal positional vertigo as a complication of postoperative bedrest.}, journal = {The Laryngoscope}, year = {1988}, volume = {98}, issue = {3}, pages = {332--333}, doi = {https://doi.org/10.1288/00005537-198803000-00019}, keywords = {Bed Rest, adverse effects; Female; Humans; Male; Postoperative Complications, etiology; Posture; Vertigo, etiology}, pmid = {3343883} }
Kim, M.-S., Lee, J.-K., Chang, B.-S. and Um, H.-S.	Benign paroxysmal positional vertigo as a complication of sinus floor elevation. [Abstract] [BibTeX]	2010	Journal of periodontal & implant science Vol. 40(2), pp. 86-89	article	DOI
Abstract: Osteotome sinus floor elevation (OSFE) is an often-used technique of great utility in certain implant patients with resorbed posterior maxilla. Recently benign paroxysmal positional vertigo (BPPV) has been reported as an early postoperative complication following OSFE. Although OSFE-induced BPPV commonly resolves itself within a month without treatment, this complication can be a cause of trouble between the implant surgeon and patient. This report presents a case of BPPV following OSFE. A 27-year-old man without any significant medical problems and missing his maxillary right first molar, was scheduled for OSFE and simultaneous implant placement. The patient suffered dizziness accompanied by nausea immediately after implant placement using OSFE. Following referral to the ear nose throat clinic, "right posterior canal BPPV" was diagnosed. Despite anti vertigo medication and a single episode of the Epley maneuver, the condition did not improve completely. The Epley maneuver was then applied 7 and 8 days later and the symptoms of BPPV disappeared. One year later, the patient remained symptom-free. Before sinus elevation with an osteotome, implant surgeons should screen out patients with a history of vertigo, to diminish the possibility of BPPV. Operators should be aware of BPPV symptoms. As the symptoms may be very incapacitating, immediate referral to an otorhinolaryngologist is recommended.
BibTeX: @article{Kim2010, author = {Kim, Moon-Sun and Lee, Jae-Kwan and Chang, Beom-Seok and Um, Heung-Sik}, title = {Benign paroxysmal positional vertigo as a complication of sinus floor elevation.}, journal = {Journal of periodontal & implant science}, year = {2010}, volume = {40}, issue = {2}, pages = {86--89}, doi = {https://doi.org/10.5051/jpis.2010.40.2.86}, keywords = {Maxillary sinus; Vertigo}, pmid = {20498765} }
Motin, M., Keren, O., Groswasser, Z. and Gordon, C.R.	Benign paroxysmal positional vertigo as the cause of dizziness in patients after severe traumatic brain injury: diagnosis and treatment. [Abstract] [BibTeX]	2005	Brain injury Vol. 19(9), pp. 693-697	article	DOI
Abstract: To identify patients with benign paroxysmal positional vertigo (BPPV) among patients with severe traumatic brain injury (TBI) and to evaluate the effectiveness of the Particle Repositioning Maneouvre (PRM). Eighteen months prospective study of 150 consecutive patients with severe TBI referred to an in-patients rehabilitation department. A structured interview emphasizing the possible presence of vertigo followed by a detailed neuro-otological examination. Patients diagnosed with BPPV were immediately treated with the PRM. BPPV diagnosis was based on a positive Dix-Hallpike positional test. PRM efficacy was determined by repeating the positional test 1 or 2 weeks after treatment. Twenty out of 150 (13.3%) patients complained about positional vertigo. The diagnosis of BPPV was confirmed in 10 patients. Signs and symptoms were completely relieved in six patients after a single PRM, while the other four patients needed repeated treatment for complete resolution of BPPV. About half of the patients with severe TBI who complain about positional vertigo suffer from BPPV. These patients can be efficiently treated by physical maneouvres improving the rehabilitation outcome.
BibTeX: @article{Motin2005, author = {Motin, M and Keren, O and Groswasser, Z and Gordon, C R}, title = {Benign paroxysmal positional vertigo as the cause of dizziness in patients after severe traumatic brain injury: diagnosis and treatment.}, journal = {Brain injury}, year = {2005}, volume = {19}, issue = {9}, pages = {693--697}, doi = {https://doi.org/10.1080/02699050400013600}, keywords = {Accidents; Adult; Brain Injuries, complications, physiopathology; Dizziness, etiology, physiopathology; Female; Humans; Interviews as Topic; Male; Middle Aged; Physical Therapy Modalities; Prospective Studies; Vertigo, complications, diagnosis, physiopathology}, pmid = {16195183} }
Balatsouras, D.G., Ganelis, P., Aspris, A., Economou, N.C., Moukos, A. and Koukoutsis, G.	Benign paroxysmal positional vertigo associated with Meniere's disease: epidemiological, pathophysiologic, clinical, and therapeutic aspects. [Abstract] [BibTeX]	2012	The Annals of otology, rhinology, and laryngology Vol. 121(10), pp. 682-688	article	DOI
Abstract: We studied the demographic, pathogenetic, and clinical features of benign paroxysmal positional vertigo (BPPV) associated with Meniere's disease. The medical records of patients with BPPV associated with Meniere's disease were reviewed. In all patients, results of a complete otolaryngological, audiological, and neurotologic evaluation, including nystagmography, were available. Patients with idiopathic BPPV were used as a control group. Twenty-nine patients with both disorders were found and were compared with 233 patients with idiopathic BPPV. The patients with BPPV associated with Meniere's disease presented the following features, in which they differed from the patients with idiopathic BPPV: 1) a higher percentage of female patients; 2) a longer duration of symptoms; 3) common involvement of the horizontal semicircular canal; 4) a greater incidence of canal paresis; and 5) more therapeutic sessions needed for cure and a higher rate of recurrence. The BPPV associated with Meniere's disease differs from idiopathic BPPV in regard to several epidemiological and clinical features, may follow a different course, and responds less effectively to treatment.
BibTeX: @article{Balatsouras2012, author = {Balatsouras, Dimitrios G and Ganelis, Panayotis and Aspris, Andreas and Economou, Nicolas C and Moukos, Antonis and Koukoutsis, George}, title = {Benign paroxysmal positional vertigo associated with Meniere's disease: epidemiological, pathophysiologic, clinical, and therapeutic aspects.}, journal = {The Annals of otology, rhinology, and laryngology}, year = {2012}, volume = {121}, issue = {10}, pages = {682--688}, doi = {https://doi.org/10.1177/000348941212101011}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Case-Control Studies; Female; Humans; Male; Meniere Disease, epidemiology, physiopathology, therapy; Middle Aged; Nystagmus, Pathologic, epidemiology, physiopathology; Paresis, physiopathology; Recurrence; Retrospective Studies; Semicircular Canals, physiopathology; Severity of Illness Index; Sex Distribution; Time Factors; Vertigo, epidemiology, physiopathology, therapy; Vestibular Function Tests}, pmid = {23130545} }
Zhu, M., Yu, F., Zhou, F., Wang, H., Jiao, Y., Wang, M., Huang, L. and Liang, Z.	Benign paroxysmal positional vertigo associated with Meniere's disease. [Abstract] [BibTeX]	2018	Journal of vestibular research : equilibrium & orientation Vol. 28(3-4), pp. 359-364	article	DOI
Abstract: We studied the clinical features of benign paroxysmal positional vertigo (BPPV) associated with Meniere's disease. The medical records of 120 patients with BPPV was retrospectively analyzed. Complete otolaryngological, audiological, and neurotological evaluation results were available for all patients, including nystagmography. All patients were diagnosed using the Dix-Hallpike test or roll test and treated with the canalith repositioning procedure. The outcomes were compared among the three groups. A series of 120 BPPV cases. Results showed that Group A and Group B based on the following features: unilateral semicircular canal BPPV occurred more often than bilateral BPPV and the posterior semicircular canal was the most common canal involved. Additionally, Meniere's disease patients with multiple semicircular canal BPPV required repeated canalith repositioning procedures and had a higher recurrence rate. A lower treatment success rate and a higher recurrence rate were found in the BPPV patients with Meniere's disease compared with the patients without Meniere's disease. The recurrence rate was highest in the patients with multiple semicircular canal BPPV with Meniere's disease.
BibTeX: @article{Zhu2018, author = {Zhu, Meichan and Yu, Feng and Zhou, Feng and Wang, Haitao and Jiao, Yuenong and Wang, Meng and Huang, Lifen and Liang, Zijian}, title = {Benign paroxysmal positional vertigo associated with Meniere's disease.}, journal = {Journal of vestibular research : equilibrium & orientation}, year = {2018}, volume = {28}, issue = {3-4}, pages = {359--364}, doi = {https://doi.org/10.3233/VES-180638}, keywords = {Benign paroxysmal positional vertigo; Meniere’s disease; canalith repositioning procedure; nystagmography}, pmid = {30149485} }
Jáuregui-Renaud, K., Aw, S.T., Todd, M.J., McGarvie, L.A. and Halmagyi, G.M.	Benign paroxysmal positional vertigo can interfere with the cardiac response to head-down tilt. [Abstract] [BibTeX]	2005	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 26(3), pp. 484-488	article
Abstract: To assess the pulse rate and the respiratory rate responses to head-down tilt of the whole body in the plane of the posterior canals in healthy subjects and in patients with benign paroxysmal positional vertigo (BPPV). Although BPPV attacks are usually accompanied by autonomic symptoms, there are no studies assessing autonomic responses during triggering maneuvers for BPPV, neither in healthy subjects nor in patients. We evaluated nine healthy subjects and four BPPV patients (3 unilateral and 1 bilateral). Using a two-axis rotator, from an upright position they were rotated 135 degrees backwards to head-down tilt, either in the plane of the right or the left posterior canal. In healthy subjects, head-down tilt always induced a significant decrease of the pulse rate, which was similar after rotation to the right and to the left posterior canals. This response was observed in patients with unilateral BPPV only when they were rotated toward the nonaffected side, and it was not evident when they were rotated toward the affected side (p < 0.025). In the patient with bilateral BPPV, no change of the pulse rate was observed after rotation toward the right or to the left posterior canal. Although, in all the patients, the respiratory rate increased during the tilt, a similar increase was observed in two healthy subjects. After rotation in the plane of the affected semicircular canal, BPPV can interfere with the cardiac response to head-down tilt of the whole body.
BibTeX: @article{Jauregui-Renaud2005, author = {Jáuregui-Renaud, Kathrine and Aw, Swee T and Todd, Michael J and McGarvie, Leigh A and Halmagyi, G Michael}, title = {Benign paroxysmal positional vertigo can interfere with the cardiac response to head-down tilt.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2005}, volume = {26}, issue = {3}, pages = {484--488}, keywords = {Adult; Case-Control Studies; Female; Head-Down Tilt; Heart, physiopathology; Humans; Male; Middle Aged; Posture; Pulse; Respiratory Mechanics; Rotation; Semicircular Canals, physiopathology; Vertigo, etiology, physiopathology}, pmid = {15891654} }
Selcuk, O.T., Eraslan, A., Osma, U., Eren, E., Eyigor, H. and Yilmaz, M.D.	Benign paroxysmal positional vertigo caused by swimming. [BibTeX]	2014	Asian journal of sports medicine Vol. 5(1), pp. 71-72	article
BibTeX: @article{Selcuk2014, author = {Selcuk, Omer Tarık and Eraslan, Ali and Osma, Ustun and Eren, Emin and Eyigor, Hulya and Yilmaz, Mustafa Deniz}, title = {Benign paroxysmal positional vertigo caused by swimming.}, journal = {Asian journal of sports medicine}, year = {2014}, volume = {5}, issue = {1}, pages = {71--72}, keywords = {Benign Paroxysmal Positional Vertigo Swimming; Epley Maneuver; Vertigo}, pmid = {24868435} }
Barber, S.R., Cheng, Y.S., Owoc, M., Lin, B.M., Remenschneider, A.K., Kozin, E.D. and Lee, D.J.	Benign paroxysmal positional vertigo commonly occurs following repair of superior canal dehiscence. [Abstract] [BibTeX]	2016	The Laryngoscope Vol. 126(9), pp. 2092-2097	article	DOI
Abstract: Repair of superior canal dehiscence (SCD) often results in the resolution of preoperative auditory and vestibular symptoms; however, many patients experience dizziness in the postoperative period. Postoperative dizziness may be the result of new-onset benign paroxysmal positional vertigo (BPPV). This study aims to investigate the prevalence of BPPV before and following SCD repair. Retrospective chart review at a tertiary care center. Electronic medical records were reviewed for patients with a diagnosis of SCD syndrome (SCDS) between January 2002 and May 2015. Collected information included demographic data, incidence of BPPV diagnosed by Dix-Hallpike maneuver before and following surgery, operative technique, repair material, and the duration of time to BPPV onset. A total of 180 patients with a diagnosis of SCDS were identified: 84 patients underwent surgery (operated subjects) and 96 were observed (nonoperated, control group). In operated subjects, 20 of 84 (23.8%) developed BPPV following SCD repair versus 6.2% of nonoperated (P < 0.005). Benign paroxysmal positional vertigo lateralized to the operated side in all but one subject whose laterality was unknown (P < 0.0001). There were no associations of BPPV with surgical approach (P = 0.50) or repair material (P = 0.33). The majority of subjects (58%) were diagnosed with BPPV within 3 months of surgery. New-onset BPPV occurs commonly after SCD repair and may be the result of mobilized otoliths from inner ear pressure changes. Although the exact etiology of post-SCD repair BPPV remains unknown, postoperative dizziness is important to discuss with patients during preoperative counseling. 4. Laryngoscope, 126:2092-2097, 2016.
BibTeX: @article{Barber2016, author = {Barber, Samuel R and Cheng, Yew Song and Owoc, Maryanna and Lin, Brian M and Remenschneider, Aaron K and Kozin, Elliott D and Lee, Daniel J}, title = {Benign paroxysmal positional vertigo commonly occurs following repair of superior canal dehiscence.}, journal = {The Laryngoscope}, year = {2016}, volume = {126}, issue = {9}, pages = {2092--2097}, doi = {https://doi.org/10.1002/lary.25797}, keywords = {Benign Paroxysmal Positional Vertigo, epidemiology, etiology; Female; Humans; Labyrinth Diseases, surgery; Male; Middle Aged; Postoperative Complications, epidemiology, etiology; Prevalence; Retrospective Studies; Semicircular Canals; Benign paroxysmal positional vertigo; dizziness; outcomes; plugging; resurfacing; superior canal dehiscence; superior canal dehiscence syndrome; surgery}, pmid = {26666775} }
Imai, T., Takeda, N., Ito, M., Nakamae, K., Sakae, H., Fujioka, H., Matsunaga, T. and Kubo, T.	Benign paroxysmal positional vertigo due to a simultaneous involvement of both horizontal and posterior semicircular canals. [Abstract] [BibTeX]	2006	Audiology & neuro-otology Vol. 11(3), pp. 198-205	article	DOI
Abstract: From April 2001 to November 2003, we investigated 8 patients with benign paroxysmal positional vertigo (BPPV) that was suspected to simultaneously affect both the horizontal and posterior semicircular canals (HSCC and PSCC). These cases showed typical vertical-torsional nystagmus induced by the Dix-Hallpike maneuver, followed by a horizontal nystagmus. They also showed a direction-changing geotropic or apogeotropic positional nystagmus triggered by lateral head rotations in the supine position. Using the three-dimensional analysis of the positional nystagmus, the rotation axis of the positional nystagmus had a component perpendicular to the plane of PSCC and another component perpendicular to the plane of HSCC. All these findings suggest that BPPV in these patients was a combination of posterior and horizontal canal BPPV. The observation of a vertical-torsional positional nystagmus should prompt the specialist to perform not only the canalith repositioning procedure, but also to execute lateral head turns in the supine position.
BibTeX: @article{Imai2006a, author = {Imai, Takao and Takeda, Noriaki and Ito, Mahito and Nakamae, Koji and Sakae, Hideki and Fujioka, Hiromu and Matsunaga, Takashi and Kubo, Takeshi}, title = {Benign paroxysmal positional vertigo due to a simultaneous involvement of both horizontal and posterior semicircular canals.}, journal = {Audiology & neuro-otology}, year = {2006}, volume = {11}, issue = {3}, pages = {198--205}, doi = {https://doi.org/10.1159/000091892}, keywords = {Adult; Aged; Female; Humans; Labyrinth Diseases, diagnosis, physiopathology; Male; Middle Aged; Nystagmus, Pathologic; Semicircular Canals, pathology; Vertigo, etiology, pathology; Vestibular Function Tests}, pmid = {16534183} }
Reddy K, S., Shivu, M.E. and Billimaga, A.	Benign paroxysmal positional vertigo during lateral window sinus lift procedure: a case report and review. [Abstract] [BibTeX]	2015	Implant dentistry Vol. 24(1), pp. 106-109	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is a possible and well-documented complication after the osteotome internal sinus lift technique. But we report a case of unexpected BPPV complication after direct sinus lift by lateral approach for implant placement that was not reported till date. A 30-year-old woman had undergone direct sinus lift procedure by lateral window technique to replace her missing right molar with dental implant. The patient suffered with intense vertigo with nausea, vomiting, and aggravated when she changed the position of her head towards right immediately after procedure and was diagnosed with BPPV after the referral. We assume that prolonged hyperextended head position of iatrogenic origin can be the reason, in this case, for BPPV after direct lateral sinus lift procedure. There is also a possibility that the temporal relationship with the surgical area and surgical action by rotating tools during window preparation are also contributing factors.
BibTeX: @article{ReddyK2015, author = {Reddy K, Sudhakara and Shivu, M E and Billimaga, Akarsh}, title = {Benign paroxysmal positional vertigo during lateral window sinus lift procedure: a case report and review.}, journal = {Implant dentistry}, year = {2015}, volume = {24}, issue = {1}, pages = {106--109}, doi = {https://doi.org/10.1097/ID.0000000000000188}, keywords = {Adult; Benign Paroxysmal Positional Vertigo, etiology; Dental Implantation, Endosseous, adverse effects, methods; Dental Implants, Single-Tooth; Female; Humans; Sinus Floor Augmentation, adverse effects, methods}, pmid = {25621557} }
Sammartino, G., Mariniello, M. and Scaravilli, M.S.	Benign paroxysmal positional vertigo following closed sinus floor elevation procedure: mallet osteotomes vs. screwable osteotomes. A triple blind randomized controlled trial. [Abstract] [BibTeX]	2011	Clinical oral implants research Vol. 22(6), pp. 669-672	article	DOI
Abstract: To compare mallet osteotomes with screwable osteotomes determining benign paroxysmal positional vertigo (BPPV) following the osteotome closed sinus floor elevation procedure. This triple-blind randomized controlled trial involved 196 patients affected by edentulous atrophic ridges (107 males and 89 females; mean age 62.05±7.10; age range 49-79 years), requiring an osteotome closed sinus floor elevation procedure. Patients were randomly allocated to either a mallet-osteotomes group (Group 1, n=98) or a screwable osteotomes group (Group 2, n=98). Two different surgeons, blind to the study, performed the closed sinus lift procedure according to the blocks allocation. A complete post-surgical examination, including the Dix-Hallpike maneuver, was performed on 196 patients before and after surgery. The diagnosis of BPPV was supported by the existence of ageotropic nystagmus concurrent with vertigo. Three patients of Group 1 (3/98-3.06%) showed a BPPV of the posterior semicircular canal omo-lateral to the implanted side 1 or 2 days after the surgical procedure, which was promptly solved using the Epley re-positioning maneuver. Preparation of implant beds with osteotome and mallet transmits percussive and vibratory forces capable of detaching the otoliths from their normal location; moreover, the patient's surgical head position favors the displacement of otoliths into the posterior semicircular canal. Implant surgeons should be aware of this possible complication following closed sinus lift procedure and patients should always be informed before undergoing surgery.
BibTeX: @article{Sammartino2011, author = {Sammartino, Gilberto and Mariniello, Mauro and Scaravilli, Maria Serena}, title = {Benign paroxysmal positional vertigo following closed sinus floor elevation procedure: mallet osteotomes vs. screwable osteotomes. A triple blind randomized controlled trial.}, journal = {Clinical oral implants research}, year = {2011}, volume = {22}, issue = {6}, pages = {669--672}, doi = {https://doi.org/10.1111/j.1600-0501.2010.01998.x}, keywords = {Aged; Alveolar Ridge Augmentation, instrumentation; Dental Implants, Single-Tooth; Epidemiologic Research Design; Equipment Design; Female; Follow-Up Studies; Head Movements; Humans; Jaw, Edentulous, surgery; Male; Maxilla, surgery; Maxillary Sinus, surgery; Middle Aged; Osteotomy, instrumentation; Patient Positioning; Percussion; Physical Therapy Modalities; Postoperative Complications, therapy; Vertigo, etiology, therapy; Vibration}, pmid = {21054553} }
Strzelczyk, A., Kepenek, Y., Rindock, H., Müller-Mazzotta, J., Oertel, W.H., Mylius, V. and Rosenow, F.	Benign paroxysmal positional vertigo following diagnostic transcranial magnetic stimulation. [Abstract] [BibTeX]	2011	Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology Vol. 32(3), pp. 503-505	article	DOI
Abstract: Benign paroxysmal positional vertigo is the most frequent cause of recurrent vertigo and according to the canalo- and cupulolithiasis theory it is caused by detached otoconia which accumulate in the semicircular canals. However, the mechanisms leading to detachment of otoconia from the matrix are still poorly understood. Head trauma, inner ear diseases, advanced age, migraine and bed rest are known predisposing factors. We report a case of a healthy 44-year-old female, who developed left sided benign paroxysmal positional vertigo 10 hours following standard bilateral diagnostic transcranial magnetic stimulation. As our patient did not innate any established predisposing factor and has a relatively young age, we conclude that diagnostic transcranial magnetic stimulation to elicit motor evoked potentials might be an iatrogenic cause of benign paroxysmal positional vertigo.
BibTeX: @article{Strzelczyk2011, author = {Strzelczyk, Adam and Kepenek, Yildiz and Rindock, Heike and Müller-Mazzotta, Jochen and Oertel, Wolfgang H and Mylius, Veit and Rosenow, Felix}, title = {Benign paroxysmal positional vertigo following diagnostic transcranial magnetic stimulation.}, journal = {Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology}, year = {2011}, volume = {32}, issue = {3}, pages = {503--505}, doi = {https://doi.org/10.1007/s10072-011-0511-x}, keywords = {Adult; Benign Paroxysmal Positional Vertigo; Female; Humans; Sensation Disorders, diagnosis; Transcranial Magnetic Stimulation, adverse effects, methods; Vertigo, etiology; Vestibule, Labyrinth, radiation effects}, pmid = {21374092} }
Koc, E.A.O., Koc, B., Eryaman, E. and Ozluoglu, L.N.	Benign paroxysmal positional vertigo following septorhinoplasty. [Abstract] [BibTeX]	2013	The Journal of craniofacial surgery Vol. 24(1), pp. e89-e90	article	DOI
Abstract: We present 2 cases of benign paroxysmal positional vertigo (BPPV) following septorhinoplasty. Benign paroxysmal positional vertigo following septorhinoplasty is an unusual entity. Two young women who had difficulty in breathing and nasal deformity underwent septorhinoplasty. On the second and the third postoperative days, the patients experienced vertigo that was induced by position changes. Both patients had neither preexisting ear disease nor vertigo before the surgery. All the examinations were normal. With Dix-Hallpike maneuver, which is the criterion-standard test, the characteristic nystagmus was observed. Right posterior canal BPPV was diagnosed, and they were both treated with Epley canalith repositioning maneuver. Publications related to postsurgical vertigo are available in literature, but it is still an underdiagnosed disorder. We would like to mention about this rare entity and inform the surgeons that they must keep in mind that a patient who is complaining about vertigo or dizziness after the surgery should be observed and investigated for BPPV.
BibTeX: @article{Koc2013, author = {Koc, Eltaf Ayca Ozbal and Koc, Bulent and Eryaman, Esra and Ozluoglu, Levent N}, title = {Benign paroxysmal positional vertigo following septorhinoplasty.}, journal = {The Journal of craniofacial surgery}, year = {2013}, volume = {24}, issue = {1}, pages = {e89--e90}, doi = {https://doi.org/10.1097/SCS.0b013e318272d9e0}, keywords = {Adult; Benign Paroxysmal Positional Vertigo; Female; Humans; Rhinoplasty, adverse effects; Vertigo, etiology, rehabilitation}, pmid = {23348352} }
Akcay, H., Ulu, M., Kelebek, S. and Aladag, I.	Benign Paroxysmal Positional Vertigo Following Sinus Floor Elevation in Patient with Antecedents of Vertigo. [Abstract] [BibTeX]	2016	Journal of maxillofacial and oral surgery Vol. 15(Suppl 2), pp. 351-354	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is an unfamiliar and rare complication occurring following osteotome sinus floor elevation (OSFE) and simultaneous implant placement. Etiology of this disorder is commonly displacement of otoliths by vibratory forces transmitted by osteotomes and mallet along with the hyperextension of the head during the operation, causing them to float around in the endolymph. This report presents a case of protracted BPPV following OSFE and simultaneous implant placement. A 43-year-old female suffered intense vertigo and nausea immediately after implant placement using an OSFE procedure. Upon further questioning after the procedure she gave an account of two times vertigo history within the last 9 years. Despite nootropic drug medication and canalith repositioning procedure applied by a specialist at operation night, the condition did not improve. Patient did not totally recover and was admitted again after 1 month. After repeated maneuvers, nine dosage intravenous serous fluid and piracetam administration the patient recovered. Duration of these procedures took 10 days and the patient was successfully treated with no recurrence of dizziness. Prevention and management of OSFE related BPPV are reviewed especially in patients having prior vertigo history in this report.
BibTeX: @article{Akcay2016, author = {Akcay, Huseyin and Ulu, Murat and Kelebek, Seyfi and Aladag, Ibrahim}, title = {Benign Paroxysmal Positional Vertigo Following Sinus Floor Elevation in Patient with Antecedents of Vertigo.}, journal = {Journal of maxillofacial and oral surgery}, year = {2016}, volume = {15}, issue = {Suppl 2}, pages = {351--354}, doi = {https://doi.org/10.1007/s12663-016-0891-9}, keywords = {Benign paroxysmal positional vertigo; Dental implants; Mallet osteotomes; Osteotome sinus floor elevation}, pmid = {27408469} }
Dispenza, F., De Stefano, A., Mathur, N., Croce, A. and Gallina, S.	Benign paroxysmal positional vertigo following whiplash injury: a myth or a reality? [Abstract] [BibTeX]	2011	American journal of otolaryngology Vol. 32(5), pp. 376-380	article	DOI
Abstract: The aim of the study was to evaluate the true incidence, diagnosis, and treatment of benign paroxysmal positional vertigo (BPPV) arising after whiplash injury and to distinguish this type of posttraumatic vertigo from other types of dizziness complained after trauma. This was a retrospective study comprising patients referred to our center after whiplash injury. The patients were evaluated with neurotologic examination including bedside and instrumental tests. A Dizziness Handicap Inventory evaluating the symptoms of patients was submitted before and after treatment and was evaluated. The BPPV patients were separately evaluated from those with cervicogenic vertigo, and a comparison between our data about idiopathic BPPV was done. Eighteen patients of whiplash who had BPPV were evaluated. The mean age was 38.2 years. BPPV was the cause of vertigo in 33.9% of total whiplash patients. In 16 cases, the posterior semicircular canal was involved; the lateral semicircular canal was involved in 2 cases. The instrumental neurotologic assessment did not show any alteration of either vestibulospinal reflexes or dynamic ocular movements. Duration of symptoms before treatment ranged from 3 to 26 days. A total of 55.5% of patients had relief from their symptoms after first repositioning maneuver. The Dizziness Handicap Inventory score improved in all patients treated with repositioning maneuvers, but no difference emerged with idiopathic BPPV data. BPPV after whiplash injury could be unveiled with a simple bedside examination of peripheral vestibular system, and a treatment could be done in the same session. The diagnosis of posttraumatic BPPV is not different from the idiopathic form, but the treatment may require more maneuvers to achieve satisfactory results.
BibTeX: @article{Dispenza2011, author = {Dispenza, Francesco and De Stefano, Alessandro and Mathur, Navneet and Croce, Adelchi and Gallina, Salvatore}, title = {Benign paroxysmal positional vertigo following whiplash injury: a myth or a reality?}, journal = {American journal of otolaryngology}, year = {2011}, volume = {32}, issue = {5}, pages = {376--380}, doi = {https://doi.org/10.1016/j.amjoto.2010.07.009}, keywords = {Adolescent; Adult; Aged; Benign Paroxysmal Positional Vertigo; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nystagmus, Physiologic, physiology; Patient Positioning; Prognosis; Recurrence; Retrospective Studies; Semicircular Canals, physiopathology; Trauma Severity Indices; Vertigo, diagnosis, etiology, physiopathology; Whiplash Injuries, complications, diagnosis, physiopathology; Young Adult}, pmid = {20832902} }
Fay, J.L.	Benign Paroxysmal Positional Vertigo in 2 Children: A Case Series. [Abstract] [BibTeX]	2016	Pediatric physical therapy : the official publication of the Section on Pediatrics of the American Physical Therapy Association Vol. 28(3), pp. 355-360	article	DOI
Abstract: The purpose of this case report is to present the cases of 2 boys with benign paroxysmal positional vertigo (BPPV). Patient A (11 years old) and Patient B (9 years old) had complaints of vertigo with position changes. Both exhibited left torsion upbeating nystagmus in the left Dix-Hallpike (DH) test and complaints of vertigo with reproduction of their symptoms, indicating BPPV. Both were treated with a left canalith repositioning maneuver and reported decreased incidence of positional vertigo upon reevaluation. Scores on the Dizziness Handicap Inventory and the Visual Analog Scale for Dizziness decreased after treatment for 1 of the boys. Benign paroxysmal positional vertigo is considered rare in children. Migraines may also cause vertigo. Differential diagnosis in these cases was made by performing the DH test. Children with vertigo should be screened for BPPV through use of history taking, and the DH test.
BibTeX: @article{Fay2016, author = {Fay, Jennifer L}, title = {Benign Paroxysmal Positional Vertigo in 2 Children: A Case Series.}, journal = {Pediatric physical therapy : the official publication of the Section on Pediatrics of the American Physical Therapy Association}, year = {2016}, volume = {28}, issue = {3}, pages = {355--360}, doi = {https://doi.org/10.1097/PEP.0000000000000249}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis, rehabilitation; Child; Diagnosis, Differential; Dizziness, physiopathology; Humans; Male; Physical Therapy Modalities}, pmid = {26986871} }
Shetye, A.	Benign paroxysmal positional vertigo in a child: an infrequent complication following a fairground ride and post-cochlear implant surgery. [Abstract] [BibTeX]	2012	Cochlear implants international Vol. 13(3), pp. 177-180	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is an uncommon complication that can develop after cochlear implantation. This condition has been documented in adults as a complication of cochlear implant surgery. However, there is no reported literature on BPPV in children who have undergone cochlear implant surgery. A 13-year-old girl underwent the insertion of a cochlear implant and developed BPPV as a result of visiting fairground rides approximately 2 years after surgery. We performed a right Epley's maneuver. She was advised to do Brandt-Daroff exercises for 6 weeks. She became symptom free within a few weeks of doing vestibular rehabilitation exercises. Nevertheless, she had been compliant with vestibular rehabilitation for 6 weeks. The vibration injury to the labyrinth caused during the various rides could be analogous to the mechanism of trauma to the labyrinth as occurs during head injury. The other possibility could be dislodgement of the otoconia from the already vulnerable utricle that has been subject to cochlear implantation. It is presumed that the vulnerability of the labyrinth following the cochlear implantation happened as the child suffered from dizziness in the immediate post-operative period. However, a chance association between the insertion of the cochlear implant and the development of the symptoms of BPPV in this patient cannot be ruled out.
BibTeX: @article{Shetye2012, author = {Shetye, Anuradha}, title = {Benign paroxysmal positional vertigo in a child: an infrequent complication following a fairground ride and post-cochlear implant surgery.}, journal = {Cochlear implants international}, year = {2012}, volume = {13}, issue = {3}, pages = {177--180}, doi = {https://doi.org/10.1179/1754762811Y.0000000011}, keywords = {Adolescent; Benign Paroxysmal Positional Vertigo; Cochlear Implantation; Female; Humans; Leisure Activities; Otolithic Membrane, physiopathology; Physical Therapy Modalities; Postoperative Complications, etiology, physiopathology, rehabilitation; Vertigo, etiology, physiopathology, rehabilitation; Vibration, adverse effects}, pmid = {22333692} }
Sen, A., Al-Deleamy, L.S. and Kendirli, T.M.	Benign paroxysmal positional vertigo in an airline pilot. [Abstract] [BibTeX]	2007	Aviation, space, and environmental medicine Vol. 78(11), pp. 1060-1063	article
Abstract: Benign paroxysmal positional vertigo (BPPV) is one of the most common types of peripheral vertigo, characterized by violent whirling vertigo after a positional change. Although the condition is termed "benign," the clinical presentation can be incapacitating for pilots in certain maneuvers. We present a case of an airline transport pilot with the complaint of vertigo for 5 d. The vertigo was aggravated by head movements when looking up or rolling over, lasting for a few seconds. The patient was diagnosed with BPPV, and he was treated with physical therapy with the use of Epley maneuver. The airman applied for his First-Class medical examination after the treatment was successfully completed. The aviation medical examiner (AME) issued the airman medical certificate after contacting and receiving verbal approval from the Federal Aviation Administration's (FAA's) Aerospace Medical Certification Division (AMCD). While evaluating aviators who have had BPPV, AMEs should not issue medical certificates for any class until the condition is fully resolved. Although the AME Guide states that certification of pilots with other types of vertigo requires an FAA decision, once the patient is successfully treated and free of symptoms, approval for issuing the medical certificate can be obtained through contacting AMCD and by submitting all information and documentation pertaining to the diagnosis and treatment.
BibTeX: @article{Sen2007, author = {Sen, Ahmet and Al-Deleamy, Louai S and Kendirli, Tansel M}, title = {Benign paroxysmal positional vertigo in an airline pilot.}, journal = {Aviation, space, and environmental medicine}, year = {2007}, volume = {78}, issue = {11}, pages = {1060--1063}, keywords = {Adult; Aerospace Medicine; Aircraft; Certification; Humans; Male; Nystagmus, Pathologic, diagnosis, etiology; Risk Factors; Vertigo, diagnosis, etiology; Vestibular Function Tests}, pmid = {18018439} }
Yao, Q., Song, Q., Wang, H., Shi, H. and Yu, D.	Benign paroxysmal positional vertigo in children. [Abstract] [BibTeX]	2019	Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery Vol. 44(1), pp. 21-25	article	DOI
Abstract: To describe the clinical features of benign paroxysmal positional vertigo (BPPV) in children. A retrospective study. Six children diagnosed with BPPV between March 2014 and March 2015 were retrospectively evaluated. BPPV was diagnosed using the Dix-Hallpike and supine roll tests and treated with either the modified Epley particle repositioning procedure or Lempert or Gufoni manoeuvre. Follow-up was performed at 1-week intervals until vertigo and nystagmus disappeared during positional testing. A total of six children were followed up for a period of 10-22 months. Clinical features such as history, nystagmus and symptoms of vertigo, dizziness and nausea. Six children were diagnosed with BPPV using positional testing and treated with the modified Epley or Lempert/Gufoni particle repositioning procedures. Four children were diagnosed with posterior canal BPPV, while the remaining two were diagnosed with horizontal canal BPPV. One girl reported a history of head trauma, one girl had a family history of vertigo, and one boy reported hearing loss in the same ear as that affected by BPPV. Overall, 83.33% of children (5/6) were completely relieved of vertigo following one treatment session. The remaining child was asymptomatic after two sessions. No child reported relapse of vertigo during the follow-up period. BPPV can be diagnosed accurately by taking a detailed medical history and by use of positional testing. BPPV in children can be successfully identified and treated.
BibTeX: @article{Yao2019, author = {Yao, Qingxiu and Song, Qiang and Wang, Hui and Shi, Haibo and Yu, Dongzhen}, title = {Benign paroxysmal positional vertigo in children.}, journal = {Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery}, year = {2019}, volume = {44}, issue = {1}, pages = {21--25}, doi = {https://doi.org/10.1111/coa.13226}, keywords = {benign paroxysmal positional vertigo; child; diagnosis; dizziness; nystagmus; treatment; vertigo}, pmid = {30220115} }
Feng, S., Fan, Y., Guo, L., Liang, Z. and Mi, J.	Benign paroxysmal positional vertigo in irradiated nasopharyngeal carcinoma survivors. [Abstract] [BibTeX]	2013	ISRN otolaryngology Vol. 2013, pp. 698575	article	DOI
Abstract: Purpose. It has been assumed that postirradiated nasopharyngeal carcinoma (NPC) patients are prone to benign paroxysmal positional vertigo (BPPV). The purpose of this study was to better understand this clinical entity. Materials and Methods. From September 2003 to June 2011, we conducted a retrospective study of 11 irradiated NPC patients with BPPV in our institute. During the same period, 11 irradiated NPC patients without BPPV were randomly selected and enrolled as the control group. All medical records of these patients were evaluated. Results. The risk of BPPV rises significantly when the patient undergoes radiotherapy (RT) twice and the threshold radiation dose is >120 Gy (P = 0.027). The occurrence of postirradiated BPPV was significantly related to incidences of otitis media and sensorineural hearing loss (SNHL) (P = 0.011 and 0.009, resp.). All the patients responded well to repositioning maneuvers. Conclusion. A second course of RT, postirradiated otitis media, or SNHL is associated with the potential risk of radiation-induced BPPV. Repositioning maneuvers were safe and effective for relief of this disease.
BibTeX: @article{Feng2013, author = {Feng, Shaoyan and Fan, Yunping and Guo, Liqing and Liang, Zibin and Mi, Jiaoping}, title = {Benign paroxysmal positional vertigo in irradiated nasopharyngeal carcinoma survivors.}, journal = {ISRN otolaryngology}, year = {2013}, volume = {2013}, pages = {698575}, doi = {https://doi.org/10.1155/2013/698575}, pmid = {24282647} }
Vibert, D., Redfield, R.C. and Häusler, R.	Benign paroxysmal positional vertigo in mountain bikers. [Abstract] [BibTeX]	2007	The Annals of otology, rhinology, and laryngology Vol. 116(12), pp. 887-890	article	DOI
Abstract: We evaluated 4 men who had benign paroxysmal positional vertigo (BPPV) that occured several hours after intensive mountain biking but without head trauma. The positional maneuvers in the planes of the posterior and horizontal canals elicited BPPV, as well as transitory nystagmus. This was attributed to both the posterior and horizontal semicircular canals (SCCs) on the left side in 1 patient, in these 2 SCCs on the right side in another patient, and to the right posterior SCC in the other 2 patients. The symptoms disappeared after physiotherapeutic maneuvers in 2 patients and spontaneously in the other 2 patients. Cross-country or downhill mountain biking generates frequent vibratory impacts, which are only partially filtered through the suspension fork and the upper parts of the body. Biomechanically, during a moderate jump, before landing, the head is subjected to an acceleration close to negative 1 g, and during impact it is subjected to an upward acceleration of more than 2g. Repeated acceleration-deceleration events during intensive off-road biking might generate displacement and/or dislocation of otoconia from the otolithic organs, inducing the typical symptoms of BPPV. This new cause of posttraumatic BPPV should be considered as an injury of minor severity attributed to the practice of mountain biking.
BibTeX: @article{Vibert2007, author = {Vibert, Dominique and Redfield, Robin C and Häusler, Rudolf}, title = {Benign paroxysmal positional vertigo in mountain bikers.}, journal = {The Annals of otology, rhinology, and laryngology}, year = {2007}, volume = {116}, issue = {12}, pages = {887--890}, doi = {https://doi.org/10.1177/000348940711601203}, keywords = {Adult; Audiometry, Pure-Tone; Bicycling, injuries; Diagnosis, Differential; Humans; Male; Middle Aged; Mountaineering, injuries; Posture, physiology; Vertigo, diagnosis, etiology, physiopathology}, pmid = {18217506} }
Vibert, D., Kompis, M. and Häusler, R.	Benign paroxysmal positional vertigo in older women may be related to osteoporosis and osteopenia. [Abstract] [BibTeX]	2003	The Annals of otology, rhinology, and laryngology Vol. 112(10), pp. 885-889	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV), so-called canalolithiasis and cupulolithiasis, usually occurs after head trauma or viral vestibular neuritis. In many cases, the cause remains obscure, and it often affects women more than 50 years old. The goal of this work was to study a possible relationship between BPPV and osteopenia or osteoporosis. Thirty-two women, whose ages ranged from 50 to 85 years (median age, 69 years), who had BPPV and were free of any other otoneurologic history, were selected. The diagnosis of osteopenia or osteoporosis was confirmed by a bone mineral density measurement made with dual x-ray absorptiometry of spine and hip (T-score). The BPPV was unilateral in 26 patients and bilateral in 6 patients. Our results showed osteopenia or osteoporosis in 24 of the 32 patients (75%) with BPPV. The T-scores were compared in 3 age groups to those of 83 healthy women. The patients with BPPV had a significantly lower (p < .026) T-score in all groups. Possible pathophysiological mechanisms are discussed to explain the apparent correlation between BPPV and osteopenia or osteoporosis.
BibTeX: @article{Vibert2003, author = {Vibert, Dominique and Kompis, Martin and Häusler, Rudolf}, title = {Benign paroxysmal positional vertigo in older women may be related to osteoporosis and osteopenia.}, journal = {The Annals of otology, rhinology, and laryngology}, year = {2003}, volume = {112}, issue = {10}, pages = {885--889}, doi = {https://doi.org/10.1177/000348940311201010}, keywords = {Aged; Aged, 80 and over; Bone Diseases, Metabolic, complications, diagnosis; Female; Humans; Labyrinth Diseases, complications; Lithiasis, complications; Middle Aged; Osteoporosis, Postmenopausal, complications, diagnosis; Semicircular Canals; Vertigo, etiology}, pmid = {14587980} }
Aranke, S.V. and Sethi, K.D.	Benign paroxysmal positional vertigo in Parkinson's disease. [BibTeX]	2003	Neurology Vol. 61(8), pp. 1156	article
BibTeX: @article{Aranke2003, author = {Aranke, Shachie V and Sethi, Kapil D}, title = {Benign paroxysmal positional vertigo in Parkinson's disease.}, journal = {Neurology}, year = {2003}, volume = {61}, issue = {8}, pages = {1156}, keywords = {Aged; Antiparkinson Agents, adverse effects; Diagnosis, Differential; Dyskinesia, Drug-Induced; Female; Humans; Hypotension, Orthostatic, complications, diagnosis, physiopathology; Male; Middle Aged; Movement; Parkinson Disease, complications, physiopathology; Posture; Vertigo, diagnosis, etiology, therapy}, pmid = {14581695} }
van Wensen, E., van Leeuwen, R.B., van der Zaag-Loonen, H.J., Masius-Olthof, S. and Bloem, B.R.	Benign paroxysmal positional vertigo in Parkinson's disease. [Abstract] [BibTeX]	2013	Parkinsonism & related disorders Vol. 19(12), pp. 1110-1112	article	DOI
Abstract: Dizziness is a frequent complaint of patients with Parkinson's disease (PD), and orthostatic hypotension (OH) is often thought to be the cause. We studied whether benign paroxysmal positional vertigo (BPPV) could also be an explanation. To assess the prevalence of benign paroxysmal positional vertigo in patients with Parkinson's disease, with and without dizziness. 305 consecutive outpatients with PD completed the Movement Disorders Society-sponsored revision of the Unified Parkinsons' Disease Rating Scale-motor score, the Dizziness Handicap Inventory, the Dix-Hallpike maneuver and a test for orthostatic hypotension. When positive for benign paroxysmal positional vertigo, a repositioning maneuver was performed. Patients were followed for three months to determine the clinical response. 305 patients responded (186 men (61%), mean age 70.5 years (Standard Deviation 9.5 years)), of whom 151 (49%) complained of dizziness. 57 (38%) of the dizzy patients appeared to have orthostatic hypotension; 12 patients (8%) had a classical but previously unrecognized benign paroxysmal positional vertigo. A further four patients (3%) had a more atypical presentation of benign paroxysmal positional vertigo. Three months after treatment, 11 (92%) of patients with classical benign paroxysmal positional vertigo were almost or completely without complaints. We found no 'hidden' benign paroxysmal positional vertigo among patients without dizziness. The prevalence of benign paroxysmal positional vertigo among all patients with PD was 5.3%. Among Parkinson patients with symptoms of dizziness, up to 11% may have benign paroxysmal positional vertigo, which can be treated easily and successfully.
BibTeX: @article{Wensen2013, author = {van Wensen, E and van Leeuwen, R B and van der Zaag-Loonen, H J and Masius-Olthof, S and Bloem, B R}, title = {Benign paroxysmal positional vertigo in Parkinson's disease.}, journal = {Parkinsonism & related disorders}, year = {2013}, volume = {19}, issue = {12}, pages = {1110--1112}, doi = {https://doi.org/10.1016/j.parkreldis.2013.07.024}, keywords = {Aged; Benign Paroxysmal Positional Vertigo; Dizziness, epidemiology, etiology; Female; Humans; Male; Outpatients; Parkinson Disease, complications; Prevalence; Vertigo, epidemiology, etiology; BPPV; Dix–Hallpike maneuver; Dizziness; Orthostatic hypotension; Parkinson's disease}, pmid = {23948517} }
Józefowicz-Korczyńska, M., Pajor, A. and Skóra, W.	Benign paroxysmal positional vertigo in patients after mild traumatic brain injury. [Abstract] [BibTeX]	2018	Advances in clinical and experimental medicine : official organ Wroclaw Medical University Vol. 27(10), pp. 1355-1359	article	DOI
Abstract: Post-traumatic vertigo, dizziness and balance disorders following head trauma range from 15% to 78% in the general population. Benign paroxysmal positional vertigo (BPPV) is the most common vestibular disorder in such patients. The aim of the study was to assess the occurrence of BPPV in patients with mild traumatic brain injury (MTBI) and determine the outcome of treatment. A group of 179 patients, with a mean age of 45.2 years, complaining of vertigo/ /dizziness and balance instability after MTBI, was enrolled into the study. All these patients were diagnosed and treated in the Department of Otolaryngology (Medical University of Lodz, Poland) between the years 2012 and 2014. Anamnesis and otoneurological examination were conducted in each patient. The diagnosis was based on the medical history, the Dix-Hallpike test or the rollover test. The treatment comprised the Epley, barbecue and particle repositioning (RM) maneuvers. Nineteen patients (10.6%) complained about attacks of vertigo elicited by positional changes. The diagnosis of BPPV was confirmed in 9 (47.4%) patients: 8 cases with a positive Dix-Hallpike test and 1 with the roll test. In 10 cases, a high probability of BPPV was diagnosed based on the medical history. Eight patients were treated by a single Epley maneuver and 1 patient by the barbecue roll. In 4 (44.4%) patients, the maneuvers were repeated. On the follow-up examination, the patients were not found to have vertigo. Benign paroxysmal positional vertigo should be diagnosed and treated successfully in patients after head trauma.
BibTeX: @article{Jozefowicz-Korczynska2018, author = {Józefowicz-Korczyńska, Magdalena and Pajor, Anna and Skóra, Wojciech}, title = {Benign paroxysmal positional vertigo in patients after mild traumatic brain injury.}, journal = {Advances in clinical and experimental medicine : official organ Wroclaw Medical University}, year = {2018}, volume = {27}, issue = {10}, pages = {1355--1359}, doi = {https://doi.org/10.17219/acem/69708}, keywords = {benign paroxysmal positional vertigo; mild traumatic brain injury; rehabilitation}, pmid = {30058780} }
Perez, N., Martin, E., Zubieta, J.L., Romero, M.D. and Garcia-Tapia, R.	Benign paroxysmal positional vertigo in patients with Ménière's disease treated with intratympanic gentamycin. [Abstract] [BibTeX]	2002	The Laryngoscope Vol. 112(6), pp. 1104-1109	article	DOI
Abstract: To analyze the incidence and characteristics of benign paroxysmal positional vertigo (BPPV) in patients with Ménière's disease who did not respond to medical treatment and to whom intratympanic gentamycin treatment was proposed. This is a retrospective analysis of the patients in our database. A complete otoneurologic bedside examination of each patient, including assessment of positional nystagmus, was performed at the time of diagnosis and during the follow-up. Nine of 90 patients with Ménière's disease also had BPPV, which manifested in different ways. In 3 patients, BPPV preceded the onset of Ménière's symptomatology in the same ear; in 1, BPPV manifested after treatment for Meniere's disease had ended and the patient was in complete control of the spontaneous spells of vertigo; in 5 cases, recurrences of both Meniere's disease and the positioning symptomatology coincided. Treatment for each condition was conducted independently and favorable results were obtained after long-term follow-up when Meniere's disease and BPPV did not coincide simultaneously. In the group manifesting symptoms of both disorders at the same time, gentamycin treatment with the Canalith Repositioning Procedure and/or Semont maneuver partially resolved the symptoms. In the context of Ménière's disease, the sequence of appearance of BPPV relative to the spontaneous episodes must be taken into account when planning the treatment for each of the disorders, which should be considered independently. This pattern could also influence the prognosis for each disorder.
BibTeX: @article{Perez2002, author = {Perez, Nicolas and Martin, Eduardo and Zubieta, Jose Luis and Romero, Maria Dolores and Garcia-Tapia, Rafael}, title = {Benign paroxysmal positional vertigo in patients with Ménière's disease treated with intratympanic gentamycin.}, journal = {The Laryngoscope}, year = {2002}, volume = {112}, issue = {6}, pages = {1104--1109}, doi = {https://doi.org/10.1097/00005537-200206000-00031}, keywords = {Adult; Aged; Anti-Bacterial Agents, administration & dosage; Female; Follow-Up Studies; Gentamicins, administration & dosage; Humans; Male; Meniere Disease, complications, drug therapy; Middle Aged; Prognosis; Retrospective Studies; Tympanic Membrane; Vertigo, etiology}, pmid = {12160282} }
Lee, W.K., Koh, S.W. and Wee, S.K.	Benign paroxysmal positional vertigo in people with traumatic spinal cord injury: incidence, treatment efficacy and implications. [Abstract] [BibTeX]	2012	American journal of otolaryngology Vol. 33(6), pp. 723-730	article	DOI
Abstract: To determine the incidence of benign positional paroxysmal vertigo (BPPV) and its treatment efficacy as well as the safety of conventional and modified BPPV assessments and treatment techniques in traumatic spinal cord injury (SCI) population. Subsequently, arrive at implications for clinical practices and set foundation for future research. Consecutive traumatic SCI patients who were admitted to the rehabilitation centre during the period from August 2008 to December 2010 were screened for BPPV using the Dix-Hallpike test and roll test. The treatment efficacy was reflected by the number of treatment required for complete resolution of BPPV symptoms. Modified assessment and treatment techniques were employed for people with cervical SCI. A total of 62 subjects were included and the overall incidence of BPPV was 14.5%. People with cervical SCI were 2.87 times more likely to have BPPV compared to people with thoracic/ lumbar SCI. The treatment efficacy for posterior and horizontal canal canalithiasis were 75% and 100% respectively with one manoeuvre. All BPPVs were resolved within three manoeuvres without any complication. All conventional and modified BPPV assessment and treatment techniques were found to be safe in people with traumatic SCI. This is the first study to look into the incidence and treatment efficacy of BPPV in people with traumatic SCI. The high incidence is worth clinicians' attentions. The treatments were also highly effective for immediate symptoms resolution. We recommend that assessments and treatments for BPPV could be incorporated into the standard care for people with traumatic SCI.
BibTeX: @article{Lee2012a, author = {Lee, Wing Kuen and Koh, Sue Wei and Wee, Seng Kwee}, title = {Benign paroxysmal positional vertigo in people with traumatic spinal cord injury: incidence, treatment efficacy and implications.}, journal = {American journal of otolaryngology}, year = {2012}, volume = {33}, issue = {6}, pages = {723--730}, doi = {https://doi.org/10.1016/j.amjoto.2012.06.008}, keywords = {Adolescent; Adult; Aged; Benign Paroxysmal Positional Vertigo; Cervical Vertebrae; Exercise Therapy, methods; Female; Follow-Up Studies; Humans; Incidence; Male; Middle Aged; Patient Positioning, methods; Posture; Retrospective Studies; Semicircular Canals, physiopathology; Singapore, epidemiology; Spinal Cord Injuries, complications, physiopathology, rehabilitation; Treatment Outcome; Vertigo, epidemiology, etiology, therapy; Vibration, therapeutic use; Young Adult}, pmid = {22884482} }
Çoban, K., Yiğit, N. and Aydın, E.	Benign Paroxysmal Positional Vertigo in Pregnancy. [Abstract] [BibTeX]	2017	Turkish archives of otorhinolaryngology Vol. 55(2), pp. 83-86	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is a clinical entity characterized by acute, brief paroxysmal attacks of rotational vertigo induced by head position changes. It is the most common peripheral vestibular pathology and is seen more frequently in women. However, to our knowledge, there is very limited data on the association between BPPV and pregnancy in both English and Turkish literature. We present four pregnant women diagnosed with BPPV for the first time during gestation and revise the etiological factors of BPPV and the role of pregnancy-related changes in BPPV.
BibTeX: @article{Coban2017, author = {Çoban, Kübra and Yiğit, Nilüfer and Aydın, Erdinç}, title = {Benign Paroxysmal Positional Vertigo in Pregnancy.}, journal = {Turkish archives of otorhinolaryngology}, year = {2017}, volume = {55}, issue = {2}, pages = {83--86}, doi = {https://doi.org/10.5152/tao.2017.2079}, keywords = {Benign paroxysmal positional vertigo; gestation; pregnancy; vertigo}, pmid = {29392061} }
Xia, P., Zhang, S.-R., Zhou, Z.-J., Shao, Y.-Q. and Hu, X.-Y.	Benign paroxysmal positional vertigo in spontaneous intracranial hypotension. [Abstract] [BibTeX]	2018	Neurological research Vol. 40(10), pp. 868-873	article	DOI
Abstract: To assess the prevalence and related factors of benign paroxysmal positional vertigo (BPPV) in patients with spontaneous intracranial hypotension (SIH). We retrospectively reviewed 156 consecutive inpatients with SIH, and collected the clinical and radiological data. These patients were divided into BPPV group and non-BPPV group according to the clinical manifestation and the results of Dix-Hallpike or supine roll tests during hospitalization period. We performed a univariate analysis and a further multiple logistic regression analysis to identify the related factors of the development of BPPV in SIH patients. BPPV was detected in 18 patients among the total 156 SIH patients (11.54%). The univariate analysis showed a low cerebrospinal fluid (CSF) pressure (P = 0.018), a small pontomesencephalic angle (P = 0.012) and a positive venous distension sign (VDS) (P = 0.045) were associated with the presence of BPPV. But the multivariate analysis only demonstrated a low CSF pressure was related to the presence of BPPV (OR = 1.022, 95% CI: 1.001-1.043, P = 0.044). BPPV is common in SIH patients. SIH patients with low CSF pressure may be prone to develop BPPV.
BibTeX: @article{Xia2018, author = {Xia, Ping and Zhang, Si-Ran and Zhou, Zhi-Jie and Shao, Yu-Quan and Hu, Xing-Yue}, title = {Benign paroxysmal positional vertigo in spontaneous intracranial hypotension.}, journal = {Neurological research}, year = {2018}, volume = {40}, issue = {10}, pages = {868--873}, doi = {https://doi.org/10.1080/01616412.2018.1495883}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, diagnostic imaging, etiology; Female; Humans; Image Processing, Computer-Assisted; Intracranial Hypotension, complications, diagnostic imaging; Magnetic Resonance Imaging; Male; Middle Aged; Regression Analysis; Retrospective Studies; Young Adult; Spontaneous intracranial hypotension; benign paroxysmal positional vertigo; cerebrospinal fluid pressure}, pmid = {30052143} }
Aksoy, S. and Sennaroğlu, L.	Benign paroxysmal positional vertigo in swimmers. [Abstract] [BibTeX]	2007	Kulak burun bogaz ihtisas dergisi : KBB = Journal of ear, nose, and throat Vol. 17(6), pp. 307-310	article
Abstract: This study was designed to evaluate the relationship between swimming and benign paroxysmal positional vertigo (BPPV). This prospective study was comprised of 30 subjects (15 females, 15 males, mean age 15.6 years; range 11 to 23 years) who had been swimming regularly for at least two years. Twenty subjects (9 females, 11 males; mean age 15.4 years; range 11 to 21 years) with no vertigo and ear complaints comprised the control group. The Dix-Hallpike maneuver was used in all the swimmers and controls to diagnose BPPV. Four swimmers (13%) exhibited characteristic findings of BPPV, being unilateral in three, and bilateral in one. Interestingly, no swimmer experienced vertigo during swimming. The characteristics of nystagmus were typical of posterior semicircular canal BPPV in all cases. None of the subjects in the control group exhibited symptoms or findings of BPPV. Patients with BPPV underwent the Epley maneuver for therapy. All were free of vertigo after one month. There was no relationship between swimming and BPPV with respect to the frequency and duration of swimming. Swimming may be one of the etiological factors of BPPV. It appears that rapid head movements during swimming cause otoconia to be dislodged from the macula and enter the semicircular canals.
BibTeX: @article{Aksoy2007, author = {Aksoy, Songül and Sennaroğlu, Levent}, title = {Benign paroxysmal positional vertigo in swimmers.}, journal = {Kulak burun bogaz ihtisas dergisi : KBB = Journal of ear, nose, and throat}, year = {2007}, volume = {17}, issue = {6}, pages = {307--310}, keywords = {Adolescent; Adult; Case-Control Studies; Child; Female; Humans; Male; Posture; Prospective Studies; Swimming; Vertigo, diagnosis, etiology, physiopathology}, pmid = {18187994} }
Fife, T.D. and von Brevern, M.	Benign Paroxysmal Positional Vertigo in the Acute Care Setting. [Abstract] [BibTeX]	2015	Neurologic clinics Vol. 33(3), pp. 601-17, viii-ix	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo characterized by brief episodes provoked by head movements. The first attack of BPPV usually occurs in bed or upon getting up. Because it often begins abruptly, it can be alarming and lead to emergency department evaluation. The episodes of spinning often last 10 to 20 seconds, but may occasionally last as long as 1 minute. There are several forms of BPPV. In nearly all cases, highly effective treatment can be offered to patients. This article reviews the current state of our understanding of this condition and its management.
BibTeX: @article{Fife2015, author = {Fife, Terry D and von Brevern, Michael}, title = {Benign Paroxysmal Positional Vertigo in the Acute Care Setting.}, journal = {Neurologic clinics}, year = {2015}, volume = {33}, issue = {3}, pages = {601--17, viii-ix}, doi = {https://doi.org/10.1016/j.ncl.2015.04.003}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis, epidemiology, therapy; Critical Care; Humans; Canalith repositioning maneuver; Canalolithiasis; Cupulolithiasis; Dizziness; Liberatory maneuver; Paroxysmal vertigo; Positional vertigo}, pmid = {26231274} }
Balatsouras, D.G., Koukoutsis, G., Fassolis, A., Moukos, A. and Apris, A.	Benign paroxysmal positional vertigo in the elderly: current insights. [Abstract] [BibTeX]	2018	Clinical interventions in aging Vol. 13, pp. 2251-2266	article	DOI
Abstract: Balance disorders, unsteadiness, dizziness and vertigo in the elderly are a significant health problem, needing appropriate treatment. One third of elderly patients with vertigo were diagnosed with benign paroxysmal positional vertigo (BPPV), the most common cause of dizziness in both primary care specialist Neurology and Ear Nose Throat settings. BPPV presents a specific paroxysmal positional nystagmus which can be obtained using the appropriate diagnostic positional test and can be treated effectively using specific therapeutic maneuvers. This review presents current insights into the diagnostic, pathogenetic and therapeutic aspects of BPPV in the elderly. BPPV in older patients does not differ significantly from BPPV in younger patients, with regard to pathogenesis, diagnosis and treatment. However, in older patients, its prevalence is higher and it responds less effectively to treatment, having a tendency for recurrence. Specific issues which should be considered in the elderly are: 1) difficulty in obtaining an accurate history; 2) difficulty in performing the diagnostic and therapeutic maneuvers, which should be executed with slow and gentle movements and extremely cautiously to avoid any vascular or orthopedic complications; and 3) the relation between BPPV and falls.
BibTeX: @article{Balatsouras2018, author = {Balatsouras, D G and Koukoutsis, G and Fassolis, A and Moukos, A and Apris, A}, title = {Benign paroxysmal positional vertigo in the elderly: current insights.}, journal = {Clinical interventions in aging}, year = {2018}, volume = {13}, pages = {2251--2266}, doi = {https://doi.org/10.2147/CIA.S144134}, keywords = {Accidental Falls, prevention & control; Benign Paroxysmal Positional Vertigo, diagnosis, epidemiology, physiopathology, therapy; Cross-Sectional Studies; Diagnosis, Differential; Humans; Nystagmus, Physiologic; Otolithic Membrane, physiopathology; Primary Health Care, trends; Recurrence; Semicircular Canals, physiopathology; balance; benign paroxysmal positional vertigo; dizziness; elderly; vestibular}, pmid = {30464434} }
Batuecas-Caletrio, A., Trinidad-Ruiz, G., Zschaeck, C., del Pozo de Dios, J.C., de Toro Gil, L., Martin-Sanchez, V. and Martin-Sanz, E.	Benign paroxysmal positional vertigo in the elderly. [Abstract] [BibTeX]	2013	Gerontology Vol. 59(5), pp. 408-412	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most frequent peripheral vertigo in the elderly. It is a well-characterized entity and generally easy to treat. To evaluate the main symptoms, time to consult for the problem, vertigo characteristics, treatment and follow-up in patients over 70 with BPPV. This was a retrospective cohort study. Four hundred and four patients were diagnosed to have BPPV (between January 2006 and December 2012); 211 of them were ≥70 years old (mean 77.7 years) and 193 <70 years old (mean 53.82 years). Patients over 70 with BPPV took longer to consult for the problem (Spearman rho, p = 0.01). The frequency of a clinical presentation consisting of unsteadiness or imbalance without vertigo sensation is higher among elderly patients (χ(2), p = 10(-6)). The effectiveness of the repositioning maneuver is lower than in patients under 70 (χ(2), p = 0.002), and the recurrences are more frequent (χ(2), p = 0.04). BPPV is a frequent entity in the elderly, and it is necessary to take it into account when older patients complain about imbalance. An appropriate treatment with repositioning maneuvers and prolonged follow-up are required in order to detect recurrences.
BibTeX: @article{Batuecas-Caletrio2013, author = {Batuecas-Caletrio, Angel and Trinidad-Ruiz, Gabriel and Zschaeck, Christiane and del Pozo de Dios, Juan Carlos and de Toro Gil, Laura and Martin-Sanchez, Victor and Martin-Sanz, Eduardo}, title = {Benign paroxysmal positional vertigo in the elderly.}, journal = {Gerontology}, year = {2013}, volume = {59}, issue = {5}, pages = {408--412}, doi = {https://doi.org/10.1159/000351204}, keywords = {Age Factors; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Cohort Studies; Female; Follow-Up Studies; Humans; Male; Middle Aged; Recurrence; Retrospective Studies; Semicircular Canals, physiopathology; Treatment Outcome; Vertigo, diagnosis, physiopathology, therapy}, pmid = {23689314} }
Norré, M.E. and Beckers, A.	Benign paroxysmal positional vertigo in the elderly. Treatment by habituation exercises. [Abstract] [BibTeX]	1988	Journal of the American Geriatrics Society Vol. 36(5), pp. 425-429	article
Abstract: Exercise treatment has become generally accepted as therapy for some types of vertigo. Benign paroxysmal positional vertigo (BPPV) has been very successfully treated by vestibular habituation training (VHT). This is an exercise treatment whereby the patient is repeatedly exposed to the maneuvers eliciting vertigo. Elderly patients treated by VHT also showed very satisfying results, albeit the therapeutic effect developed somewhat slower than in the younger patients. In the scope of the problem of "falling in the elderly," the therapeutic effect for BPPV is worth emphasizing.
BibTeX: @article{Norre1988, author = {Norré, M E and Beckers, A}, title = {Benign paroxysmal positional vertigo in the elderly. Treatment by habituation exercises.}, journal = {Journal of the American Geriatrics Society}, year = {1988}, volume = {36}, issue = {5}, pages = {425--429}, keywords = {Adult; Age Factors; Aged; Exercise Therapy, methods; Female; Habituation, Psychophysiologic, physiology; Humans; Male; Middle Aged; Postural Balance; Posture; Vertigo, physiopathology, therapy; Vestibule, Labyrinth, physiology, physiopathology}, pmid = {3258876} }
Psillas, G., Triaridis, S., Markou, K., Tsalighopoulos, M. and Vital, V.	Benign paroxysmal positional vertigo in the first acute attack of Ménière's disease. [Abstract] [BibTeX]	2011	B-ENT Vol. 7(2), pp. 131-135	article
Abstract: A 69-year-old woman, with no history of vertigo attacks, presented with the classical triad of symptoms for Ménière's disease in the right ear (vertigo, tinnitus, fullness). Upon admission, the patient had a third-degree horizontal nystagmus beating to the right, after beating towards the left ear a few hours earlier. Audiometry confirmed a severe sensorineural hearing loss in the right ear, especially at low and high frequencies. The following day, the patient complained of short episodes of vertigo linked to head movement, and the Hallpike test was compatible with benign paroxysmal positional vertigo (BPPV) in the right ear. To our knowledge this is the first description of BPPV of the posterior semicircular canal manifesting during the first vertiginous attack of Ménière's disease in the same ear. It was possible that the hydropic distension or rupture damaged the otolithic apparatus, leading to the release of otoconia debris which migrated to the posterior semicircular canal where it resulted in BPPV.
BibTeX: @article{Psillas2011, author = {Psillas, G and Triaridis, S and Markou, K and Tsalighopoulos, M and Vital, V}, title = {Benign paroxysmal positional vertigo in the first acute attack of Ménière's disease.}, journal = {B-ENT}, year = {2011}, volume = {7}, issue = {2}, pages = {131--135}, keywords = {Acute Disease; Aged; Audiometry, Pure-Tone; Benign Paroxysmal Positional Vertigo; Diagnosis, Differential; Disease Progression; Female; Humans; Magnetic Resonance Imaging; Meniere Disease, complications, diagnosis; Vertigo, diagnosis, etiology}, pmid = {21838099} }
Kollén, L., Frändin, K., Möller, M., Fagevik Olsén, M. and Möller, C.	Benign paroxysmal positional vertigo is a common cause of dizziness and unsteadiness in a large population of 75-year-olds. [Abstract] [BibTeX]	2012	Aging clinical and experimental research Vol. 24(4), pp. 317-323	article
Abstract: Studies have shown that 65% of people with dizziness may have a vestibular etiologic diagnosis, possibly benign paroxysmal positional vertigo (BPPV). The diagnosis of BPPV is based on medical history and findings after the Dix-Hallpike test. It is sometimes difficult to perform the Dix-Hallpike test in elderly persons, due to the limited range of motion when extending the neck. In this study, we used a side-lying test to stimulate the posterior semicircular canal, while the head and neck were fully supported on the examination table. The aims of this study were to investigate the prevalence of dizziness and/or impaired balance and BPPV in a population of 75-year-olds by means of a questionnaire and clinical tests, and to compare elderly persons with and without BPPV. A representative population sample of 675 persons completed a questionnaire about dizziness and 571 persons underwent side-lying, static balance and dynamic walking tests. Subjective dizziness and/or impaired balance were found in 36% of subjects, especially when walking outdoors. A significant gender difference was found, with a higher prevalence in women (40%) compared with men (30%) (p<0.01). BPPV was found in 11% and was significantly more common in women (p<0.01). Elderly individuals with BPPV also displayed significantly impaired balance in static and dynamic balance tests compared with persons without BPPV (p<0.01). Persons with BPPV reported significantly more sub- jective problems with dizziness and balance compared with persons without BPPV (p<0.001). Subjective and objective unsteadiness, dizziness and BP- PV are common in the elderly.
BibTeX: @article{Kollen2012, author = {Kollén, Lena and Frändin, Kerstin and Möller, Margareta and Fagevik Olsén, Monika and Möller, Claes}, title = {Benign paroxysmal positional vertigo is a common cause of dizziness and unsteadiness in a large population of 75-year-olds.}, journal = {Aging clinical and experimental research}, year = {2012}, volume = {24}, issue = {4}, pages = {317--323}, keywords = {Age Factors; Aged; Benign Paroxysmal Positional Vertigo; Cross-Sectional Studies; Dizziness, diagnosis, epidemiology, etiology, physiopathology; Female; Humans; Longitudinal Studies; Male; Postural Balance, physiology; Posture, physiology; Semicircular Canals, physiopathology; Sex Factors; Surveys and Questionnaires; Sweden, epidemiology; Vertigo, complications, epidemiology; Walking, physiology}, pmid = {23238307} }
Liao, W.-L., Chang, T.-P., Chen, H.-J. and Kao, C.-H.	Benign paroxysmal positional vertigo is associated with an increased risk of fracture: a population-based cohort study. [Abstract] [BibTeX]	2015	The Journal of orthopaedic and sports physical therapy Vol. 45(5), pp. 406-412	article	DOI
Abstract: A nationwide, population-based, retrospective cohort study. To investigate whether benign paroxysmal positional vertigo (BPPV) is associated with an increased risk of fracture. Benign paroxysmal positional vertigo is a brief rotational vertigo induced by head position change that may increase the risk of falls and, therefore, fracture. Data from the Taiwan National Health Insurance Research Database were used for this study. We selected a case cohort comprising 3796 patients aged over 20 years who were newly diagnosed with BPPV between 2000 and 2006. In addition, we randomly selected a control cohort of 15 184 individuals without BPPV. Patients with BPPV were matched to individuals in the control group according to sex, age, and index year. A Cox proportional hazard regression was performed to compute the hazard ratio of fracture, after adjusting for demographic characteristics and comorbidities. The prevalence of comorbidities was higher among patients with BPPV. After adjusting for age, sex, and comorbidities, patients with BPPV exhibited a 1.14-fold (95% confidence interval [CI]: 1.04, 1.25; P<.01) higher risk of fracture than those without BPPV. Trunk fracture (vertebra, rib, and pelvis) was the fracture type with the highest adjusted hazard ratio (1.24; 95% CI: 1.06, 1.45; P<.01) in patients with BPPV relative to those without BPPV. An analysis stratified according to demographic factors revealed that men with BPPV exhibited a 1.43-fold (95% CI: 1.22, 1.66; P<.001) higher risk of fracture. Patients with BPPV aged over 65 years exhibited a significantly higher risk of fracture (adjusted hazard ratio = 1.17; 95% CI: 1.03, 1.33; P<.05) than did those without BPPV. Patients with BPPV exhibited a higher risk of fracture than did those without BPPV. Prognosis, level 2b.
BibTeX: @article{Liao2015, author = {Liao, Wen-Ling and Chang, Tzu-Pu and Chen, Hsuan-Ju and Kao, Chia-Hung}, title = {Benign paroxysmal positional vertigo is associated with an increased risk of fracture: a population-based cohort study.}, journal = {The Journal of orthopaedic and sports physical therapy}, year = {2015}, volume = {45}, issue = {5}, pages = {406--412}, doi = {https://doi.org/10.2519/jospt.2015.5707}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo, complications, epidemiology; Comorbidity; Dizziness, etiology; Female; Fractures, Bone, epidemiology, etiology; Humans; Male; Middle Aged; Prevalence; Proportional Hazards Models; Retrospective Studies; Risk Factors; BPPV; falls; hazard ratio}, pmid = {25808526} }
Kim, Y.H., Kim, K.-S., Choi, H., Choi, J.-S. and Han, C.D.	Benign paroxysmal positional vertigo is not a prognostic factor in sudden sensorineural hearing loss. [Abstract] [BibTeX]	2012	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 146(2), pp. 279-282	article	DOI
Abstract: Little is known concerning the role of benign paroxysmal positional vertigo (BPPV) as a prognostic factor for sudden sensorineural hearing loss (SSNHL). The purpose of this study is to analyze the hearing recovery in patients who have SSNHL with BPPV compared with those who have SSNHL without BPPV. The study also documented the relative incidence of each semicircular canal involvement. Case-control study. Academic tertiary otologic practice. Ninety patients diagnosed with SSNHL with vertigo were enrolled. Clinical characteristics such as gender, age, and pure tone audiogram threshold were compared between group A (SSNHL with BPPV, n = 17) and group B (SSNHL without BPPV, n = 73). The frequency of each canal involvement was compared between group A and another 111 patients with BPPV only (group C). The proportion of patients with hearing recovery was compared between patients with or without BPPV, and between those with or without canal paresis. Patients in group A did not display significant differences in the sex ratio, mean age, or initial results of pure tone audiogram threshold compared with those in group B. Most patients with SSNHL with BPPV had lateral canal canalithiasis (64.7%). The presence of BPPV had no influence on the recovery of hearing. The clinical characteristics of patients with SSNHL with BPPV were not different from those with SSNHL without BPPV. The lateral canal was the most frequently involved, and the presence or absence of BPPV had no dramatic impact on the outcome of SSNHL.
BibTeX: @article{Kim2012e, author = {Kim, Young Hyo and Kim, Kyu-Sung and Choi, Hoseok and Choi, Jeong-Seok and Han, Chang Dok}, title = {Benign paroxysmal positional vertigo is not a prognostic factor in sudden sensorineural hearing loss.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2012}, volume = {146}, issue = {2}, pages = {279--282}, doi = {https://doi.org/10.1177/0194599811421733}, keywords = {Adolescent; Adult; Aged; Benign Paroxysmal Positional Vertigo; Case-Control Studies; Female; Hearing Loss, Sensorineural, complications, physiopathology; Humans; Male; Middle Aged; Prognosis; Recovery of Function; Vertigo, complications; Young Adult; acute peripheral vestibulopathy; benign paroxysmal positional vertigo; sensorineural hearing loss}, pmid = {22157264} }
Reddy, V.M., Sargent, H. and Prior, M.J.	Benign paroxysmal positional vertigo nurse-led follow-up clinic. [Abstract] [BibTeX]	2011	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 268(6), pp. 829-832	article	DOI
Abstract: Patients with benign paroxysmal positional vertigo (BPPV) often require multiple appointments for treatment with Epley manoeuvres. Waiting times for medical follow up can be very long. To reduce waiting times and increase availability of ENT outpatients' appointments, a nurse-led dizziness clinic (NLDC) to follow up BPPV patients was established. Prospective audit of 99 consecutive patients attending the NLDC, at which patients are assessed and treated, was conducted. Non-responders are redirected for further medical review. 99 patients were seen in 200 appointments in the NLDC from July 2007 to May 2009. The mean time to NLDC was 16 days. 67 patients were discharged from the NLDC free of symptoms. Cost analysis revealed savings of £3,800. A survey of NLDC attendees revealed that the care they received was rated as excellent, very good or good by 92% of patients. In conclusion, the NLDC is an innovation which increases availability of ENT outpatient appointments. This is acceptable to patients and is a natural extension of the roles of ENT nurse practitioners which could be implemented in other ENT departments.
BibTeX: @article{Reddy2011, author = {Reddy, Venkat M and Sargent, Helen and Prior, Matthew J}, title = {Benign paroxysmal positional vertigo nurse-led follow-up clinic.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2011}, volume = {268}, issue = {6}, pages = {829--832}, doi = {https://doi.org/10.1007/s00405-010-1319-7}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nursing Audit; Outpatients; Practice Patterns, Nurses'; Prospective Studies; Vertigo, nursing; Young Adult}, pmid = {21191609} }
Serafini, G., Palmieri, A.M. and Simoncelli, C.	Benign paroxysmal positional vertigo of posterior semicircular canal: results in 160 cases treated with Semont's maneuver. [Abstract] [BibTeX]	1996	The Annals of otology, rhinology, and laryngology Vol. 105(10), pp. 770-775	article	DOI
Abstract: One hundred sixty patients affected by benign paroxysmal positional vertigo of the posterior semicircular canal were treated with Semont's maneuver. Complete recovery after only one session was achieved in more than 50% of cases. After a maximum of five sessions, almost all patients had recovered; only 8 needed another kind of rehabilitation. No drug therapy was required for any patient.
BibTeX: @article{Serafini1996, author = {Serafini, G and Palmieri, A M and Simoncelli, C}, title = {Benign paroxysmal positional vertigo of posterior semicircular canal: results in 160 cases treated with Semont's maneuver.}, journal = {The Annals of otology, rhinology, and laryngology}, year = {1996}, volume = {105}, issue = {10}, pages = {770--775}, doi = {https://doi.org/10.1177/000348949610501003}, keywords = {Female; Head Movements, physiology; Humans; Male; Middle Aged; Nystagmus, Pathologic, physiopathology; Posture, physiology; Semicircular Canals, physiopathology; Vertigo, physiopathology, rehabilitation}, pmid = {8865771} }
Korres, S., Riga, M., Balatsouras, D. and Sandris, V.	Benign paroxysmal positional vertigo of the anterior semicircular canal: atypical clinical findings and possible underlying mechanisms. [Abstract] [BibTeX]	2008	International journal of audiology Vol. 47(5), pp. 276-282	article	DOI
Abstract: Anterior semicircular canal (ASC) lithiasis is uncommon and usually self-treated. In the rare cases when such patients seek medical advice, diagnosis requires careful consideration of the patient's symptoms and the clinical characteristics of the nystagmus triggered by the Dix-Hallpike (D-H) examination. In this study, two atypical cases of ASC benign paroxysmal positional vertigo (BPPV) are presented and the relevant literature is reviewed. Regardless of their unique symptoms, both participants in this study were diagnosed with lithiasis of the left ASC. The clinical manifestations of ASC BPPV may differ significantly from typical symptoms seen in the more common posterior semicircular canal BPPV. The possible mechanisms responsible for this intriguing variance, as well as guidelines for diagnosing the affected side, are discussed.
BibTeX: @article{Korres2008, author = {Korres, S and Riga, M and Balatsouras, D and Sandris, V}, title = {Benign paroxysmal positional vertigo of the anterior semicircular canal: atypical clinical findings and possible underlying mechanisms.}, journal = {International journal of audiology}, year = {2008}, volume = {47}, issue = {5}, pages = {276--282}, doi = {https://doi.org/10.1080/14992020801958843}, keywords = {Electronystagmography; Female; Humans; Labyrinth Diseases, complications, diagnosis, physiopathology, therapy; Lithiasis, complications, diagnosis, physiopathology, therapy; Male; Middle Aged; Nystagmus, Pathologic, etiology, physiopathology; Posture; Semicircular Canals, physiopathology; Treatment Outcome; Vertigo, etiology, physiopathology, therapy}, pmid = {18465412} }
Nuti, D., Vannucchi, P. and Pagnini, P.	Benign paroxysmal positional vertigo of the horizontal canal: a form of canalolithiasis with variable clinical features. [Abstract] [BibTeX]	1996	Journal of vestibular research : equilibrium & orientation Vol. 6(3), pp. 173-184	article
Abstract: Benign paroxysmal positional vertigo of the horizontal semicircular canal (HC-BPPV) is a well-defined syndrome characterized by direction-changing horizontal positional nystagmus. We report the clinical features of 5 patients who illustrate the possible variables of the syndrome. In most cases, nystagmus is geotropic and more intense when the pathological ear is lowermost; less often the syndrome presents with apogeotropic nystagmus that is more intense when the affected ear is uppermost. The nystagmus pattern may vary in time in the same patient, changing from apogeotropic to geotropic even in observations at short intervals. In some patients, the features indicate involvement of more than one canal, either simultaneously or in succession. It is sustained that the clinical findings can be explained by movement of endolymph caused by displacement of otoconia in the semicircular canals and that variants are due to different positions of the otoconia within the canals.
BibTeX: @article{Nuti1996, author = {Nuti, D and Vannucchi, P and Pagnini, P}, title = {Benign paroxysmal positional vertigo of the horizontal canal: a form of canalolithiasis with variable clinical features.}, journal = {Journal of vestibular research : equilibrium & orientation}, year = {1996}, volume = {6}, issue = {3}, pages = {173--184}, keywords = {Adult; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, physiopathology; Semicircular Canals, physiopathology; Vertigo, physiopathology}, pmid = {8744525} }
De la Meilleure, G., Dehaene, I., Depondt, M., Damman, W., Crevits, L. and Vanhooren, G.	Benign paroxysmal positional vertigo of the horizontal canal. [Abstract] [BibTeX]	1996	Journal of neurology, neurosurgery, and psychiatry Vol. 60(1), pp. 68-71	article
Abstract: To review the clinical features, electronystagmography findings, the possible mechanism, and a possible therapeutic approach to benign paroxysmal positional vertigo (BPPV). Sixty-three cases of BPPV of the horizontal canal type have been reviewed. It is characterised by horizontal nystagmus and an intense vertigo, provoked by rotation of the head in a supine patient. The horizontal nystagmus beats towards the ground on both sides, becomes more pronounced when lying on the pathological side, and then the nystagmus often changes direction. Forty-eight patients underwent electronystagmography. On the pathological side, the first phase nystagmus had a mean latency of three seconds and a mean duration of 31.6 seconds. Nystagmus inversion occurred in 36 patients after a nystagmus free interval. The mean second phase nystagmus duration lasted 33.4 seconds. On the healthy side, the nystagmus had a mean latency of 3.4 seconds and a mean duration of 39.5 seconds. Fatigue was seen in six patients. Simultaneous involvement of the posterior canal was present in 16 patients. A liberatory manoeuvre was successful in six patients. The liberatory manoeuvre should be tried in patients with horizontal canal vertigo. It should not be performed in patients with severe cervical arthrosis, vertebrobasilar insufficiency, or when the patient has neck pain during the manoeuvre.
BibTeX: @article{DelaMeilleure1996, author = {De la Meilleure, G and Dehaene, I and Depondt, M and Damman, W and Crevits, L and Vanhooren, G}, title = {Benign paroxysmal positional vertigo of the horizontal canal.}, journal = {Journal of neurology, neurosurgery, and psychiatry}, year = {1996}, volume = {60}, issue = {1}, pages = {68--71}, keywords = {Adult; Aged; Aged, 80 and over; Electronystagmography; Endolymph; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, complications; Otolithic Membrane, physiopathology; Posture; Reaction Time; Retrospective Studies; Rotation; Semicircular Canals, physiopathology; Time Factors; Vertigo, diagnosis, etiology, physiopathology, therapy}, pmid = {8558155} }
Soto-Varela, A., Rossi-Izquierdo, M., Martínez-Capoccioni, G., Labella-Caballero, T. and Santos-Pérez, S.	Benign paroxysmal positional vertigo of the posterior semicircular canal: efficacy of Santiago treatment protocol, long-term follow up and analysis of recurrence. [Abstract] [BibTeX]	2012	The Journal of laryngology and otology Vol. 126(4), pp. 363-371	article	DOI
Abstract: To evaluate the efficacy of the Santiago treatment protocol for benign paroxysmal positional vertigo of the posterior semicircular canal, to analyse recurrence and to establish prognostic factors. Four hundred and twelve patients with unilateral benign paroxysmal positional vertigo of the posterior semicircular canal were treated with the Semont manoeuvre and, if symptoms did not resolve, successive application of three Epley manoeuvres plus Brandt-Daroff exercises. Symptoms resolved in 404 patients (98.1 per cent); a single Semont manoeuvre was sufficient in 334 (81.2 per cent). Aetiology had no impact on resolution of symptoms or number of manoeuvres required. The estimated likelihood of recurrence was 14 per cent in the first year and 27 per cent after 10 years. The only factor indicating a worse prognosis was recurrence. In unilateral benign paroxysmal positional vertigo of the posterior semicircular canal, the above treatment protocol cured 98 per cent of patients. More than half of recurrences occurred in the first year. None of the analysed factors increased the likelihood of recurrence.
BibTeX: @article{Soto-Varela2012, author = {Soto-Varela, A and Rossi-Izquierdo, M and Martínez-Capoccioni, G and Labella-Caballero, T and Santos-Pérez, S}, title = {Benign paroxysmal positional vertigo of the posterior semicircular canal: efficacy of Santiago treatment protocol, long-term follow up and analysis of recurrence.}, journal = {The Journal of laryngology and otology}, year = {2012}, volume = {126}, issue = {4}, pages = {363--371}, doi = {https://doi.org/10.1017/S0022215111003495}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Clinical Protocols; Exercise Therapy, methods; Female; Follow-Up Studies; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Patient Positioning, methods; Posture, physiology; Recurrence; Retreatment; Semicircular Canals, physiopathology; Treatment Outcome; Vertigo, therapy; Young Adult}, pmid = {22310108} }
von Brevern, M., Seelig, T., Neuhauser, H. and Lempert, T.	Benign paroxysmal positional vertigo predominantly affects the right labyrinth. [Abstract] [BibTeX]	2004	Journal of neurology, neurosurgery, and psychiatry Vol. 75(10), pp. 1487-1488	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) occurs when there are freely moving particles in a semicircular canal and the head is turned in the plane of the affected canal. The aim of the present study was to clarify whether BPPV manifests equally in both labyrinths or whether there is a preponderance for one side. We conducted a PubMed literature search of BPPV case series which specified the affected side and a retrospective chart review of 80 consecutive patients with BPPV of the posterior canal who had presented at our dizziness clinic. Eighteen studies with a total of 3426 patients were identified. In our own series the right side was affected in 54 of 80 patients (right/left ratio 2.08). Altogether, in 3506 patients the right labyrinth was involved 1.41 times more often than the left (95% CI 1.37 to 1.45). We think that the reason for the predominant involvement of the right ear in BPPV is the habit-of most patients-of sleeping on the right side.
BibTeX: @article{Brevern2004, author = {von Brevern, M and Seelig, T and Neuhauser, H and Lempert, T}, title = {Benign paroxysmal positional vertigo predominantly affects the right labyrinth.}, journal = {Journal of neurology, neurosurgery, and psychiatry}, year = {2004}, volume = {75}, issue = {10}, pages = {1487--1488}, doi = {https://doi.org/10.1136/jnnp.2003.031500}, keywords = {Ear, Inner, pathology; Functional Laterality; Humans; Posture; Retrospective Studies; Sleep; Vertigo, pathology}, pmid = {15377705} }
Dorigueto, R.S., Mazzetti, K.R., Gabilan, Y.P.L. and Ganança, F.F.	Benign paroxysmal positional vertigo recurrence and persistence. [Abstract] [BibTeX]	2009	Brazilian journal of otorhinolaryngology Vol. 75(4), pp. 565-572	article
Abstract: Benign paroxysmal positional vertigo (BPPV) is one of the most common vestibular disorders. To study the recurrence and persistence of BPPV in patients treated with canalith repositioning maneuvers (CRM) during the period of one year. longitudinal contemporary cohort series. One hundred patients with BPPV were followed up during 12 months after a treatment with CRM. Patients were classified according to disease evolution. Aquatic physiotherapy for vestibular rehabilitation (APVR) protocol was applied in cases of persistent BPPV. After CRM, 96% of the patients were free from BPPV's typical nystagmus and dizziness. During the follow up period of 1 year, 26 patients returned with typical BPPV nystagmus and vertigo. Nystagmus and vertigo were persistent in 4% of the patients. Persistent BPPV presented improvement when submitted to APVR. During the period of one year, BPPV was not recurrent in 70% of the patients, recurrent in 26% and persistent in 4%.
BibTeX: @article{Dorigueto2009, author = {Dorigueto, Ricardo S and Mazzetti, Karen R and Gabilan, Yeda Pereira L and Ganança, Fernando Freitas}, title = {Benign paroxysmal positional vertigo recurrence and persistence.}, journal = {Brazilian journal of otorhinolaryngology}, year = {2009}, volume = {75}, issue = {4}, pages = {565--572}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Cohort Studies; Female; Humans; Hydrotherapy, methods; Longitudinal Studies; Male; Middle Aged; Recurrence; Vertigo, rehabilitation; Young Adult}, pmid = {19784427} }
Wjst, M.	Benign paroxysmal positional vertigo relief on a roller coaster. [BibTeX]	2002	Lancet (London, England) Vol. 360(9347), pp. 1792	article	DOI
BibTeX: @article{Wjst2002, author = {Wjst, Matthias}, title = {Benign paroxysmal positional vertigo relief on a roller coaster.}, journal = {Lancet (London, England)}, year = {2002}, volume = {360}, issue = {9347}, pages = {1792}, doi = {https://doi.org/10.1016/S0140-6736(02)11708-9}, keywords = {Gravitation; Humans; Vertigo, etiology, therapy}, pmid = {12480470} }
Nigam, A., Moffat, D.A. and Varley, E.W.	Benign paroxysmal positional vertigo resulting from surgical trauma. [Abstract] [BibTeX]	1989	The Journal of laryngology and otology Vol. 103(2), pp. 203-204	article
Abstract: A patient developed benign paroxysmal positional vertigo following partial excision of the upper jaw for squamous carcinoma. It is probable that the trauma sustained by the labyrinth during surgery led to the development of vertigo. Benign paroxysmal positional vertigo may be a preventable post-operative complication.
BibTeX: @article{Nigam1989, author = {Nigam, A and Moffat, D A and Varley, E W}, title = {Benign paroxysmal positional vertigo resulting from surgical trauma.}, journal = {The Journal of laryngology and otology}, year = {1989}, volume = {103}, issue = {2}, pages = {203--204}, keywords = {Aged; Carcinoma, Squamous Cell, surgery; Ear, Inner, injuries; Humans; Intraoperative Complications; Male; Mouth Neoplasms, surgery; Posture; Vertigo, etiology; Vestibular Function Tests}, pmid = {2926270} }
Lee, N.-H., Ban, J.-H., Lee, K.-C. and Kim, S.M.	Benign paroxysmal positional vertigo secondary to inner ear disease. [Abstract] [BibTeX]	2010	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 143(3), pp. 413-417	article	DOI
Abstract: To contrast clinical characteristics of secondary benign paroxysmal positional vertigo (s-BPPV) with idiopathic BPPV (i-BPPV). Case series with chart review. University hospital. A total of 718 patients whose medical records were reviewed had BPPV. Sixty-nine patients had existing inner ear diseases and thus were considered to have s-BPPV. We reviewed demographics, concurrent causative disorders, involved area, and response to particle repositioning maneuvers for these s-BPPV patients in comparison with i-BPPV subjects. Female subjects with i-BPPV outnumbered male subjects by a ratio of 1.9:1, but there was no significant sex difference for s-BPPV patients. The diseases associated with s-BPPV were idiopathic sudden sensory hearing loss (ISSHL, 50.7%), Ménière's disease (MD, 28.9%) and unilateral vestibulopathy such as acute vestibular neuronitis and herpes zoster oticus (20.2%). The posterior canal was most commonly involved in both i-BPPV and s-BPPV. The horizontal canal was the second most common, followed by multi-canal involvement. However, MD-associated BPPV most commonly involved the lateral canal. The mean durations of treatment for i-BPPV and s-BPPV were 2.28 and 4.87 days, respectively. The mean duration of treatment was 6.28 days for ISSHL with BPPV, 5.07 days for BPPV with unilateral vestibulopathy, and 2.28 days for BPPV with MD. The mean duration of treatment for BPPV with ISSHL or unilateral vestibulopathy was longer than for other groups. The different pathophysiologies of s-BPPV associated with different inner ear diseases may explain its diverse clinical features and courses.
BibTeX: @article{Lee2010b, author = {Lee, No-Hee and Ban, Jae-Ho and Lee, Kyung-Chul and Kim, Su Mi}, title = {Benign paroxysmal positional vertigo secondary to inner ear disease.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2010}, volume = {143}, issue = {3}, pages = {413--417}, doi = {https://doi.org/10.1016/j.otohns.2010.06.905}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Cohort Studies; Female; Humans; Labyrinth Diseases, complications, diagnosis, therapy; Male; Middle Aged; Musculoskeletal Manipulations; Retrospective Studies; Risk Factors; Semicircular Canals; Treatment Outcome; Vertigo, diagnosis, etiology, therapy; Young Adult}, pmid = {20723780} }
Shan, X., Wang, A. and Wang, E.	Benign paroxysmal positional vertigo secondary to laparoscopic surgery. [Abstract] [BibTeX]	2017	SAGE open medical case reports Vol. 5, pp. 2050313X17692938	article	DOI
Abstract: Benign paroxysmal positional vertigo is a common vestibular disorder and it may be idiopathic or secondary to some conditions such as surgery, but rare following laparoscopic surgery. We report two cases of benign paroxysmal positional vertigo secondary to laparoscopic surgery, one after laparoscopic cholecystectomy in a 51-year-old man and another following laparoscopic hysterectomy in a 60-year-old woman. Both patients were treated successfully with manual or device-assisted canalith repositioning maneuvers, with no recurrence on the follow-up of 6 -18 months. Benign paroxysmal positional vertigo is a rare but possible complication of laparoscopic surgery. Both manual and device-assisted repositioning maneuvers are effective treatments for this condition, with good efficacy and prognosis.
BibTeX: @article{Shan2017, author = {Shan, Xizheng and Wang, Amy and Wang, Entong}, title = {Benign paroxysmal positional vertigo secondary to laparoscopic surgery.}, journal = {SAGE open medical case reports}, year = {2017}, volume = {5}, pages = {2050313X17692938}, doi = {https://doi.org/10.1177/2050313X17692938}, keywords = {Benign paroxysmal positional vertigo; device-assisted canalith repositioning maneuver; laparoscopic cholecystectomy; laparoscopic hysterectomy; laparoscopic surgery; postoperative complication}, pmid = {28255446} }
Balatsouras, D.G., Koukoutsis, G., Aspris, A., Fassolis, A., Moukos, A., Economou, N.C. and Katotomichelakis, M.	Benign Paroxysmal Positional Vertigo Secondary to Mild Head Trauma. [Abstract] [BibTeX]	2017	The Annals of otology, rhinology, and laryngology Vol. 126(1), pp. 54-60	article	DOI
Abstract: We studied the clinical characteristics, nystagmographic findings, and treatment outcome of a group of patients with benign paroxysmal positional vertigo (BPPV) secondary to mild head trauma and compared them with a group of patients with idiopathic BPPV. The medical records of 33 patients with BPPV associated with mild head trauma were reviewed. Data of a complete otolaryngological, audiological, neurotologic, and imaging evaluation were available for all patients. Three hundred and twenty patients with idiopathic BPPV were used as a control group. The patients with BPPV secondary to mild head trauma presented the following features, in which they differed from the patients with idiopathic BPPV: (1) lower mean age, with more intense symptoms; (2) increased rate of horizontal and anterior semicircular canal involvement and frequent multiple canal and bilateral involvement; (3) greater incidence of canal paresis and presence of spontaneous nystagmus; (4) poorer treatment results, attributed mainly to coexisting canal paresis in many patients, and higher rate of recurrence. Benign paroxysmal positional vertigo associated with mild head trauma differs from idiopathic BPPV in terms of several epidemiological and clinical features; it responds less effectively to treatment and is prone to recurrence.
BibTeX: @article{Balatsouras2017, author = {Balatsouras, Dimitrios G and Koukoutsis, George and Aspris, Andreas and Fassolis, Alexandros and Moukos, Antonis and Economou, Nicolas C and Katotomichelakis, Michael}, title = {Benign Paroxysmal Positional Vertigo Secondary to Mild Head Trauma.}, journal = {The Annals of otology, rhinology, and laryngology}, year = {2017}, volume = {126}, issue = {1}, pages = {54--60}, doi = {https://doi.org/10.1177/0003489416674961}, keywords = {Adult; Age Factors; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, etiology; Brain Injuries, complications; Case-Control Studies; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, etiology; Paresis, physiopathology; Recurrence; Retrospective Studies; Semicircular Canals, physiopathology; Severity of Illness Index; Young Adult; benign paroxysmal positional vertigo; canalith repositioning procedure; head trauma; hearing loss; nystagmography; vertigo}, pmid = {27780909} }
Balatsouras, D.G., Koukoutsis, G., Ganelis, P., Economou, N.C., Moukos, A., Aspris, A. and Katotomichelakis, M.	Benign paroxysmal positional vertigo secondary to vestibular neuritis. [Abstract] [BibTeX]	2014	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 271(5), pp. 919-924	article	DOI
Abstract: The aim of this study was to present the demographic, pathogenetic and clinical features of benign paroxysmal positional vertigo (BPPV) secondary to vestibular neuritis (VN). The medical records of 22 patients, who presented with BPPV within 12 weeks after the onset of VN, were reviewed. Data of a complete otolaryngological, audiological, neurotologic and imaging evaluation were available for all patients. Two hundred and eighty-four patients with idiopathic BPPV were used as a control group. The patients with BPPV secondary to VN presented the following features, in which they differed from the patients with idiopathic BPPV: (1) a lower mean age; (2) involvement of the posterior semicircular canal; (3) presence of canal weakness; (4) more therapeutic sessions needed for cure and a higher rate of recurrence. It may be, thus, concluded that BPPV associated with VN differs from idiopathic BPPV in regard to several epidemiological and clinical features, it responds less effectively to treatment and may follow a protracted course, having a tendency for recurrence.
BibTeX: @article{Balatsouras2014, author = {Balatsouras, Dimitrios G and Koukoutsis, George and Ganelis, Panayotis and Economou, Nicolas C and Moukos, Antonis and Aspris, Andreas and Katotomichelakis, Michael}, title = {Benign paroxysmal positional vertigo secondary to vestibular neuritis.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2014}, volume = {271}, issue = {5}, pages = {919--924}, doi = {https://doi.org/10.1007/s00405-013-2484-2}, keywords = {Adult; Age Factors; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, diagnosis, etiology, physiopathology, therapy; Diagnosis, Differential; Electronystagmography; Female; Humans; Male; Middle Aged; Otolithic Membrane, physiopathology; Recurrence; Semicircular Canals, physiopathology; Treatment Outcome; Vestibular Neuronitis, complications, diagnosis, physiopathology, therapy}, pmid = {23575935} }
Imai, T., Takeda, N., Uno, A., Horii, A., Kitahara, T., Nishiike, S., Higashi-Shingai, K. and Inohara, H.	Benign paroxysmal positional vertigo showing sequential translations of four types of nystagmus. [Abstract] [BibTeX]	2012	Auris, nasus, larynx Vol. 39(5), pp. 544-548	article	DOI
Abstract: We report a case of benign paroxysmal positional vertigo (BPPV) showing sequential translation of four types of nystagmus and discuss its pathophysiology. The case was 65-year-old female. We analyzed her nystagmus three-dimensionally. At the first visit, she showed vertical-torsio nystagmus of the posterior canal type of BPPV (P-BPPV) and subsequently showed recently reported geotropic nystagmus with a long time constant. Two weeks later, she showed apogeotropic nystagmus of the horizontal canal type of BPPV (AH-BPPV) and subsequently a geotropic nystagmus with a short time constant of the horizontal canal type of BPPV (GH-BPPV). Three kind of nystagmus, namely P-BPPV, AH-BPPV and GH-BPPV can be explained by the otoconial debris hypothesis of the same ear. Finally, the recently reported geotropic nystagmus with a long time constant may be explained by a reversible lesion such as the denatured cupula or utricular imbalance of the same ear.
BibTeX: @article{Imai2012, author = {Imai, Takao and Takeda, Noriaki and Uno, Atsuhiko and Horii, Arata and Kitahara, Tadashi and Nishiike, Suetaka and Higashi-Shingai, Kayoko and Inohara, Hidenori}, title = {Benign paroxysmal positional vertigo showing sequential translations of four types of nystagmus.}, journal = {Auris, nasus, larynx}, year = {2012}, volume = {39}, issue = {5}, pages = {544--548}, doi = {https://doi.org/10.1016/j.anl.2011.10.007}, keywords = {Aged; Benign Paroxysmal Positional Vertigo; Eye Movement Measurements; Female; Gravitation; Humans; Nystagmus, Pathologic, complications, physiopathology; Rotation; Semicircular Canals, physiopathology; Vertigo, complications, physiopathology}, pmid = {22088257} }
Soto-Varela, A., Rossi-Izquierdo, M. and Santos-Pérez, S.	Benign paroxysmal positional vertigo simultaneously affecting several canals: a 46-patient series. [Abstract] [BibTeX]	2013	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 270(3), pp. 817-822	article	DOI
Abstract: Although it is uncommon for benign paroxysmal positional vertigo (BPPV) to affect more than one canal simultaneously, it is not exceptional. We attempt to determine whether these patients present differences relative to "single-canal" cases. A prospective study was done in patients with BPPV, divided into three groups: single-canal BPPV, multi-canal BPPV in one ear and multi-canal BPPV in both ears. Diagnosis was by Dix and Hallpike, supine roll and cephalic hyperextension tests. Treatment was according to the affected canals, by Semont, Epley, Lempert and Yacovino manoeuvres. Aetiology, sex, age, response to treatment, recurrence and final status in each of the three groups was evaluated. Five hundred and eighty-three patients were diagnosed with BPPV: 537 single-canal (92 %) and 46 multi-canal (8 %); of the latter, 36 bilateral and 10 unilateral cases. Basic differences between groups were: greater percentage of idiopathic cases in single-canal (p < 0.0001, Chi-square), greater percentage of post-traumatic cases in bilateral multi-canals (p = 0.006, Chi-square) and prior history of BPPV was more common in unilateral multi-canal (p = 0.006, Chi-square). No differences between groups in response to treatment, recurrence and final status were detected. There are aetiological differences between patients with single-canal BPPV, unilateral multi-canal BPPV and bilateral multi-canal BPPV. Response to therapeutic manoeuvres, however, shows that over 90 % of the patients in all the groups are cured.
BibTeX: @article{Soto-Varela2013b, author = {Soto-Varela, Andrés and Rossi-Izquierdo, Marcos and Santos-Pérez, Sofía}, title = {Benign paroxysmal positional vertigo simultaneously affecting several canals: a 46-patient series.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2013}, volume = {270}, issue = {3}, pages = {817--822}, doi = {https://doi.org/10.1007/s00405-012-2043-2}, keywords = {Adult; Age Distribution; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Disease Progression; Female; Humans; Male; Middle Aged; Prospective Studies; Recurrence; Semicircular Canals, physiopathology; Severity of Illness Index; Sex Distribution; Treatment Outcome; Vertigo, epidemiology, etiology, physiopathology}, pmid = {22566181} }
Saker, M. and Ogle, O.	Benign paroxysmal positional vertigo subsequent to sinus lift via closed technique. [BibTeX]	2005	Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons Vol. 63(9), pp. 1385-1387	article	DOI
BibTeX: @article{Saker2005, author = {Saker, Manaf and Ogle, Orrett}, title = {Benign paroxysmal positional vertigo subsequent to sinus lift via closed technique.}, journal = {Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons}, year = {2005}, volume = {63}, issue = {9}, pages = {1385--1387}, doi = {https://doi.org/10.1016/j.joms.2005.05.296}, keywords = {Adult; Alveolar Ridge Augmentation, adverse effects; Dizziness, etiology; Female; Humans; Maxilla, surgery; Maxillary Sinus, surgery; Nausea, etiology; Osteotomy, adverse effects; Posture; Vertigo, etiology}, pmid = {16122608} }
Balatsouras, D.G.	Benign paroxysmal positional vertigo with multiple canal involvement. [Abstract] [BibTeX]	2012	American journal of otolaryngology Vol. 33(2), pp. 250-258	article	DOI
Abstract: The aims of this study were to describe the frequency and clinical features of benign paroxysmal positional vertigo (BPPV) with multiple canal involvement and to evaluate the results of treatment by appropriate canalith repositioning procedures. A total of 345 patients were referred for BPPV between 2006 and 2010. Thirty-two of them (9.3%) who had BPPV of multiple canals were studied. Thirteen were men (mean age, 60.4 years) and 19 were women (mean age, 56.8 years). Dix-Hallpike and supine roll tests were performed for diagnosis. Canalith repositioning procedures for treatment included modified Epley, barbecue, Gufoni, and anterior BPPV-specific maneuvers. Twenty-one patients had bilateral posterior canal BPPV, and 11 had mixed canal BPPV either on the same side (7 patients) or on both sides (4 patients). Thirty-one patients were cured with an average of 2.9 therapeutic sessions per patient. Recurrences occurred in 5 patients (15.6%). Benign paroxysmal positional vertigo of multiple canals is not rare and presents a clinical challenge. However, accurate diagnosis results in successful treatment comparable with BPPV of 1 canal.
BibTeX: @article{Balatsouras2012b, author = {Balatsouras, Dimitrios G}, title = {Benign paroxysmal positional vertigo with multiple canal involvement.}, journal = {American journal of otolaryngology}, year = {2012}, volume = {33}, issue = {2}, pages = {250--258}, doi = {https://doi.org/10.1016/j.amjoto.2011.07.007}, keywords = {Audiometry, Pure-Tone; Benign Paroxysmal Positional Vertigo; Electronystagmography; Evoked Potentials, Auditory, Brain Stem; Exercise Therapy, methods; Female; Follow-Up Studies; Greece, epidemiology; Humans; Immobilization, methods; Incidence; Male; Middle Aged; Patient Positioning, methods; Posture, physiology; Prognosis; Retrospective Studies; Semicircular Canals, physiopathology; Vertigo, diagnosis, epidemiology, therapy}, pmid = {21917354} }
Shim, D.B., Song, C.E., Jung, E.J., Ko, K.M., Park, J.W. and Song, M.H.	Benign paroxysmal positional vertigo with simultaneous involvement of multiple semicircular canals. [Abstract] [BibTeX]	2014	Korean journal of audiology Vol. 18(3), pp. 126-130	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) generally involves a single semicircular canal (single canal BPPV) but it has been reported that more than one semicircular canal on either the same or the opposite side can be involved in 6.8-20% of the cases (multiple canal BPPV). In this study, the clinical characteristics of multiple canal BPPV were analyzed and compared to those of single canal BPPV. Retrospective analysis was performed on 1054 consecutive patients diagnosed with BPPV. Multiple canal BPPV was diagnosed when the combination of typical nystagmus was provoked by the Dix-Hallpike and supine head roll tests. Canalith repositioning maneuver was performed sequentially starting with the semicircular canal causing more severe nystagmus or symptoms. Clinical characteristics and the treatment course were statistically compared between single canal BPPV and multiple canal BPPV. Among the 1054 patients, single canal BPPV was diagnosed in 1005 patients (95.4%) while multiple canal BPPV was diagnosed in 49 patients (4.6%). BPPV involving semicircular canals on the same side was more common (79.6%) than BPPV with bilateral involvement. The most common combination of the involved canals was ipsilateral posterior and horizontal semicircular canals (63.3%). Multiple canal BPPV was significantly more associated with underlying otologic diseases, especially labyrinthitis. Multiple canal BPPV required more treatment sessions and longer duration of treatment to achieve resolution of nystagmus and symptoms. As all cases of multiple canal BPPV were treated successfully although a longer duration of treatment and more treatment sessions were required compared to single canal BPPV, the results of our study could aid in making an accurate diagnosis and providing appropriate treatment of multiple canal BPPV.
BibTeX: @article{Shim2014a, author = {Shim, Dae Bo and Song, Chang Eun and Jung, Eun Jung and Ko, Kyung Min and Park, Jin Woo and Song, Mee Hyun}, title = {Benign paroxysmal positional vertigo with simultaneous involvement of multiple semicircular canals.}, journal = {Korean journal of audiology}, year = {2014}, volume = {18}, issue = {3}, pages = {126--130}, doi = {https://doi.org/10.7874/kja.2014.18.3.126}, keywords = {Benign paroxysmal positional vertigo; Labyrinthitis; Multiple; Semicircular canal}, pmid = {25558406} }
Alvarenga, G.A., Barbosa, M.A. and Porto, C.C.	Benign paroxysmal positional vertigo without nystagmus: diagnosis and treatment. [Abstract] [BibTeX]	2011	Brazilian journal of otorhinolaryngology Vol. 77(6), pp. 799-804	article
Abstract: Nystagmus tests to diagnose BPPV are still relevant in the clinical evaluation of BPPV. However, in everyday practice, there are cases of vertigo caused by head movements, which do not follow this sign in the Dix-Hallpike maneuver and the turn test. To characterize BPPV without nystagmus and treatment for it. A non-systematic review of diagnosis and treatment of benign paroxysmal positional vertigo (BPPV) without nystagmus in the PubMed, SciELO, Cochrane, BIREME, LILACS and MEDLINE databases in the years between 2001 and 2009. We found nine papers dealing with BPPV without nystagmus, whose diagnoses were based solely on clinical history and physical examination. The treatment of BPPV without nystagmus was made by Epley maneuvers, Sémont, modified releasing for posterior semicircular canal and Brandt-Daroff exercises. From 50% to 97.1% of the patients with BPPV without nystagmus had symptom remission, while patients with BPPV with nystagmus with symptom remission ranged from 76% to 100%. These differences may not be significant, which points to the need for more studies on BPPV without nystagmus.
BibTeX: @article{Alvarenga2011, author = {Alvarenga, Gabriella Assumpção and Barbosa, Maria Alves and Porto, Celmo Celeno}, title = {Benign paroxysmal positional vertigo without nystagmus: diagnosis and treatment.}, journal = {Brazilian journal of otorhinolaryngology}, year = {2011}, volume = {77}, issue = {6}, pages = {799--804}, keywords = {Humans; Vertigo, diagnosis, therapy}, pmid = {22183288} }
Hornibrook, J.	Benign paroxysmal positional vertigo without nystgamus. [BibTeX]	2012	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 146(6), pp. 1041; author reply 1041-1041; author reply 1042	article	DOI
BibTeX: @article{Hornibrook2012, author = {Hornibrook, Jeremy}, title = {Benign paroxysmal positional vertigo without nystgamus.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2012}, volume = {146}, issue = {6}, pages = {1041; author reply 1041--1041; author reply 1042}, doi = {https://doi.org/10.1177/0194599812445005}, keywords = {Female; Humans; Male; Nystagmus, Pathologic, epidemiology; Patient Positioning, methods; Vertigo, therapy}, pmid = {22648942} }
Mosca, F. and Morano, M.	Benign paroxysmal positional vertigo, incidence and treatment. [Abstract] [BibTeX]	2001	Annales d'oto-laryngologie et de chirurgie cervico faciale : bulletin de la Societe d'oto-laryngologie des hopitaux de Paris Vol. 118(2), pp. 95-101	article
Abstract: Benign paroxysmal positional vertigo is characterized by acute vertigo that is accentuated by movements of the head. It can be identified by the presence of nystagmus triggered by certain head positions. Over a 1-year period, among 1,902 cases of different types of equilibrium disorders, there were 98 cases of BPPV including 63 BPPV ofthe posterior canal, 21 of the lateral canal, 13 combined (HC + PC) and one case affecting the anterior canal. Most of the cases were idiopathic. Treatment was based on the Semont maneuver for BPPV-PC. BPPV-HC was treated with the Vannucchi maneuver and a personal method. The one case of BPPV-AC was treated with a modified Semont maneuver. Satisfactory therapeutic results were noted in all cases. Cases with a long-term follow-up showed a high percentage of elimination of relapse after 24 months.
BibTeX: @article{Mosca2001, author = {Mosca, F and Morano, M}, title = {Benign paroxysmal positional vertigo, incidence and treatment.}, journal = {Annales d'oto-laryngologie et de chirurgie cervico faciale : bulletin de la Societe d'oto-laryngologie des hopitaux de Paris}, year = {2001}, volume = {118}, issue = {2}, pages = {95--101}, keywords = {Adult; Aged; Aged, 80 and over; Female; Humans; Incidence; Male; Middle Aged; Posture; Vertigo, epidemiology, etiology, therapy}, pmid = {11319410} }
Prokopakis, E.P., Chimona, T., Tsagournisakis, M., Christodoulou, P., Hirsch, B.E., Lachanas, V.A., Helidonis, E.S., Plaitakis, A. and Velegrakis, G.A.	Benign paroxysmal positional vertigo: 10-year experience in treating 592 patients with canalith repositioning procedure. [Abstract] [BibTeX]	2005	The Laryngoscope Vol. 115(9), pp. 1667-1671	article	DOI
Abstract: To assess the long-term efficacy of canalith repositioning procedure (CRP) in the treatment of patients with benign paroxysmal positional vertigo (BPPV). Alternative theories for the pathophysiology of BPPV have been redefined in the past few years. CRP is considered to be the standard technique for its management. However, long-term follow-up results have been minimally reported in the literature. Five hundred ninety-two patients, 290 (49%) men and 302 (51%) women, were enrolled in this prospective study; their ages ranged from 18 to 84 (mean 59) years. At the time of their first examination, patients reported the duration of symptoms varied from 1 day to 18 months. Inclusion criteria were patient history compatible with BPPV and positive provocative maneuver (either Dix-Hallpike or Roll test). A variant of Epley and Barbeque maneuver was used. The Epley maneuver was used for posterior and anterior canal involvement, and "Barbeque roll" was used for horizontal canal involvement. Short-term follow-up was obtained 48 hours and 7 days after initial treatment, whereas long-term follow-up was obtained at repeated 6 month intervals. The posterior semicircular canal was involved in 521 (88%) patients treated, whereas the horizontal and anterior semicircular canals were involved in 59 (10%) and 12 (2%) patients, respectively. Symptoms subsided immediately in 497 (84%) patients. In 77 (13%) patients, the Dix-Hallpike maneuver remained positive after 48 hours, and CRP was performed again. Patients' mean follow-up was 46 months; 544 (92%) of 592 patients treated reported no symptoms of vertigo. Our data, based on long-term follow-up, suggest that CRP remains an efficient and long-lasting noninvasive treatment for BPPV.
BibTeX: @article{Prokopakis2005, author = {Prokopakis, Emmanuel P and Chimona, Theognosia and Tsagournisakis, Minas and Christodoulou, Panagiotis and Hirsch, Barry E and Lachanas, Vassilios A and Helidonis, Emmanuel S and Plaitakis, Andreas and Velegrakis, George A}, title = {Benign paroxysmal positional vertigo: 10-year experience in treating 592 patients with canalith repositioning procedure.}, journal = {The Laryngoscope}, year = {2005}, volume = {115}, issue = {9}, pages = {1667--1671}, doi = {https://doi.org/10.1097/01.mlg.0000175062.36144.b9}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Female; Follow-Up Studies; Humans; Male; Middle Aged; Posture; Semicircular Canals; Treatment Outcome; Vertigo, therapy}, pmid = {16148714} }
Oas, J.G.	Benign paroxysmal positional vertigo: a clinician's perspective. [Abstract] [BibTeX]	2001	Annals of the New York Academy of Sciences Vol. 942, pp. 201-209	article
Abstract: The pathogenesis and epidemiology of benign paroxysmal positional vertigo are still not well defined. Treatment protocols have emerged along with complementary hypotheses regarding pathogenesis. Ultrastructural studies suggest a multistep process of otoconia metabolism responsible for forming the otolith membrane. A defect in otoconia metabolism leads to an excess of otoconia within the utricular sac (utriculolithiasis). Gravitational forces cause the entrapment of otoconia within the semicircular canal system (canalolithiasis). Localization of these otoconia within the semicircular canal system is deducted by combining the gravitational orientation of the canal involved with the vestibular neurophysiology of the resulting nystagmus recorded during testing and throughout treatment. New terminology is required to differentiate short-arm from long-arm canalolithiasis. Evidence from digital videonystagmography recordings of nystagmus is coupled with principles of gravitational fluid mechanics to explain the mechanisms of disease development and treatment. These observations lead to important questions that define future directions in research.
BibTeX: @article{Oas2001, author = {Oas, J G}, title = {Benign paroxysmal positional vertigo: a clinician's perspective.}, journal = {Annals of the New York Academy of Sciences}, year = {2001}, volume = {942}, pages = {201--209}, keywords = {Humans; Vertigo}, pmid = {11710462} }
Salvinelli, F., Casale, M., Trivelli, M., D'Ascanio, L., Firrisi, L., Lamanna, F., Greco, F. and Costantino, S.	Benign paroxysmal positional vertigo: a comparative prospective study on the efficacy of Semont's maneuver and no treatment strategy. [Abstract] [BibTeX]	2003	La Clinica terapeutica Vol. 154(1), pp. 7-11	article
Abstract: The present study investigates the efficacy of Semont's repositioning liberatory maneuver by comparing it with no-treatment in a population of patients with benign paroxysmal positional vertigo (BPPV). In this randomised, controlled, 6-month efficacy trial, 40 patients affected by BPPV were treated with Semont's maneuver. Outcomes were measured subjectively by patients about their Activities of Daily Living (ADL) and quality of life, based on the "Vestibular Disorders Activities of Daily Living Scale". Results were compared to those obtained in 40 non-treated BPPV patients. During the first month of the study, 92.5% of patients of Semont's group resolved their symptoms. Cure rates with Semont's maneuver were significantly higher than those obtained with no-therapy (92.5% versus 37.5%). Within a six month follow-up, relapse rates were lower among patients treated with Semont's maneuver than among the no-treated ones (5% versus 60%). All patients with a resolution of symptoms and a negative Dix-Hallpike's test presented a great improvement in daily activities and quality of life. BPPV is easy to solve with a successful repositioning maneuver. Since BPPV is a very common cause of vertigo and can represent a medical emergency, we believe that it is of interest for every general practitioner to be able to promptly recognize this frequent balance disorder and to be able to treat a patient affected by BPPV with a safe repositioning maneuver.
BibTeX: @article{Salvinelli2003, author = {Salvinelli, F and Casale, M and Trivelli, M and D'Ascanio, L and Firrisi, L and Lamanna, F and Greco, F and Costantino, S}, title = {Benign paroxysmal positional vertigo: a comparative prospective study on the efficacy of Semont's maneuver and no treatment strategy.}, journal = {La Clinica terapeutica}, year = {2003}, volume = {154}, issue = {1}, pages = {7--11}, keywords = {Activities of Daily Living; Adult; Aged; Chi-Square Distribution; Female; Humans; Male; Middle Aged; Posture; Prospective Studies; Quality of Life; Surveys and Questionnaires; Time Factors; Vertigo, diagnosis, therapy}, pmid = {12854277} }
Pournaras, I., Kos, I. and Guyot, J.-P.	Benign paroxysmal positional vertigo: a series of eight singular neurectomies. [Abstract] [BibTeX]	2008	Acta oto-laryngologica Vol. 128(1), pp. 5-8	article	DOI
Abstract: The singular neurectomy as described by Gacek in 1974 is an efficient procedure to control symptoms in case of intractable benign paroxysmal positional vertigo (BPPV), with an acceptable risk of postoperative sensorineural hearing loss (SNHL). We postulate that this complication may not be a direct consequence of the surgical procedure but rather may be consecutive to the reactivation of the biological phenomenon that caused the BPPV. We also observed in one patient that BPPV may exist although no nystagmus can be elicited by provocative manoeuvres. To report our experience of the surgery, and to analyse the rate and causes of complications. The eight patients operated in the department between August 1997 and April 2006 were evaluated in June 2006. One had been operated because he had a typical history of BPPV, but no nystagmus could be elicited by the Hallpike's manoeuvre. All patients were free of vertigo and considered their quality of life improved. The Hallpike's manoeuvre was negative in all cases. A SNHL occurred in two patients, immediately after surgery in one and several months later in the second. The patient with a negative Hallpike's manoeuvre before surgery went back to work 3 weeks after surgery.
BibTeX: @article{Pournaras2008, author = {Pournaras, Irene and Kos, Izabel and Guyot, Jean-Philippe}, title = {Benign paroxysmal positional vertigo: a series of eight singular neurectomies.}, journal = {Acta oto-laryngologica}, year = {2008}, volume = {128}, issue = {1}, pages = {5--8}, doi = {https://doi.org/10.1080/00016480701275279}, keywords = {Adult; Female; Follow-Up Studies; Head Injuries, Closed, complications; Hearing Loss, Sensorineural, etiology; Humans; Male; Meniere Disease, diagnosis, etiology, surgery; Microsurgery; Middle Aged; Otoscopy; Postoperative Complications, etiology; Quality of Life; Reoperation; Risk Factors; Semicircular Ducts, innervation; Sensory Receptor Cells, surgery; Vertigo, diagnosis, etiology, surgery; Vestibular Function Tests; Vestibular Neuronitis, diagnosis, etiology, surgery}, pmid = {17851926} }
Cavaliere, M., Mottola, G. and Iemma, M.	Benign paroxysmal positional vertigo: a study of two manoeuvres with and without betahistine. [Abstract] [BibTeX]	2005	Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale Vol. 25(2), pp. 107-112	article
Abstract: Efficacy of the liberatory manoeuvre and of gradual otolitis dispersion technique, with or without associated drug therapy, have been compared. Included in this prospective study were 103 patients with benign paroxysmal positional vertigo seen in the Outpatient Department. Patients were classified into 4 groups according to treatment: Liberatory Manoeuvre according to methods described by Semont et al., with and without betahistine, Gradual Otolitis Dispersion Technique according to Brandt and Daroff, with and without betahistine. Evaluation was performed at baseline and at 3, 7, 14, 30, 60 and 90 days after start of treatment. Response to treatment was evaluated using criteria of Epley. At day 14, liberatory manoeuvre-betahistine and Brandt and Daroff-betahistine groups did significantly better than liberatory manoeuvre and Brandt and Daroff groups (p < 0.05). Improvement reached at day 30 was: 100% in liberatory manoeuvre-betahistine group; 96.30% (p > 0.05) in Brandt and Daroff-betahistine group; these results were significantly better (p < 0.05) than those of liberatory manoeuvre (54.17%) and Brandt and Daroff (25%) groups. As far as concerns differences between disease onset and start of therapy (less and more than 2 weeks), and age (< or =60 years and > or =60 years), response to treatment was similar. In conclusion, both liberatory manoeuvre and Brandt and Daroff, when associated with betahistine, were significantly more effective than manoeuvres alone (p < 0.05). Improvement in liberatory manoeuvre-betahistine group, in the initial phase, was greater that in Brandt and Daroff-betahistine group, albeit, differences were not significant (p > 0.05). Age-related effects of manoeuvres were compared in 71 patients < 60 years and 32 patients > or =60 years, showing a similar improvement rate at the end of the investigation in both groups. In our opinion, liberatory manoeuvre and Brandt and Daroff associated with betahistamine produces faster recovery compared to liberatory manoeuvre and Brandt and Daroff alone. Nevertheless, 3 months after onset of treatment, all patients showed complete recovery due to spontaneous evolution of paroxysmal positional vertigo, in other words, treatment does not appear to influence the final improvement rate and its role should be accepted as a significant reduction in persistence of symptoms.
BibTeX: @article{Cavaliere2005, author = {Cavaliere, M and Mottola, G and Iemma, M}, title = {Benign paroxysmal positional vertigo: a study of two manoeuvres with and without betahistine.}, journal = {Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale}, year = {2005}, volume = {25}, issue = {2}, pages = {107--112}, keywords = {Adult; Age Factors; Aged; Betahistine, therapeutic use; Female; Humans; Male; Middle Aged; Posture; Prospective Studies; Severity of Illness Index; Vasodilator Agents, therapeutic use; Vertigo, diagnosis, drug therapy, therapy}, pmid = {16116833} }
Boniver, R.	Benign paroxysmal positional vertigo: an overview. [Abstract] [BibTeX]	2008	The international tinnitus journal Vol. 14(2), pp. 159-167	article
Abstract: This study consists of a general review of benign paroxysmal positional vertigo and nystagmus. The main etiopathogenesis, diagnosis, and treatments are evoked. The author describes his experience on the subject.
BibTeX: @article{Boniver2008, author = {Boniver, Raymond}, title = {Benign paroxysmal positional vertigo: an overview.}, journal = {The international tinnitus journal}, year = {2008}, volume = {14}, issue = {2}, pages = {159--167}, keywords = {Electronystagmography; Humans; Neural Inhibition, physiology; Nystagmus, Pathologic, diagnosis, etiology, physiopathology, therapy; Nystagmus, Physiologic, physiology; Otolithic Membrane, physiopathology; Prognosis; Semicircular Canals, physiopathology; Vertigo, diagnosis, etiology, physiopathology, therapy; Vestibular Function Tests; Vestibular Nerve, physiopathology}, pmid = {19205169} }
D'Ascanio, L., Salvinelli, F. and Martinelli, M.	Benign paroxysmal positional vertigo: an unusual complication of molar teeth extraction. [BibTeX]	2007	The British journal of oral & maxillofacial surgery Vol. 45(2), pp. 176-177	article	DOI
BibTeX: @article{DAscanio2007, author = {D'Ascanio, Luca and Salvinelli, Fabrizio and Martinelli, Marzia}, title = {Benign paroxysmal positional vertigo: an unusual complication of molar teeth extraction.}, journal = {The British journal of oral & maxillofacial surgery}, year = {2007}, volume = {45}, issue = {2}, pages = {176--177}, doi = {https://doi.org/10.1016/j.bjoms.2006.03.003}, keywords = {Adult; Female; Head Movements, physiology; Humans; Molar, Third, surgery; Otolithic Membrane, physiopathology; Posture; Tooth Extraction, adverse effects; Vertigo, etiology}, pmid = {16621204} }
Persichetti, P., Di Lella, F., Simone, P., Marangi, G.F., Cagli, B., Tenna, S. and Trivelli, M.	Benign paroxysmal positional vertigo: an unusual complication of rhinoplasty. [BibTeX]	2004	Plastic and reconstructive surgery Vol. 114(1), pp. 277-278	article
BibTeX: @article{Persichetti2004, author = {Persichetti, Paolo and Di Lella, Filippo and Simone, Pierfranco and Marangi, Giovanni Francesco and Cagli, Barbara and Tenna, Stefania and Trivelli, Maurizio}, title = {Benign paroxysmal positional vertigo: an unusual complication of rhinoplasty.}, journal = {Plastic and reconstructive surgery}, year = {2004}, volume = {114}, issue = {1}, pages = {277--278}, keywords = {Adult; Female; Head; Humans; Movement; Otolithic Membrane; Postoperative Complications; Rhinoplasty; Vertigo, etiology}, pmid = {15220629} }
Weider, D.J., Ryder, C.J. and Stram, J.R.	Benign paroxysmal positional vertigo: analysis of 44 cases treated by the canalith repositioning procedure of Epley. [Abstract] [BibTeX]	1994	The American journal of otology Vol. 15(3), pp. 321-326	article
Abstract: Between September 1987 and February 1993, the authors treated 44 consecutive cases of benign paroxysmal positional vertigo with the canalith repositioning procedure of Epley. The authors report a success rate of 87.7 percent using this treatment technique. Clinical observations and case reports are presented.
BibTeX: @article{Weider1994, author = {Weider, D J and Ryder, C J and Stram, J R}, title = {Benign paroxysmal positional vertigo: analysis of 44 cases treated by the canalith repositioning procedure of Epley.}, journal = {The American journal of otology}, year = {1994}, volume = {15}, issue = {3}, pages = {321--326}, keywords = {Adult; Aged; Female; Functional Laterality; Humans; Male; Mastoid; Middle Aged; Nystagmus, Pathologic; Posture; Vertigo, therapy}, pmid = {8579135} }
von Brevern, M., Neuhauser, H. and Lempert, T.	Benign paroxysmal positional vertigo: are roller coasters really beneficial? [BibTeX]	2003	Lancet (London, England) Vol. 361(9358), pp. 701-702	article	DOI
BibTeX: @article{Brevern2003, author = {von Brevern, Michael and Neuhauser, Hannelore and Lempert, Thomas}, title = {Benign paroxysmal positional vertigo: are roller coasters really beneficial?}, journal = {Lancet (London, England)}, year = {2003}, volume = {361}, issue = {9358}, pages = {701--702}, doi = {https://doi.org/10.1016/S0140-6736(03)12581-0}, keywords = {Adult; Female; Humans; Male; Middle Aged; Movement Disorders; Semicircular Canals, physiopathology; Vertigo, etiology}, pmid = {12606196} }
Lawson, J., Johnson, I., Bamiou, D.E. and Newton, J.L.	Benign paroxysmal positional vertigo: clinical characteristics of dizzy patients referred to a Falls and Syncope Unit. [Abstract] [BibTeX]	2005	QJM : monthly journal of the Association of Physicians Vol. 98(5), pp. 357-364	article	DOI
Abstract: Dizziness is a common symptom in older people that affects quality of life and increases the risk of falls. Benign paroxysmal positional vertigo (BPPV) is a common cause of dizziness that increases in prevalence with age, and is potentially curable. To compare patients with BPPV referred initially to a Falls and Syncope Unit (FSS group) with those initially referred to a Regional ENT/Balance Service (ENT group). Retrospective case-note review. Medical notes, investigations and outcomes were reviewed for all patients. Of 59 patients with BPPV confirmed by Dix-Hallpike test, 31 (53%) were initially referred to the FSS (2.6 patients per month, 71% females) and 28 (47%) were initially referred to ENT (4.7 patients per month, 86% females). Compared to those referred initially to ENT, FSS patients were significantly older (mean +/- SD 69 +/- 13 vs. 55.4 +/- 13 years, p = 0.0003) and had dizzy symptoms for longer before diagnosis (median (range) 12 (4-120) vs. 6 (1-36) months, p = 0.0273). FSS patients were more likely to have more than one type of dizziness (16% vs. 0%, p = 0.001), more likely to have cerebrovascular or cardiovascular co-morbidity (13% vs. 4%, p = 0.0152) and were taking significantly more medications (3.2 vs. 1.7; p = 0.0271). Cure rates on intervention were similar (83% FSS, 86% ENT). BPPV is a potentially curable cause for dizziness in older people. Older people are frequently referred directly to Falls units, who will be seeing increasing numbers of patients with dizziness. A high index of suspicion allows early identification and treatment of this condition.
BibTeX: @article{Lawson2005, author = {Lawson, J and Johnson, I and Bamiou, D E and Newton, J L}, title = {Benign paroxysmal positional vertigo: clinical characteristics of dizzy patients referred to a Falls and Syncope Unit.}, journal = {QJM : monthly journal of the Association of Physicians}, year = {2005}, volume = {98}, issue = {5}, pages = {357--364}, doi = {https://doi.org/10.1093/qjmed/hci057}, keywords = {Accidental Falls; Adult; Age Distribution; Aged; Aged, 80 and over; Dizziness, diagnosis, etiology; Female; Hospital Units, statistics & numerical data; Humans; Male; Middle Aged; Referral and Consultation, statistics & numerical data; Retrospective Studies; Vertigo, complications, diagnosis}, pmid = {15820968} }
Silva, A.L.D.S., Marinho, M.R.C., Gouveia, F.M.d.V., Silva, J.G., Ferreira, A.d.S. and Cal, R.	Benign Paroxysmal Positional Vertigo: comparison of two recent international guidelines. [Abstract] [BibTeX]	2011	Brazilian journal of otorhinolaryngology Vol. 77(2), pp. 191-200	article
Abstract: Benign Paroxysmal Positional Vertigo (BPPV) is characterized by vertigo, lasting for a few seconds and usually managed by head positioning maneuvers. To educate clinicians concerning the state-of-the art knowledge about its management, the international societies developed guidelines. the aim of this paper is to discuss, in a practical fashion, the current options available to manage BPPV. non-systematic review. This study reviews two recent guidelines regarding the evaluation and treatment of BPPV. The first one was published by the American Academy of Otolaryngology Head and Neck surgery (AAO-HNS) and the other by the American Academy of Neurology (AAN). The similarities were presented in different tables. Those guidelines presented differences regarding methods. Only the AAO-HNS guidelines recommend the Dix-Hallpike test for the diagnosis of BPPV. Only canalith repositioning maneuver, Semont maneuver and vestibular rehabilitation had showed some benefit and were recommended as good treatment options. Both guidelines fulfilled all the aspects required for clinicians to diagnosed and manage BPPV; only the AAO-HNS's guidelines were more comprehensive and of better quality.
BibTeX: @article{Silva2011, author = {Silva, André Luís Dos Santos and Marinho, Marina Reis Campos and Gouveia, Fabiana Maria de Vasconcelos and Silva, Julio Guilherme and Ferreira, Arthur de Sá and Cal, Renato}, title = {Benign Paroxysmal Positional Vertigo: comparison of two recent international guidelines.}, journal = {Brazilian journal of otorhinolaryngology}, year = {2011}, volume = {77}, issue = {2}, pages = {191--200}, keywords = {Benign Paroxysmal Positional Vertigo; Humans; Practice Guidelines as Topic; Vertigo, diagnosis, therapy}, pmid = {21537621} }
Tomaz, A., Ganança, M.M., Ganança, C.F., Ganança, F.F., Caovilla, H.H. and Harker, L.	Benign paroxysmal positional vertigo: concomitant involvement of different semicircular canals. [Abstract] [BibTeX]	2009	The Annals of otology, rhinology, and laryngology Vol. 118(2), pp. 113-117	article	DOI
Abstract: We evaluated the simultaneous ipsilateral or contralateral involvement of the posterior and lateral, anterior and lateral, or posterior and anterior semicircular canals in patients with benign paroxysmal positional vertigo (BPPV). The files of 2345 patients with BPPV were analyzed. Single-canal BPPV occurred in 2310 cases (98.5%)--unilaterally in 2058 (89.1%) and bilaterally in 252 (10.9%). Multiple-canal BPPV occurred in 35 cases (1.5%). Of these 35 cases, there was simultaneous involvement of the posterior and lateral canals on the same side (23) or on opposite sides (9) in 32 cases (91.4%). Simultaneous involvement of the anterior canal on one side and the posterior canal on the opposite side occurred in 2 cases (5.7%), and that of the anterior canal on one side and the lateral canal on the opposite side occurred in 1 case (2.9%). All cases represented canalithiasis. Multiple-canal BPPV was rare, and usually involved canals on the same side; simultaneous involvement of the posterior and lateral canals was much more common than involvement of the anterior and posterior canals or the anterior and lateral canals. Trauma increased the risk for multiple-canal BPPV, but not the risk for bilateral single-canal BPPV. Cupulolithiasis was not a factor in multiple-canal BPPV.
BibTeX: @article{Tomaz2009, author = {Tomaz, Andreza and Ganança, Maurício Malavasi and Ganança, Cristina Freitas and Ganança, Fernando Freitas and Caovilla, Heloisa Helena and Harker, Lee}, title = {Benign paroxysmal positional vertigo: concomitant involvement of different semicircular canals.}, journal = {The Annals of otology, rhinology, and laryngology}, year = {2009}, volume = {118}, issue = {2}, pages = {113--117}, doi = {https://doi.org/10.1177/000348940911800206}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Audiometry, Pure-Tone; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Male; Middle Aged; Posture, physiology; Retrospective Studies; Semicircular Canals, physiopathology; Tilt-Table Test; Vertigo, diagnosis, physiopathology; Young Adult}, pmid = {19326761} }
von Brevern, M., Lezius, F., Tiel-Wilck, K., Radtke, A. and Lempert, T.	Benign paroxysmal positional vertigo: current status of medical management. [BibTeX]	2004	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 130(3), pp. 381-382	article	DOI
BibTeX: @article{Brevern2004b, author = {von Brevern, Michael and Lezius, Franziska and Tiel-Wilck, Klaus and Radtke, Andrea and Lempert, Thomas}, title = {Benign paroxysmal positional vertigo: current status of medical management.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2004}, volume = {130}, issue = {3}, pages = {381--382}, doi = {https://doi.org/10.1016/j.otohns.2003.07.007}, keywords = {Adult; Aged; Humans; Middle Aged; Recurrence; Retrospective Studies; Vertigo, diagnosis, therapy; Vestibular Function Tests, methods}, pmid = {15054387} }
Koelliker, P., Summers, R.L. and Hawkins, B.	Benign paroxysmal positional vertigo: diagnosis and treatment in the emergency department--a review of the literature and discussion of canalith-repositioning maneuvers. [Abstract] [BibTeX]	2001	Annals of emergency medicine Vol. 37(4), pp. 392-398	article	DOI
Abstract: Dizziness is a frequent presenting complaint in emergency department patients. Although seen in patients of all ages, it is more prevalent in patients older than 50 years of age. Vertigo represents a subset of dizziness and is defined as an illusion of movement, usually rotational, of the patient or the patient's surroundings. The illusion of motion may be of oneself (subjective vertigo) or of external objects (objective vertigo). The emergency physician should consider a large differential in the evaluation of vertigo with special attention to whether the vertigo is central or peripheral in origin.
BibTeX: @article{Koelliker2001, author = {Koelliker, P and Summers, R L and Hawkins, B}, title = {Benign paroxysmal positional vertigo: diagnosis and treatment in the emergency department--a review of the literature and discussion of canalith-repositioning maneuvers.}, journal = {Annals of emergency medicine}, year = {2001}, volume = {37}, issue = {4}, pages = {392--398}, doi = {https://doi.org/10.1067/mem.2001.112250}, keywords = {Emergency Service, Hospital; Humans; Posture; Vertigo, diagnosis, physiopathology, therapy}, pmid = {11275832} }
Bittar, R.S.M., Mezzalira, R.M., Furtado, P.L., Venosa, A.R., Sampaio, A.L.L. and Pires de Oliveira, C.A.C.	Benign paroxysmal positional vertigo: diagnosis and treatment. [Abstract] [BibTeX]	2011	The international tinnitus journal Vol. 16(2), pp. 135-145	article
Abstract: Benign paroxysmal positional vertigo is a common disorder in Neurotology. This vestibular syndrome is characterized by transient attacks of vertigo, caused by change in head position, and associated with paroxysmal characteristic nystagmus. The symptoms result from movement of the free floating otoconia particles in the endolymph or their attachment to the cupulae of the semicircular canal. The diagnosis is essentially clinical and should be confirmed by performing diagnostic maneuvers. Treatment is based on the identification of the affected semicircular canal and performance of liberatory maneuvers or repositioning of free floating particles of otoliths. The effectiveness varies from 70 to 100%.
BibTeX: @article{Bittar2011, author = {Bittar, Roseli Saraiva Moreira and Mezzalira, Raquel Mezzalira and Furtado, Paula Lobo and Venosa, Alessandra Ramos and Sampaio, Andre Luis Lopes and Pires de Oliveira, Carlos Augusto Costa}, title = {Benign paroxysmal positional vertigo: diagnosis and treatment.}, journal = {The international tinnitus journal}, year = {2011}, volume = {16}, issue = {2}, pages = {135--145}, keywords = {Benign Paroxysmal Positional Vertigo; Diagnosis, Differential; Dizziness, diagnosis, physiopathology, therapy; Humans; Otolithic Membrane, physiopathology; Physical Therapy Modalities; Posture, physiology; Semicircular Canals, physiopathology; Supine Position, physiology; Vertigo, diagnosis, physiopathology, therapy; Vestibular Function Tests, methods}, pmid = {22249873} }
Salvinelli, F., Firrisi, L., Casale, M., Trivelli, M., D'Ascanio, L., Lamanna, F., Greco, F. and Costantino, S.	Benign paroxysmal positional vertigo: diagnosis and treatment. [Abstract] [BibTeX]	2004	La Clinica terapeutica Vol. 155(9), pp. 395-400	article
Abstract: Benign paroxysmal positional vertigo (BPPV) has been recognized as the most common vestibular disorder; it is a term coined in 1952 by Dix and Hallpike, and it is most commonly used to describe a disease with a characteristic clinical presentation believed to be caused by free-floating particles leaving the macula and entering one of the semicircular canals, usually the posterior one, more rarely the horizontal or superior ones. A lot of studies showed as the prevalence is higher in females than in males with a ratio of 2:1; furthermore, prevalence increases with the age: the mean age at onset is 54 years, with a range of 11 to 84 years. The most important clinical manifestations of BPPV are: vertigo, lightheadedness, dysequilibrium and sometimes nausea, vomiting, pallor and sweating. The diagnosis of BPPV is very simple through the Dix-Hallpike test or the diagnostic Semont's maneuver; the increasing information about the BPPV's pathogenesis has led most authors to consider the rehabilitative therapy, and in particular the so-called Semont's "liberatory" maneuver, as the first choice treatment of BPPV, in relation to its quickness and efficacy. In this treatment the debris are moved from the posterior semicircular canal to another location within the vestibular labyrinth. In our review we consider the possible pathogenesis of this disease and the best therapies, like repositioning maneuvers, in a patient affected by BPPV.
BibTeX: @article{Salvinelli2004, author = {Salvinelli, F and Firrisi, L and Casale, M and Trivelli, M and D'Ascanio, L and Lamanna, F and Greco, F and Costantino, S}, title = {Benign paroxysmal positional vertigo: diagnosis and treatment.}, journal = {La Clinica terapeutica}, year = {2004}, volume = {155}, issue = {9}, pages = {395--400}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Child; Combined Modality Therapy; Denervation; Diagnosis, Differential; Female; Humans; Hypnotics and Sedatives, therapeutic use; Incidence; Male; Middle Aged; Nystagmus, Pathologic, etiology; Otolithic Membrane, physiopathology; Physical Examination; Physical Therapy Modalities; Vertigo, diagnosis, epidemiology, physiopathology, rehabilitation, therapy; Vestibular Nerve, surgery; Vestibule, Labyrinth, physiopathology}, pmid = {15700633} }
von Brevern, M., Bertholon, P., Brandt, T., Fife, T., Imai, T., Nuti, D. and Newman-Toker, D.	Benign paroxysmal positional vertigo: Diagnostic criteria Consensus document of the Committee for the Classification of Vestibular Disorders of the Bárány Society. [Abstract] [BibTeX]	2017	Acta otorrinolaringologica espanola Vol. 68(6), pp. 349-360	article	DOI
Abstract: This article presents operational diagnostic criteria for benign paroxysmal positional vertigo (BPPV), formulated by the Committee for Classification of Vestibular Disorders of the Bárány Society. The classification reflects current knowledge of clinical aspects and pathomechanisms of BPPV and includes both established and emerging syndromes of BPPV. It is anticipated that growing understanding of the disease will lead to further development of this classification.
BibTeX: @article{Brevern2017, author = {von Brevern, Michael and Bertholon, Pierre and Brandt, Thomas and Fife, Terry and Imai, Takao and Nuti, Daniele and Newman-Toker, David}, title = {Benign paroxysmal positional vertigo: Diagnostic criteria Consensus document of the Committee for the Classification of Vestibular Disorders of the Bárány Society.}, journal = {Acta otorrinolaringologica espanola}, year = {2017}, volume = {68}, issue = {6}, pages = {349--360}, doi = {https://doi.org/10.1016/j.otorri.2017.02.007}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis, epidemiology, physiopathology; Diagnosis, Differential; Head Movements; Humans; Migraine Disorders, diagnosis; Nystagmus, Physiologic; Physical Examination, methods; Posture; Semicircular Canals, physiopathology; Vertigo, diagnosis; Vestibular Diseases, classification; Criteria; Criterios; Diagnóstico; Nistagmo; Nystagmus, Diagnosis; Posicional; Positional; Vertigo; Vértigo}, pmid = {29056234} }
von Brevern, M., Bertholon, P., Brandt, T., Fife, T., Imai, T., Nuti, D. and Newman-Toker, D.	Benign paroxysmal positional vertigo: Diagnostic criteria. [Abstract] [BibTeX]	2015	Journal of vestibular research : equilibrium & orientation Vol. 25(3-4), pp. 105-117	article	DOI
Abstract: This article presents operational diagnostic criteria for benign paroxysmal positional vertigo (BPPV), formulated by the Committee for Classification of Vestibular Disorders of the Bárány Society. The classification reflects current knowledge of clinical aspects and pathomechanisms of BPPV and includes both established and emerging syndromes of BPPV. It is anticipated that growing understanding of the disease will lead to further development of this classification.
BibTeX: @article{Brevern2015, author = {von Brevern, Michael and Bertholon, Pierre and Brandt, Thomas and Fife, Terry and Imai, Takao and Nuti, Daniele and Newman-Toker, David}, title = {Benign paroxysmal positional vertigo: Diagnostic criteria.}, journal = {Journal of vestibular research : equilibrium & orientation}, year = {2015}, volume = {25}, issue = {3-4}, pages = {105--117}, doi = {https://doi.org/10.3233/VES-150553}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis, surgery; Diagnosis, Differential; Humans; Otologic Surgical Procedures; Vestibular Diseases, classification, diagnosis; Vertigo; criteria; diagnosis; nystagmus; positional}, pmid = {26756126} }
White, J.	Benign paroxysmal positional vertigo: how to diagnose and quickly treat it. [Abstract] [BibTeX]	2004	Cleveland Clinic journal of medicine Vol. 71(9), pp. 722-728	article
Abstract: Benign paroxysmal positional vertigo, the most common cause of vertigo, can be diagnosed and treated with a simple maneuver that can quickly be performed in the primary care physician's office. How to diagnose and manage other causes of dizziness, including Meniere disease, acute vestibular syndrome, migraine-associated vertigo, and motion sickness, is also covered in this article.
BibTeX: @article{White2004, author = {White, Judith}, title = {Benign paroxysmal positional vertigo: how to diagnose and quickly treat it.}, journal = {Cleveland Clinic journal of medicine}, year = {2004}, volume = {71}, issue = {9}, pages = {722--728}, keywords = {Humans; Meniere Disease, therapy; Motion Sickness, physiopathology; Nystagmus, Physiologic; Physical Examination; Risk Factors; Vertigo, diagnosis, physiopathology, therapy}, pmid = {15478703} }
Longo, G., Onofri, M., Pellicciari, T. and Quaranta, N.	Benign paroxysmal positional vertigo: is vestibular evoked myogenic potential testing useful? [Abstract] [BibTeX]	2012	Acta oto-laryngologica Vol. 132(1), pp. 39-43	article	DOI
Abstract: In benign paroxysmal positional vertigo (BPPV), vestibular evoked myogenic potentials (VEMPs) help to better define the extent of saccular damage and the patient's prognosis. To report the results of VEMPs in patients affected by BPPV of the posterior semicircular canal (PSC) in order to evaluate the presence of signs of saccular dysfunction compared to the normal population and to correlate them with the clinical picture. This was a prospective study in a tertiary referral center; 23 patients affected by BPPV of the PSC and 24 controls were evaluated. All patients underwent complete clinical history and otoneurologic and audiovestibular evaluation consisting of pure-tone audiometry, caloric testing, and registration of VEMPs. VEMP thresholds and latencies were not different between patients and controls. As a group BPPV patients presented significantly higher abnormal VEMPs compared with controls (p < 0.001). Age positively correlated with VEMP threshold in the affected ear of patients and in controls; the number of BPPV attacks positively correlated with threshold and negatively with amplitude of VEMPs in the affected ear; duration of the last attack was negatively correlated with the effect of the maneuver performed.
BibTeX: @article{Longo2012, author = {Longo, Giovanni and Onofri, Marina and Pellicciari, Teresa and Quaranta, Nicola}, title = {Benign paroxysmal positional vertigo: is vestibular evoked myogenic potential testing useful?}, journal = {Acta oto-laryngologica}, year = {2012}, volume = {132}, issue = {1}, pages = {39--43}, doi = {https://doi.org/10.3109/00016489.2011.619570}, keywords = {Adult; Aged; Audiometry, Pure-Tone; Benign Paroxysmal Positional Vertigo; Female; Follow-Up Studies; Humans; Male; Middle Aged; Prospective Studies; Reproducibility of Results; Semicircular Canals, physiopathology; Severity of Illness Index; Vertigo, diagnosis, physiopathology; Vestibular Evoked Myogenic Potentials, physiology; Vestibular Function Tests, methods; Young Adult}, pmid = {22103311} }
Jumani, K. and Powell, J.	Benign Paroxysmal Positional Vertigo: Management and Its Impact on Falls. [Abstract] [BibTeX]	2017	The Annals of otology, rhinology, and laryngology Vol. 126(8), pp. 602-605	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most common cause of dizziness in the elderly. This has been identified as a risk factor in falls. Falls are the leading cause of disability and the leading cause of death from injury among people over 75 in the UK. We assessed the effect of BPPV treatment on falls in an elderly population by retrospectively reviewing one unit's experience of BPPV management over an 8-year period from June 2008 to June 2016. We specifically assessed patients who were referred for the primary reason of falls and were aged over 65 years. These patients were evaluated and treated with particle repositioning maneuvers if their positional tests were positive. The frequency of falls prior to their visit and at 6-month clinic follow-up were reviewed. The total number of falls in the cohort reduced significantly ( P < .0001) after the procedure, from 128 to 46 falls (64% reduction). Associated comorbidities were also evaluated in this group. A prompt and effective treatment of BPPV is prudent to prevent devastating falls in older people in our communities.
BibTeX: @article{Jumani2017, author = {Jumani, Kiran and Powell, Jason}, title = {Benign Paroxysmal Positional Vertigo: Management and Its Impact on Falls.}, journal = {The Annals of otology, rhinology, and laryngology}, year = {2017}, volume = {126}, issue = {8}, pages = {602--605}, doi = {https://doi.org/10.1177/0003489417718847}, keywords = {Accidental Falls, prevention & control; Adolescent; Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, therapy; Cohort Studies; Disease Management; Female; Humans; Male; Middle Aged; Otolithic Membrane; Patient Positioning, methods; Retrospective Studies; United Kingdom; Young Adult; benign paroxysmal positional vertigo; elderly; inner ear disorders; miscellaneous; otolaryngology; otology; risk of falls; vertigo; vestibular rehabilitation}, pmid = {28718303} }
Kerber, K.A. and Helmchen, C.	Benign paroxysmal positional vertigo: new opportunities but still old challenges. [BibTeX]	2012	Neurology Vol. 78(3), pp. 154-156	article	DOI
BibTeX: @article{Kerber2012a, author = {Kerber, Kevin A and Helmchen, Christoph}, title = {Benign paroxysmal positional vertigo: new opportunities but still old challenges.}, journal = {Neurology}, year = {2012}, volume = {78}, issue = {3}, pages = {154--156}, doi = {https://doi.org/10.1212/WNL.0b013e318241f2a2}, keywords = {Anxiety Disorders, epidemiology; Epilepsy, Temporal Lobe, epidemiology; Female; Humans; Male; Mood Disorders, epidemiology; Substance-Related Disorders, epidemiology}, pmid = {22170880} }
Kerber, K.A.	Benign paroxysmal positional vertigo: opportunities squandered. [Abstract] [BibTeX]	2015	Annals of the New York Academy of Sciences Vol. 1343, pp. 106-112	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) presentations are unique opportunities to simultaneously improve the effectiveness and efficiency of care. The test and treatment for BPPV--the Dix-Hallpike test (DHT) and the canalith repositioning maneuver (CRM), respectively--are supported by two evidence-based guidelines (American Academy of Otolaryngology--Head and Neck Surgery and American Academy of Neurology). With these processes, patients can be readily identified and treated at the bedside, quickly and without expensive tests. Patients randomized to the CRM have a cure rate of 80% at 24 h, compared to only 10% of controls. Despite this large effect size, less than 10% of affected patients receive the treatment, which shows that the management of BPPV in routine care is suboptimal. Future research is necessary to disseminate and implement the DHT and the CRM into routine practice.
BibTeX: @article{Kerber2015a, author = {Kerber, Kevin A}, title = {Benign paroxysmal positional vertigo: opportunities squandered.}, journal = {Annals of the New York Academy of Sciences}, year = {2015}, volume = {1343}, pages = {106--112}, doi = {https://doi.org/10.1111/nyas.12721}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis, therapy; Humans; Posture; Dix-Hallpike test; benign paroxysmal positional vertigo; canalith repositioning maneuver; dizziness; vertigo}, pmid = {25758295} }
Patangay, K.K. and Ansari, R.	Benign Paroxysmal Positional Vertigo: Our Experience. [Abstract] [BibTeX]	2016	Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India Vol. 68(1), pp. 39-41	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is probably common cause of vertigo. A total of 205 cases reported to ENT OPD for vertigo. Of these 43 patients were found to suffer from BPPV and in our experience BPPV is common condition. BPPV was more common in age group of 4th and 7th decades. The youngest patient reported was 41 years and the oldest patient was 78 years with a mean of 56.5. In this group there were 16 females and 27 males. This is a retrospective case study of 205 cases presenting with vertigo. The modality of treatment was Epley's manoeuvre in cases diagnosed with BPPV. The age of patients ranged from 41 to 78 years with mean of 56.5. The over all success rate was 96 %. All cases were instructed to report recurrence and were followed for 1 year.
BibTeX: @article{Patangay2016, author = {Patangay, K K and Ansari, Rahbar}, title = {Benign Paroxysmal Positional Vertigo: Our Experience.}, journal = {Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India}, year = {2016}, volume = {68}, issue = {1}, pages = {39--41}, doi = {https://doi.org/10.1007/s12070-014-0818-z}, keywords = {Benign paroxysmal positional vertigo; CSOM; Dix-Hallpike manoeuvre; Epley’s manoeuvre; Singular neurctomy; Vestibular neurectomy}, pmid = {27066408} }
Bronstein, A.M.	Benign paroxysmal positional vertigo: some recent advances. [BibTeX]	2003	Current opinion in neurology Vol. 16(1), pp. 1-3	article	DOI
BibTeX: @article{Bronstein2003a, author = {Bronstein, Adolfo M}, title = {Benign paroxysmal positional vertigo: some recent advances.}, journal = {Current opinion in neurology}, year = {2003}, volume = {16}, issue = {1}, pages = {1--3}, doi = {https://doi.org/10.1097/01.wco.0000053581.70044.39}, keywords = {Diagnosis, Differential; Electronystagmography; Head Movements, physiology; Otolithic Membrane, physiopathology; Saccule and Utricle, physiopathology; Semicircular Canals, physiopathology; Vertigo, etiology, physiopathology, therapy}, pmid = {12544851} }
Bernard, M.E., Bachenberg, T.C. and Brey, R.H.	Benign paroxysmal positional vertigo: the canalith repositioning procedure. [Abstract] [BibTeX]	1996	American family physician Vol. 53(8), pp. 2613-6, 2621	article
Abstract: As much as 20 percent of patients presenting with dizziness may have benign paroxysmal positional vertigo. This condition, which may be caused by otoliths lodged in the semicircular canals of the ear, tends to be persistent or recurrent. Traditionally, it has been treated symptomatically with medication. The canalith repositioning procedure, a series of defined head positions, is designed to shift the location of the otoliths to afford relief from the nausea, vomiting and dizziness often experienced by patients with this disorder.
BibTeX: @article{Bernard1996, author = {Bernard, M E and Bachenberg, T C and Brey, R H}, title = {Benign paroxysmal positional vertigo: the canalith repositioning procedure.}, journal = {American family physician}, year = {1996}, volume = {53}, issue = {8}, pages = {2613--6, 2621}, keywords = {Aged; Aged, 80 and over; Humans; Vertigo, etiology, therapy}, pmid = {8644574} }
von Brevern, M. and Lempert, T.	Benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2001	Archives of neurology Vol. 58(9), pp. 1491-1493	article
Abstract: Benign paroxysmal positional vertigo has been recognized as the most common vestibular disorder. The evolution of its pathophysiological concepts has led to current therapeutic strategies that have made it the most successfully treatable cause of vertigo.
BibTeX: @article{Brevern2001, author = {von Brevern, M and Lempert, T}, title = {Benign paroxysmal positional vertigo.}, journal = {Archives of neurology}, year = {2001}, volume = {58}, issue = {9}, pages = {1491--1493}, keywords = {History, 20th Century; Humans; Neurology, history; Vertigo, history, physiopathology}, pmid = {11559327} }
von Brevern, M.	Benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2013	Seminars in neurology Vol. 33(3), pp. 204-211	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most common and the most effectively treated vestibular disorder. The prevailing pathomechanism is canalolithiasis, which is otoconia falling in one of the semicircular canals where they move in response to changes of the head position, triggering excitation of the vestibular receptors of the affected canal. In the majority of patients with BPPV, the posterior canal is affected by canalolithiasis and there are two highly effective therapeutic maneuvers for treatment. About 20% of patients present with lithiasis of the horizontal or anterior canal. The author focuses on recent advances in diagnosis and treatment of the more rare variants of BPPV.
BibTeX: @article{Brevern2013, author = {von Brevern, Michael}, title = {Benign paroxysmal positional vertigo.}, journal = {Seminars in neurology}, year = {2013}, volume = {33}, issue = {3}, pages = {204--211}, doi = {https://doi.org/10.1055/s-0033-1354590}, keywords = {Benign Paroxysmal Positional Vertigo; Humans; Prognosis; Semicircular Canals, physiopathology; Vertigo, diagnosis, epidemiology, physiopathology, therapy; Vestibular Diseases, therapy}, pmid = {24057823} }
Denholm, S.W.	Benign paroxysmal positional vertigo. [BibTeX]	1993	BMJ (Clinical research ed.) Vol. 307(6918), pp. 1507-1508	article
BibTeX: @article{Denholm1993, author = {Denholm, S W}, title = {Benign paroxysmal positional vertigo.}, journal = {BMJ (Clinical research ed.)}, year = {1993}, volume = {307}, issue = {6918}, pages = {1507--1508}, keywords = {Aging, physiology; Exercise Therapy; Humans; Otolithic Membrane; Vertigo, etiology, rehabilitation}, pmid = {8274914} }
Fife, T.D.	Benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2009	Seminars in neurology Vol. 29(5), pp. 500-508	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most common cause of recurrent vertigo and has a lifetime prevalence of 2.4% in the general population. Benign paroxysmal positional vertigo is caused when calcium carbonate material originating from the macula of the utricle falls into one of the semicircular canals. Due to their density relative to the endolymph, they move in response to gravity and trigger excitation of the ampullary nerve of the affected canal. This, in turn, produces a burst of vertigo associated with nystagmus unique to that canal. Recognition of this condition is important not only because it may avert expensive and often unnecessary testing, but also because treatment is rapid, easy, and effective in >90% of cases. Two well-established methods of treating BPPV are discussed and explained in this article along with a brief discussion of the most commonly used method for treatment of horizontal canal BPPV. Recurrence rates approach 50% in those followed for at least 5 years.
BibTeX: @article{Fife2009, author = {Fife, Terry D}, title = {Benign paroxysmal positional vertigo.}, journal = {Seminars in neurology}, year = {2009}, volume = {29}, issue = {5}, pages = {500--508}, doi = {https://doi.org/10.1055/s-0029-1241041}, keywords = {Humans; Neurologic Examination, methods; Recurrence; Vertigo, diagnosis, physiopathology, therapy}, pmid = {19834861} }
Furman, J.M. and Cass, S.P.	Benign paroxysmal positional vertigo. [Abstract] [BibTeX]	1999	The New England journal of medicine Vol. 341(21), pp. 1590-1596	article	DOI
Abstract: Benign paroxysmal positional vertigo is a common disorder of the inner ear that should be suspected in all patients with a history of positionally provoked vertigo. The condition appears to be caused by free-floating debris in the posterior semicircular canal. The diagnosis is confirmed by eliciting characteristic symptoms and signs during the Dix-Hallpike test. Although benign paroxysmal positional vertigo is usually a self-limited disorder, treatment with a specific bedside maneuver is effective and can provide the patient immediate and long-lasting relief. Although many patients with positionally provoked vertigo have typical benign paroxysmal positional vertigo, physicians should be aware of nonbenign variants.
BibTeX: @article{Furman1999, author = {Furman, J M and Cass, S P}, title = {Benign paroxysmal positional vertigo.}, journal = {The New England journal of medicine}, year = {1999}, volume = {341}, issue = {21}, pages = {1590--1596}, doi = {https://doi.org/10.1056/NEJM199911183412107}, keywords = {Calcium Carbonate; Calculi, chemistry; Diagnosis, Differential; Humans; Posture; Semicircular Canals, pathology; Terminology as Topic; Vertigo, diagnosis, etiology, therapy}, pmid = {10564690} }
Gordon, N.	Benign paroxysmal positional vertigo. [Abstract] [BibTeX]	1996	The British journal of clinical practice Vol. 50(4), pp. 208-210	article
Abstract: Benign paroxysmal positional vertigo should be considered when a patient complains of attacks of dizziness of brief duration, that seem to occur under particular circumstances related to the position of the head. The true nature of the disorder may be missed unless examination is carried out in a certain way: the head must be positioned below the rest of the body and turned to one or other side. Diagnosis then depends on the occurrence of vertigo and on noting the transient nystagmus. There are a number of causes of benign paroxysmal positional vertigo-head injury is a relatively frequent one. It has been suggested that this disorder is due to deposits on the cupula of the precipitating posterior semicircular canal. Indeed, exercises designed to dislodge such deposits can be successful. If not, and the vertigo lasts for more than a few months, surgery can be considered.
BibTeX: @article{Gordon1996, author = {Gordon, N}, title = {Benign paroxysmal positional vertigo.}, journal = {The British journal of clinical practice}, year = {1996}, volume = {50}, issue = {4}, pages = {208--210}, keywords = {Humans; Nystagmus, Pathologic, complications; Otolithic Membrane, pathology; Posture; Vertigo, complications, diagnosis, etiology, therapy}, pmid = {8759567} }
Hilton, M. and Pinder, D.	Benign paroxysmal positional vertigo. [BibTeX]	2003	BMJ (Clinical research ed.) Vol. 326(7391), pp. 673	article	DOI
BibTeX: @article{Hilton2003, author = {Hilton, Malcolm and Pinder, Darren}, title = {Benign paroxysmal positional vertigo.}, journal = {BMJ (Clinical research ed.)}, year = {2003}, volume = {326}, issue = {7391}, pages = {673}, doi = {https://doi.org/10.1136/bmj.326.7391.673}, keywords = {Humans; Patient Education as Topic; Remission, Spontaneous; Vertigo, diagnosis, therapy}, pmid = {12663379} }
Hughes, C.A. and Proctor, L.	Benign paroxysmal positional vertigo. [Abstract] [BibTeX]	1997	The Laryngoscope Vol. 107(5), pp. 607-613	article
Abstract: Benign paroxysmal positional vertigo (BPPV) has received renewed clinical interest. At the Johns Hopkins Otological Vestibular Laboratory, 781 patients were tested on more than one occasion between September 1976 and November 1992. Of these patients, 187 (24%) were found to have positional nystagmus consistent with a diagnosis of BPPV. A retrospective analysis of these patients' records, including vestibular test and eye movement reports, audiograms, questionnaires, and hospital charts was performed. After this review, the nystagmus, initially diagnosed as due to BPPV, was believed to be a manifestation of another disease process in 36 cases. Of the remaining 151 cases, 52 (34%) presented with no significant preceding disorder and have been termed primary BPPV. In the remaining 99 patients we found coexisting or associated disorders which included Meniere's disease, head trauma, prior ear surgery, vestibular neuronitis, migraine, and others. Forty-five of these 151 patients (31%) had an associated diagnosis of Meniere's disease. To our knowledge a significant association between Meniere's disease and BPPV has not been reported. A review of the literature with discussion of BPPV and the associated disorders is offered.
BibTeX: @article{Hughes1997, author = {Hughes, C A and Proctor, L}, title = {Benign paroxysmal positional vertigo.}, journal = {The Laryngoscope}, year = {1997}, volume = {107}, issue = {5}, pages = {607--613}, keywords = {Audiometry; Cerebellar Neoplasms, complications, diagnosis; Cerebellopontine Angle; Cerebrovascular Disorders, complications, diagnosis; Craniocerebral Trauma, complications, diagnosis; Diagnosis, Differential; Eye Movements; Female; Humans; Labyrinth Diseases, complications, diagnosis; Meniere Disease, complications, diagnosis; Middle Aged; Migraine Disorders, complications; Neuritis, complications, diagnosis; Nystagmus, Pathologic, etiology; Retrospective Studies; Stapes Surgery, adverse effects; Vertigo, etiology; Vestibular Nerve}, pmid = {9149161} }
Kim, J.C. and Amedee, R.G.	Benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2002	The Journal of the Louisiana State Medical Society : official organ of the Louisiana State Medical Society Vol. 154(1), pp. 9-11	article
Abstract: Benign paroxysmal positional vertigo is a disorder of the peripheral vestibular system characterized by brief episodes of vertigo precipitated by head movements in certain planes. It is one of the most common causes of vertigo. Displaced otolithic debris in the posterior semicircular canal is the proposed mechanism of this disorder and explains the success of repositioning procedures in treating these patients. The pathophysiology, diagnosis, and treatment options are discussed.
BibTeX: @article{Kim2002, author = {Kim, Jenny C and Amedee, Ronald G}, title = {Benign paroxysmal positional vertigo.}, journal = {The Journal of the Louisiana State Medical Society : official organ of the Louisiana State Medical Society}, year = {2002}, volume = {154}, issue = {1}, pages = {9--11}, keywords = {Humans; Vertigo, diagnosis, physiopathology, therapy}, pmid = {11892885} }
Korres, S., Luxon, L., Vannucchi, P. and Gibson, B.	Benign paroxysmal positional vertigo. [BibTeX]	2011	International journal of otolaryngology Vol. 2011, pp. 353865	article	DOI
BibTeX: @article{Korres2011, author = {Korres, Stavros and Luxon, Linda and Vannucchi, Paolo and Gibson, Bill}, title = {Benign paroxysmal positional vertigo.}, journal = {International journal of otolaryngology}, year = {2011}, volume = {2011}, pages = {353865}, doi = {https://doi.org/10.1155/2011/353865}, pmid = {22013447} }
Lee, S.-H. and Kim, J.S.	Benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2010	Journal of clinical neurology (Seoul, Korea) Vol. 6(2), pp. 51-63	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is characterized by brief recurrent episodes of vertigo triggered by changes in head position. BPPV is the most common etiology of recurrent vertigo and is caused by abnormal stimulation of the cupula by free-floating otoliths (canalolithiasis) or otoliths that have adhered to the cupula (cupulolithiasis) within any of the three semicircular canals. Typical symptoms and signs of BPPV are evoked when the head is positioned so that the plane of the affected semicircular canal is spatially vertical and thus aligned with gravity. Paroxysm of vertigo and nystagmus develops after a brief latency during the Dix-Hallpike maneuver in posterior-canal BPPV, and during the supine roll test in horizontal-canal BPPV. Positioning the head in the opposite direction usually reverses the direction of the nystagmus. The duration, frequency, and symptom intensity of BPPV vary depending on the involved canals and the location of otolithic debris. Spontaneous recovery may be expected even with conservative treatments. However, canalithrepositioning maneuvers usually provide an immediate resolution of symptoms by clearing the canaliths from the semicircular canal into the vestibule.
BibTeX: @article{Lee2010c, author = {Lee, Seung-Han and Kim, Ji Soo}, title = {Benign paroxysmal positional vertigo.}, journal = {Journal of clinical neurology (Seoul, Korea)}, year = {2010}, volume = {6}, issue = {2}, pages = {51--63}, doi = {https://doi.org/10.3988/jcn.2010.6.2.51}, keywords = {benign paroxysmal positional vertigo; canalith-repositioning maneuver; nystagmus; vertigo}, pmid = {20607044} }
Neatherlin, J.S. and Egan, J.	Benign paroxysmal positional vertigo. [Abstract] [BibTeX]	1994	The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses Vol. 26(6), pp. 330-335	article
Abstract: Benign paroxysmal positional vertigo (BPPV) is a peripheral vestibular disorder affecting the posterior semicircular canal. It is most often idiopathic in nature, though it has been known to occur in patients following head injury, Meniere's disease, acoustic neuroma and viral neuronitis. Two basic theories of the pathology of BPPV include cupulolithiasis and canalithiasis. Diagnosis is made by instituting the Hallpike-Dix maneuver to elicit the positional vertigo and nystagmus. While many patients suffer from BPPV on a limited basis, treatment options are available for those individuals with recurrent episodes and permanent BPPV, including surgery and conservative medical exercises and maneuvers. Nursing care is aimed toward teaching the exercises and maneuvers and assisting the patient to adjust the individual lifestyle movements that may precipitate an attack.
BibTeX: @article{Neatherlin1994, author = {Neatherlin, J S and Egan, J}, title = {Benign paroxysmal positional vertigo.}, journal = {The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses}, year = {1994}, volume = {26}, issue = {6}, pages = {330--335}, keywords = {Diagnosis, Differential; Humans; Meniere Disease, diagnosis, etiology, nursing; Nursing Diagnosis; Prognosis; Vertigo, diagnosis, etiology, nursing}, pmid = {7706835} }
Solomon	Benign Paroxysmal Positional Vertigo. [Abstract] [BibTeX]	2000	Current treatment options in neurology Vol. 2(5), pp. 417-428	article
Abstract: Benign paroxysmal positional vertigo can be diagnosed with great certainty, and treated effectively at the bedside using one of the canalith repositioning procedures described in this paper. This treatment has been shown effective in properly controlled trials, has a rational basis, and has minimal risk.
BibTeX: @article{Solomon2000, author = {Solomon}, title = {Benign Paroxysmal Positional Vertigo.}, journal = {Current treatment options in neurology}, year = {2000}, volume = {2}, issue = {5}, pages = {417--428}, pmid = {11096767} }
Tusa, R.J.	Benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2001	Current neurology and neuroscience reports Vol. 1(5), pp. 478-485	article
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most common and most treatable cause of vertigo. In most cases, a simple maneuver that takes less than a few minutes to do resolves the problem. BPPV is caused by misplaced calcium carbonate crystals (otoconia) in the semicircular canal of the inner ear that have broken free from the utricle. When these crystals break free, they either remain loose in one of three different semicircular canals or attach to the hair cells within a canal. Several different types of treatment maneuvers have been described. The maneuver to use varies according to the semicircular canal involved and whether the crystals are loose or attached to the hair cells.
BibTeX: @article{Tusa2001, author = {Tusa, R J}, title = {Benign paroxysmal positional vertigo.}, journal = {Current neurology and neuroscience reports}, year = {2001}, volume = {1}, issue = {5}, pages = {478--485}, keywords = {Humans; Vertigo, diagnosis, physiopathology, therapy}, pmid = {11898559} }
Xiang-Dong, G.	Benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2011	Journal of neurosciences in rural practice Vol. 2(1), pp. 109-110	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is a common clinical disorder characterized by brief recurrent spells of vertigo often brought about by certain head position changes as may occur with looking up, turning over in bed, or straightening up after bending over. It is important to understand BPPV not only because it may avert expensive and often unnecessary testing, but also because treatment is rapid, easy, and effective in >90% of cases. The diagnosis of BPPV can be made based on the history and examination. Patients usually report episodes of spinning evoked by certain movements, such as lying back or getting out of bed, turning in bed, looking up, or straightening after bending over. At present, the generally accepted recurrence rate of BPPV after successful treatment is 40%-50% at 5 years of average follow-up. There does appear to be a subset of individuals prone to multiple recurrences.
BibTeX: @article{Xiang-Dong2011, author = {Xiang-Dong, Guo}, title = {Benign paroxysmal positional vertigo.}, journal = {Journal of neurosciences in rural practice}, year = {2011}, volume = {2}, issue = {1}, pages = {109--110}, doi = {https://doi.org/10.4103/0976-3147.80091}, keywords = {Benign paroxysmal positional vertigo; vertigo}, pmid = {21716871} }
Zappia, J.J.	Benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2013	Current opinion in otolaryngology & head and neck surgery Vol. 21(5), pp. 480-486	article	DOI
Abstract: To review benign paroxysmal positional vertigo (BPPV) and some of the recent literature. As BPPV is such a common diagnosis, it is important to understand the disorder and treatment considerations. Although BPPV is typically an easy diagnosis to make, one must be aware of the differential diagnosis. An unusual entity, convergence spasm, is recently presented and discussed as an addition to the differential diagnosis. The recent literature confirms the efficacy of treatment of BPPV. Large studies of horizontal canal BPPV support the success of the barbeque roll and present the simple head shake as a possible treatment in the apogeotropic form. There is reported success with the less often discussed Gufoni (and its variations) maneuver. The presence of orthoptic nystagmus during treatment has positive predictive value for the success of the maneuver. Although uncommon, canal conversion is important to recognize during treatment as it can be readily treated. BPPV is a very common cause of dizziness and generally straightforward to identify and treat. Awareness of possible horizontal canal variants and nonvestibular differential diagnosis possibilities is important. Repositioning maneuvers of various types are typically successful and understanding the nuances is important in assuring successful outcomes.
BibTeX: @article{Zappia2013, author = {Zappia, John J}, title = {Benign paroxysmal positional vertigo.}, journal = {Current opinion in otolaryngology & head and neck surgery}, year = {2013}, volume = {21}, issue = {5}, pages = {480--486}, doi = {https://doi.org/10.1097/MOO.0b013e32836463d6}, keywords = {Benign Paroxysmal Positional Vertigo; Diagnosis, Differential; Humans; Physical Examination; Posture; Prognosis; Vertigo, diagnosis, etiology}, pmid = {23995328} }
Norré, M.E., Forrez, G. and Beckers, A.	Benign paroxysmal positional vertigo. Clinical observations by vestibular habituation training and by posturography. [Abstract] [BibTeX]	1987	The Journal of laryngology and otology Vol. 101(5), pp. 443-447	article
Abstract: Vestibular Habituation Training (VHT) is the treatment of choice for paroxysmal positional vertigo (ppv). The origin of the disturbance is peripheral and the data observed in the cases treated confirm that it is not located in horizontal canal function. However, canal dysfunction can be present together with ppv. Usually a separate course is observed for the phenomena attributed to horizontal dysfunction and those to the ppv lesion. The specificity of the Dix-Hallpike manoeuvres linked to the typical ppv is also confirmed by the data obtained by testing for VHT (VHT-test-battery). Ppv can have a repercussion upon the vestibulospinal reflex. That the same ppv disturbance can coincide with normal as well as with abnormal posturographic data, pleads for the intervention of central adaptive mechanisms. The effect of VHT is due to stimulation of these central adaptive mechanisms and not to any impact upon the peripheral lesion.
BibTeX: @article{Norre1987, author = {Norré, M E and Forrez, G and Beckers, A}, title = {Benign paroxysmal positional vertigo. Clinical observations by vestibular habituation training and by posturography.}, journal = {The Journal of laryngology and otology}, year = {1987}, volume = {101}, issue = {5}, pages = {443--447}, keywords = {Exercise Therapy; Habituation, Psychophysiologic; Humans; Nystagmus, Pathologic, rehabilitation; Posture; Vertigo, rehabilitation}, pmid = {3585156} }
Boniver, R.	Benign paroxysmal positional vertigo. State of the art. [Abstract] [BibTeX]	1998	Acta oto-rhino-laryngologica Belgica Vol. 52(4), pp. 281-289	article
Abstract: This paper defines the benign paroxysmal vertigo (BPV). It recalls the ethiopathogeny of the syndrome and describes the different types of BPV and their treatment by "liberatory maneuvers". The paper also discusses the need for an otoneurological examination to achieve an exact diagnosis.
BibTeX: @article{Boniver1998, author = {Boniver, R}, title = {Benign paroxysmal positional vertigo. State of the art.}, journal = {Acta oto-rhino-laryngologica Belgica}, year = {1998}, volume = {52}, issue = {4}, pages = {281--289}, keywords = {Humans; Nystagmus, Physiologic; Posture; Vertigo, diagnosis, etiology, therapy; Vestibular Function Tests}, pmid = {9914800} }
Silva, C., Amorim, A.M. and Paiva, A.	Benign paroxysmal positional vertigo--a review of 101 cases. [Abstract] [BibTeX]	2015	Acta otorrinolaringologica espanola Vol. 66(4), pp. 205-209	article	DOI
Abstract: Benign paroxysmal positional vertigo is one of the most common vestibular disorders, with a lifetime prevalence of 2.4%. This study aimed to assess age, gender, lesion type and site, association with other vestibular diseases, progression and recurrence in a Portuguese population. This was a retrospective observational study of 101 patients diagnosed with benign paroxysmal positional vertigo by the same senior doctor, in a tertiary academic hospital, between January 2009 and May 2011. A total of 101 cases were pooled, with a mean age of 56.57±15.33 years (15-90 years). From these, 72.3% were women. The posterior canal was affected in 72.3%, the lateral in 24.7%, the anterior in 2% and multiple canals in 1%. Unilateral canal and left labyrinth involvement were more frequent. The therapeutic maneuver used most was Epley's. Recurrence was observed in 10.9% of the cases. It was idiopathic in 83.2% of cases. No association was found between the number of maneuvers necessary to treat benign paroxysmal positional vertigo and etiology. Benign paroxysmal positional vertigo is more frequent in female subjects, in the 6th decade and involves preferably the posterior semicircular canal of the right labyrinth. In most cases it is idiopathic and treatment with repositioning maneuvers has a mean success of 90%. Our results were in accordance with the literature; nevertheless, in this study the left labyrinth was most affected and the follow-up period was variable.
BibTeX: @article{Silva2015, author = {Silva, Clara and Amorim, Ana Margarida and Paiva, António}, title = {Benign paroxysmal positional vertigo--a review of 101 cases.}, journal = {Acta otorrinolaringologica espanola}, year = {2015}, volume = {66}, issue = {4}, pages = {205--209}, doi = {https://doi.org/10.1016/j.otorri.2014.09.003}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, epidemiology, etiology, therapy; Cardiovascular Diseases, epidemiology; Craniocerebral Trauma, complications; Female; Humans; Male; Meniere Disease, complications; Middle Aged; Migraine Disorders, complications; Patient Positioning, methods; Recurrence; Retrospective Studies; Risk Factors; Semicircular Canals, physiopathology; Treatment Outcome; Young Adult; Laberinto; Labyrinth; Nistagmo; Nystagmus; Vertigo; Vértigo}, pmid = {25865125} }
Colreavy, M., Keogh, I., Hone, S. and Walsh, M.	Benign paroxysmal positional vertigo--an old disease with a new cure? [BibTeX]	1999	Irish medical journal Vol. 92(3), pp. 295	article
BibTeX: @article{Colreavy1999, author = {Colreavy, M and Keogh, I and Hone, S and Walsh, M}, title = {Benign paroxysmal positional vertigo--an old disease with a new cure?}, journal = {Irish medical journal}, year = {1999}, volume = {92}, issue = {3}, pages = {295}, keywords = {Audiometry; Ear, Inner, surgery; Humans; Magnetic Resonance Imaging; Physical Therapy Modalities; Posture; Temporal Bone, surgery; Vertigo, etiology, surgery, therapy; Vestibular Nerve, surgery}, pmid = {10394754} }
Büki, B.	Benign paroxysmal positional vertigo--toward new definitions. [Abstract] [BibTeX]	2014	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 35(2), pp. 323-328	article	DOI
Abstract: To review new clinical data and theories concerning atypical positional nystagmus in vertical canal benign paroxysmal positional vertigo (BPPV). Peer reviewed, clinical papers describing nystagmus provoked by positioning in cases with BPPV. Basic scientific articles detailing 3D anatomical reconstructions of the inner ear. In BPPV, it is hypothetically possible that otoconia become dislocated but do not fall into the common crus of the vertical canals or into the horizontal canal; in these cases, they may gravitate toward the most inferior part of the utriculus, the ampulla of the inferior canal. It is argued that in these cases, depending on their behavior (free-floating or sticking to the cupula) and the precise position of the inferior ampulla, either no nystagmus or a slow downbeat nystagmus should ensue when the patient is positioned from sitting to a Dix-Hallpike position. Such scenarios could hypothetically explain commonly seen clinical entities such as "subjective BPPV" and/or cases with a peripheral positional downbeat nystagmus.
BibTeX: @article{Bueki2014a, author = {Büki, Béla}, title = {Benign paroxysmal positional vertigo--toward new definitions.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2014}, volume = {35}, issue = {2}, pages = {323--328}, doi = {https://doi.org/10.1097/MAO.0000000000000197}, keywords = {Benign Paroxysmal Positional Vertigo; Ear, Inner, physiopathology; Humans; Nystagmus, Physiologic, physiology; Patient Positioning; Posture, physiology; Vertigo, diagnosis, physiopathology; Vestibular Function Tests}, pmid = {24448292} }
Frohman, E.M., Kramer, P.D., Dewey, R.B., Kramer, L. and Frohman, T.C.	Benign paroxysmal positioning vertigo in multiple sclerosis: diagnosis, pathophysiology and therapeutic techniques. [Abstract] [BibTeX]	2003	Multiple sclerosis (Houndmills, Basingstoke, England) Vol. 9(3), pp. 250-255	article	DOI
Abstract: To report on the most common causes of vertigo in patients with multiple sclerosis (MS) and emphasize appropriate diagnostic techniques and treatment interventions. True vertigo is estimated to occur in about 20% of MS patients. Lesions within the vestibular nuclei and in the root entry zone of cranial nerve VIII represent the most common locations where demyelinating activity can provoke vertigo in patients with MS. However, other causes of vertigo should be explored in MS patients in order to avoid unnecessary treatment with corticosteroids and vestibular suppressants. Recently, we reviewed our four-year experience with new onset vertigo in our university-based MS population and found that benign paroxysmal positioning vertigo (BPPV) to be the most common cause. All patients diagnosed with BPPV were treated successfully with particle repositioning maneuvers. The remaining patients were treated with conventional therapies appropriate for the specific diagnosis. Empiric treatments with corticosteroids and/or vestibular suppressants should not be employed until all MS patients undergo a careful bedside examination, which includes diagnostic positional and, if indicated, particle repositioning maneuvers. Here we emphasize the pathophysiology of BPPV and illustrate the proper techniques for the diagnostic and therapeutic maneuvers.
BibTeX: @article{Frohman2003, author = {Frohman, E M and Kramer, P D and Dewey, R B and Kramer, L and Frohman, T C}, title = {Benign paroxysmal positioning vertigo in multiple sclerosis: diagnosis, pathophysiology and therapeutic techniques.}, journal = {Multiple sclerosis (Houndmills, Basingstoke, England)}, year = {2003}, volume = {9}, issue = {3}, pages = {250--255}, doi = {https://doi.org/10.1191/1352458503ms901oa}, keywords = {Humans; Magnetic Resonance Imaging; Multiple Sclerosis, complications, physiopathology; Posture; Vertigo, diagnosis, etiology, physiopathology, therapy}, pmid = {12814171} }
Lynn, S. and Brey, R.	Benign paroxysmal positioning vertigo with indeterminate cerebellar lesion: case report. [Abstract] [BibTeX]	1993	Journal of the American Academy of Audiology Vol. 4(6), pp. 384-391	article
Abstract: Of the numerous causes of dizziness, those that represent a life-threatening condition are rare. Physicians must guard against missing these rare but serious conditions while controlling the cost of the evaluation of patients who present with dizziness. This case study involving a 41-year-old female was written to illustrate the importance of systematic case history taking and of obtaining an ENG. The patient presented with classic symptoms of benign paroxysmal positioning vertigo (BPPV). The managing physician performed an MRI, which showed a cerebellar lesion. Results of a biopsy were negative. The patient's symptoms persisted, and she travelled to our clinic for further assessment. An ENG demonstrated a classic response to the Dix-Hallpike maneuvers, and a canalith repositioning maneuver was performed. The positioning dizziness resolved, and when contacted several months later, the patient stated she had remained asymptomatic.
BibTeX: @article{Lynn1993, author = {Lynn, S and Brey, R}, title = {Benign paroxysmal positioning vertigo with indeterminate cerebellar lesion: case report.}, journal = {Journal of the American Academy of Audiology}, year = {1993}, volume = {4}, issue = {6}, pages = {384--391}, keywords = {Adult; Audiometry, Pure-Tone; Audiometry, Speech; Auditory Threshold; Caloric Tests; Cerebellum, diagnostic imaging, pathology; Electronystagmography; Female; Humans; Magnetic Resonance Imaging; Neurologic Examination; Nystagmus, Pathologic; Posture; Radiography; Vertigo, diagnosis, pathology, therapy; Vestibular Function Tests}, pmid = {8298174} }
Brandt, T., Huppert, D., Hecht, J., Karch, C. and Strupp, M.	Benign paroxysmal positioning vertigo: a long-term follow-up (6-17 years) of 125 patients. [Abstract] [BibTeX]	2006	Acta oto-laryngologica Vol. 126(2), pp. 160-163	article	DOI
Abstract: The study disclosed a few predictive factors for benign paroxysmal positioning vertigo (BPPV) recurrences, which are clinically relevant and essential for patient awareness of the often long-term course of the condition. To determine the long-term recurrence rate of posterior canal BPPV after successful liberatory maneuvers. A retrospective self-evaluation questionnaire with a structured interview was conducted 6-17 years after assessment of the diagnosis in 125 patients. The recurrence rate in patients with a mean follow-up of 10 years was 50%. Most recurrences (80%) were within the first year after treatment, irrespective of the liberatory maneuver applied. None of the patients observed a recurrence after a symptom-free period of 8 years. Recurrences were seen significantly more often in women (58% versus 39%). The recurrence rate of patients in the seventh decade was half that of those in the sixth decade (p=0.0009). A history of three or more BPPV attacks prior to treatment indicated a higher risk of impending multiple recurrences in about two-thirds of the patients.
BibTeX: @article{Brandt2006, author = {Brandt, Thomas and Huppert, Doreen and Hecht, Joachim and Karch, Cornelia and Strupp, Michael}, title = {Benign paroxysmal positioning vertigo: a long-term follow-up (6-17 years) of 125 patients.}, journal = {Acta oto-laryngologica}, year = {2006}, volume = {126}, issue = {2}, pages = {160--163}, doi = {https://doi.org/10.1080/00016480500280140}, keywords = {Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Child; Child, Preschool; Female; Follow-Up Studies; Humans; Infant; Male; Middle Aged; Recurrence; Retrospective Studies; Risk Factors; Surveys and Questionnaires; Vertigo, epidemiology, etiology}, pmid = {16428193} }
Lanska, D.J. and Remler, B.	Benign paroxysmal positioning vertigo: classic descriptions, origins of the provocative positioning technique, and conceptual developments. [Abstract] [BibTeX]	1997	Neurology Vol. 48(5), pp. 1167-1177	article
Abstract: The original description of benign paroxysmal positioning vertigo (BPPV) has been variously attributed to Bárány, Adler, and others. In addition, the proper eponymic designation for the provocative positioning test used to diagnose BPPV has been unclear, because authors use a variety of different terms, including Bárány, Nylén-Bárány, Nylén, Hallpike, Hallpike-Dix, and Dix-Hallpike to refer to the procedure in current use. Based on a review of the extant medical literature, Bárány was the first to describe the condition in detail, and Dix and Hallpike were the first to clearly describe both the currently used provocative positioning technique and the essential clinical manifestations of benign paroxysmal positioning vertigo elicited by that technique. Nevertheless, despite their important contributions, neither Bárány nor Dix and Hallpike understood the pathophysiology of BPPV nor did they appreciate that the positioning techniques they used actually demonstrated pathology in the semicircular canals rather than the utricle. The modern understanding of the pathophysiology of BPPV began with Schuknecht's proposal that the dysfunction resulted from the gravity-dependent movement of loose or fixed dense material within the posterior semicircular canal ("cupulolithiasis"). Although Schuknecht's formulations were not consistent with all clinical features of the disease, they led to the modern "canalolithiasis theory" and highly effective canalith repositioning or "liberatory" maneuvers for BPPV.
BibTeX: @article{Lanska1997, author = {Lanska, D J and Remler, B}, title = {Benign paroxysmal positioning vertigo: classic descriptions, origins of the provocative positioning technique, and conceptual developments.}, journal = {Neurology}, year = {1997}, volume = {48}, issue = {5}, pages = {1167--1177}, keywords = {History, 20th Century; Humans; Neurology, history; Posture; Vertigo, etiology, history}, pmid = {9153438} }
Yakinthou, A., Maurer, J. and Mann, W.	Benign paroxysmal positioning vertigo: diagnosis and therapy using video-oculographic control. [Abstract] [BibTeX]	2003	ORL; journal for oto-rhino-laryngology and its related specialties Vol. 65(5), pp. 290-294	article	DOI
Abstract: In this prospective study, 82 patients (40 males, 42 females, aged between 15 and 80 years) with benign paroxysmal positioning vertigo (BPPV) were treated with different positioning manoeuvres using video-oculographic control. The maximum age for females and males was 31 and 40 years respectively. After an interview about the special history related to vertigo imbalance symptoms and using video-oculographic control, we diagnosed 79 patients with BPPV of the posterior semicircular canal and 3 of the horizontal semicircular canal. The Dix-Hallpike and Cawthorne manoeuvres were used for the diagnosis of BPPV of the posterior semicircular canal and the McClure manoeuvre for the diagnosis of BPPV of the horizontal semicircular canal. 72% of the patients had an idiopathic BPPV and 12.2% were post-traumatic. 3.7% had BPPV after ear surgery and 2.4% were pregnant. 39 patients with posterior BPPV were treated with Semont's manoeuvre and 40 with Epley's. The 3 patients with horizontal BPPV were treated with Baloh's manoeuvre. More than half of the patients (52.5%) were free of symptoms after one session of Epley's manoeuvre and all of them after four sessions. 51.3% had no further symptoms after one session of Semont's manoeuvre and all of them after four sessions. These results, in agreement with the literature, show that the success rate of Semont's and Epley's manoeuvres is approximately the same. Video-oculographic control is helpful for the diagnosis and for the registration of the eye movements during the therapeutic manoeuvres.
BibTeX: @article{Yakinthou2003, author = {Yakinthou, A and Maurer, J and Mann, W}, title = {Benign paroxysmal positioning vertigo: diagnosis and therapy using video-oculographic control.}, journal = {ORL; journal for oto-rhino-laryngology and its related specialties}, year = {2003}, volume = {65}, issue = {5}, pages = {290--294}, doi = {https://doi.org/10.1159/000075229}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Electrooculography, methods; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, physiopathology; Posture; Prospective Studies; Vertigo, diagnosis, physiopathology, therapy; Videotape Recording}, pmid = {14730186} }
Herndon, J.W., Haug, O., Horowitz, M.J. and Lynes, T.E.	Benign paroxysmal positonal vertigo: A clinical study. [Abstract] [BibTeX]	1975	The Annals of otology, rhinology, and laryngology Vol. 84(2 PART 1), pp. 218-222	article	DOI
Abstract: Summary--Ru-Vert, a combination product, containing in each tablet, 25 mg of pentylenetetrazol, 12.5 mg of pheniramine maleate, and 50 mg of nictonic acid, was evaluated in the treatment of seventeen patients with benign paroxysmal positional vertigo. The study was double-blind with crossover. Ru-Vert at a dosage of two tablets t.i.d. was found to reduce significantly the nystagmus and the vertigo induced by Hallpike maneuvers in these patients.
BibTeX: @article{Herndon1975, author = {Herndon, J W and Haug, O and Horowitz, M J and Lynes, T E}, title = {Benign paroxysmal positonal vertigo: A clinical study.}, journal = {The Annals of otology, rhinology, and laryngology}, year = {1975}, volume = {84}, issue = {2 PART 1}, pages = {218--222}, doi = {https://doi.org/10.1177/000348947508400214}, keywords = {Adult; Clinical Trials as Topic; Drug Combinations; Drug Evaluation; Electronystagmography; Female; Humans; Male; Maleates, administration & dosage, therapeutic use; Middle Aged; Nicotinic Acids, administration & dosage, therapeutic use; Nystagmus, Pathologic, complications, diagnosis; Pentylenetetrazole, administration & dosage, therapeutic use; Pheniramine, administration & dosage, therapeutic use; Posture; Tablets; Vertigo, complications, diagnosis, drug therapy}, pmid = {1092245} }
Kostić, M., Trotić, R., Jankes, K.R. and Leventić, M.	Benign paroxysmal vertigo in childhood. [Abstract] [BibTeX]	2012	Collegium antropologicum Vol. 36(3), pp. 1033-1036	article
Abstract: The aim of the paper is to describe the clinical picture of benign paroxysmal vertigo (BPV) in childhood. BPV in childhood often goes unrecognized in spite of the fact that vertigo and balance disorders are not uncommon in children. Four cases are described with clinical examination findings between the attacks.
BibTeX: @article{Kostic2012, author = {Kostić, Mirjana and Trotić, Robert and Jankes, Ksenija Ribarić and Leventić, Miro}, title = {Benign paroxysmal vertigo in childhood.}, journal = {Collegium antropologicum}, year = {2012}, volume = {36}, issue = {3}, pages = {1033--1036}, keywords = {Benign Paroxysmal Positional Vertigo; Child; Child, Preschool; Family Health; Female; Humans; Infant; Male; Severity of Illness Index; Vertigo, diagnosis, physiopathology}, pmid = {23213967} }
Prasad, M.	Benign paroxysmal vertigo of childhood is a precursor of migraine. [BibTeX]	2014	Archives of disease in childhood. Education and practice edition Vol. 99(5), pp. 165	article	DOI
BibTeX: @article{Prasad2014, author = {Prasad, Manish}, title = {Benign paroxysmal vertigo of childhood is a precursor of migraine.}, journal = {Archives of disease in childhood. Education and practice edition}, year = {2014}, volume = {99}, issue = {5}, pages = {165}, doi = {https://doi.org/10.1136/archdischild-2013-305458}, keywords = {Adolescent; Benign Paroxysmal Positional Vertigo, complications; Child; Child, Preschool; Disease Progression; Female; Follow-Up Studies; Humans; Male; Migraine Disorders, etiology; Prevalence; Time Factors; Accident & Emergency; Neurology; Paediatric Practice}, pmid = {24430854} }
Marcelli, V., Russo, A., Cristiano, E. and Tessitore, A.	Benign paroxysmal vertigo of childhood: A 10-year observational follow-up. [Abstract] [BibTeX]	2015	Cephalalgia : an international journal of headache Vol. 35(6), pp. 538-544	article	DOI
Abstract: The aim of this article is to explore the progression of neurological, neuro-otological and cochlear features in benign paroxysmal vertigo (BPV) in children over time and its relation with migraine, neuro-otological and cochlear disorders in adulthood. From January 2002 to December 2002, 15 children with BPV were prospectively recruited and then evaluated during a 10-year observational follow-up. All patients underwent detailed neurological, neuro-otological and cochlear examinations during interictal phases. Six children were also studied during ictal periods. At first assessment, four children reported migraine with aura (MwA) and six children reported migraine without aura (MwoA). Neuro-otological examinations were abnormal in two of 15 children. Cochlear examinations were normal in all patients. During the 10-year follow-up, recurrent vestibular symptoms and/or MwA and/or MwoA have been observed in the children. Neuro-otological examinations were abnormal in three of 15 individuals during the interictal period, and abnormal in four out of six patients who were studied during the ictal period. Two patients developed cochlear signs and/or symptoms. During the 10-year follow-up, a phenotype variability in BPV patients has been observed. Specifically, de novo cochlear signs and/or symptoms developed in children with BPV, suggesting that cochlear symptoms should be properly investigated in these patients over time.
BibTeX: @article{Marcelli2015, author = {Marcelli, Vincenzo and Russo, Antonio and Cristiano, Elisabetta and Tessitore, Alessandro}, title = {Benign paroxysmal vertigo of childhood: A 10-year observational follow-up.}, journal = {Cephalalgia : an international journal of headache}, year = {2015}, volume = {35}, issue = {6}, pages = {538--544}, doi = {https://doi.org/10.1177/0333102414547781}, keywords = {Benign Paroxysmal Positional Vertigo, complications; Child; Child, Preschool; Female; Follow-Up Studies; Humans; Male; Migraine Disorders, complications; Vestibular Diseases, complications; BPV; Migraine; benign paroxysmal vertigo; childhood; cochlear; vestibular}, pmid = {25179293} }
Batson, G.	Benign paroxysmal vertigo of childhood: A review of the literature. [Abstract] [BibTeX]	2004	Paediatrics & child health Vol. 9(1), pp. 31-34	article
Abstract: Childrens' complaints of headache and dizziness merit careful evaluation to differentially diagnose a vestibular disorder. Children can manifest with a syndrome mimicking certain classic signs and symptoms of adult vestibular disorders, such as benign paroxysmal positional vertigo, usually associated with aging. Benign paroxysmal vertigo of childhood in which migraine is a key manifestation along with sudden onset of dizziness, is a rare peripheral vestibular disorder in children that is commonly overlooked or misdiagnosed. This review covers the historical development of the diagnosis, evaluation and treatment approaches of benign paroxysmal vertigo of childhood.
BibTeX: @article{Batson2004, author = {Batson, Glenna}, title = {Benign paroxysmal vertigo of childhood: A review of the literature.}, journal = {Paediatrics & child health}, year = {2004}, volume = {9}, issue = {1}, pages = {31--34}, keywords = {Childhood; Dizziness; Migraine; Vertigo; Vestibular}, pmid = {19654978} }
Zhang, D., Fan, Z., Han, Y., Wang, M., Xu, L., Luo, J., Ai, Y. and Wang, H.	Benign paroxysmal vertigo of childhood: diagnostic value of vestibular test and high stimulus rate auditory brainstem response test. [Abstract] [BibTeX]	2012	International journal of pediatric otorhinolaryngology Vol. 76(1), pp. 107-110	article	DOI
Abstract: To investigate the diagnostic value of vestibular test and high stimulus rate auditory brainstem response (ABR) test and the possible mechanism responsible for benign paroxysmal vertigo of childhood (BPVC). Data of 56 patients with BPVC in vertigo clinic of our hospital from May 2007 to September 2008 were retrospectively analyzed in this study. Patients with BPVC were tested with pure tone audiometry, high stimulus rate auditory brainstem response test (ABR), transcranial Doppler sonography (TCD), bithermal caloric test, and VEMP. The results of the hearing and vestibular function test were compared and analyzed. There were 56 patients with BPVC, including 32 men, 24 women, aged 3-12 years old, with an average of 6.5 years. Among 56 cases of BPVC patients, the results of pure tone audiometry were all normal. High stimulus rate ABR was abnormal in 66.1% (37/56) of cases. TCD showed 57.1% abnormality in 56 cases, including faster flow rate in 28 cases and slower flow rate in 4 cases. High stimulus rate ABR and TCD were both abnormal in 48.2% (27/56) of cases. Bithermal caloric test was abnormal in 14.3% (8/56) of cases. VEMP showed 32.1% abnormality, including amplitude abnormality in 16 cases and latency abnormality in 2 cases. The abnormal rate of VEMP was much higher than that of caloric test. Vascular mechanisms might be involved in the pathogenesis of BPVC and there is strong evidence for close relationship between BPVC and migraine. High stimulus rate ABR is helpful in the diagnosis of BPVC. The inferior vestibular pathway is much more impaired than the superior vestibular pathway in BPVC.
BibTeX: @article{Zhang2012b, author = {Zhang, Daogong and Fan, Zhaomin and Han, Yuechen and Wang, Mingming and Xu, Lei and Luo, Jianfen and Ai, Yu and Wang, Haibo}, title = {Benign paroxysmal vertigo of childhood: diagnostic value of vestibular test and high stimulus rate auditory brainstem response test.}, journal = {International journal of pediatric otorhinolaryngology}, year = {2012}, volume = {76}, issue = {1}, pages = {107--110}, doi = {https://doi.org/10.1016/j.ijporl.2011.10.013}, keywords = {Benign Paroxysmal Positional Vertigo; Caloric Tests, methods; Case-Control Studies; Child; Child, Preschool; Electroencephalography, methods; Electronystagmography, methods; Evoked Potentials, Auditory, Brain Stem, physiology; Female; Humans; Male; Reference Values; Retrospective Studies; Sensitivity and Specificity; Severity of Illness Index; Ultrasonography, Doppler, Transcranial; Vertigo, diagnosis; Vestibular Function Tests}, pmid = {22070871} }
Krams, B., Echenne, B., Leydet, J., Rivier, F. and Roubertie, A.	Benign paroxysmal vertigo of childhood: long-term outcome. [Abstract] [BibTeX]	2011	Cephalalgia : an international journal of headache Vol. 31(4), pp. 439-443	article	DOI
Abstract: Benign paroxysmal vertigo (BPV) is characterized by recurrent attacks of dizziness in a healthy child. Complete recovery typically takes place during childhood, and an epidemiological link with migraine has been pointed out. Nevertheless, data concerning long-term patient outcome are scarce. We analyzed the clinical data of 17 patients diagnosed with BPV between 1991 and 2008 in our neuropediatric department; we particularly focused on family medical history and long-term patient outcome by reviewing their medical files and by interviewing the families with a standardized questionnaire administered by phone. Thirteen families responded to the questionnaire, performed 1.1 to 24.5 years after onset. Among 10 patients older than 11 years of age, five continue to suffer attacks of vertigo. Median age at recovery was six years. Nine subjects exhibited migraine, including all six aged 15 years or older. There was a first-degree history of migraine in eight out of 13 children. BPV may not be a homogeneous condition, as some children have a poorer prognosis than others. The strong link with migraine, already noticed by previous authors, led us to discuss the pathophysiology of this condition.
BibTeX: @article{Krams2011, author = {Krams, Benjamin and Echenne, Bernard and Leydet, Julie and Rivier, François and Roubertie, Agathe}, title = {Benign paroxysmal vertigo of childhood: long-term outcome.}, journal = {Cephalalgia : an international journal of headache}, year = {2011}, volume = {31}, issue = {4}, pages = {439--443}, doi = {https://doi.org/10.1177/0333102410382797}, keywords = {Adolescent; Adult; Benign Paroxysmal Positional Vertigo; Child; Child, Preschool; Cohort Studies; Female; Follow-Up Studies; Humans; Male; Surveys and Questionnaires; Time Factors; Treatment Outcome; Vertigo, diagnosis, epidemiology, therapy; Young Adult}, pmid = {20851837} }
BASSER, L.S.	BENIGN PAROXYSMAL VERTIGO OF CHILDHOOD. (A VARIETY OF VESTIBULAR NEURONITIS). [BibTeX]	1964	Brain : a journal of neurology Vol. 87, pp. 141-152	article
BibTeX: @article{BASSER1964, author = {BASSER, L S}, title = {BENIGN PAROXYSMAL VERTIGO OF CHILDHOOD. (A VARIETY OF VESTIBULAR NEURONITIS).}, journal = {Brain : a journal of neurology}, year = {1964}, volume = {87}, pages = {141--152}, keywords = {Benign Paroxysmal Positional Vertigo; Cerebellar Neoplasms; Child; Diagnosis, Differential; Epilepsy; Humans; Infant; Meniere Disease; Neurons; Vertigo; Vestibular Neuronitis; CEREBELLAR NEOPLASMS; CHILD; DIAGNOSIS, DIFFERENTIAL; EPILEPSY; INFANT; MENIERE'S DISEASE; NEURONS; VERTIGO}, pmid = {14152207} }
Pagnini, P., Nuti, D. and Vannucchi, P.	Benign paroxysmal vertigo of the horizontal canal. [Abstract] [BibTeX]	1989	ORL; journal for oto-rhino-laryngology and its related specialties Vol. 51(3), pp. 161-170	article	DOI
Abstract: Over a period of 4 years we observed 15 cases of benign positional vertigo (BPV) probably caused by deposition of otoliths in the horizontal semicircular canal. Rapid rolling onto one side in recumbent position provokes a paroxysmal, purely horizontal and geotropic nystagmus which nearly always spontaneously inverts direction. Rolling the patient onto the other side provokes a left intense geotropic nystagmus. BPV is more violent but resolves more rapidly than that of the better known posterior canal positional vertigo. Sometimes both syndromes are present together.
BibTeX: @article{Pagnini1989, author = {Pagnini, P and Nuti, D and Vannucchi, P}, title = {Benign paroxysmal vertigo of the horizontal canal.}, journal = {ORL; journal for oto-rhino-laryngology and its related specialties}, year = {1989}, volume = {51}, issue = {3}, pages = {161--170}, doi = {https://doi.org/10.1159/000276052}, keywords = {Adult; Aged; Electronystagmography; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, etiology; Posture; Semicircular Canals, physiopathology; Vertigo, etiology}, pmid = {2734007} }
Peñarrocha-Diago, M., Rambla-Ferrer, J., Perez, V. and Pérez-Garrigues, H.	Benign paroxysmal vertigo secondary to placement of maxillary implants using the alveolar expansion technique with osteotomes: a study of 4 cases. [Abstract] [BibTeX]	2008	The International journal of oral & maxillofacial implants Vol. 23(1), pp. 129-132	article
Abstract: The osteotome method is an often-used technique of great utility in certain patients with maxillary bone atrophy. However, it has been associated with the provocation of benign paroxysmal positional vertigo (BPPV), which has been described as a consequence of working the implant bed with osteotomes. During the placement of maxillary dental implants using the osteotome technique, the trauma induced by percussion with the surgical hammer, along with hyperextension of the neck during the operation, can displace otoliths and induce BPPV. Four cases of BPPV occurring after the preparation of maxillary implant beds are presented. Treatment consists fundamentally of maneuvers to move the calcium carbonate crystals from their anomalous location in the semicircular canal to their correct place in the utricle.
BibTeX: @article{Penarrocha-Diago2008, author = {Peñarrocha-Diago, Miguel and Rambla-Ferrer, Javier and Perez, Vanesa and Pérez-Garrigues, Herminio}, title = {Benign paroxysmal vertigo secondary to placement of maxillary implants using the alveolar expansion technique with osteotomes: a study of 4 cases.}, journal = {The International journal of oral & maxillofacial implants}, year = {2008}, volume = {23}, issue = {1}, pages = {129--132}, keywords = {Aged; Alveolar Ridge Augmentation, adverse effects, methods; Dental Implantation, Endosseous, adverse effects, instrumentation, methods; Female; Humans; Male; Maxilla, surgery; Middle Aged; Osteotomy, adverse effects, instrumentation, methods; Percussion, adverse effects; Treatment Outcome; Vertigo, etiology, therapy}, pmid = {18416423} }
Pearce, J.M.S.	Benign paroxysmal vertigo, and Bárány's caloric reactions. [Abstract] [BibTeX]	2007	European neurology Vol. 57(4), pp. 246-248	article	DOI
Abstract: The Nobel Prize winner Robert Bárány described benign positional vertigo and related it to the otoliths in 1921. Dix and Hallpike further elucidated this clinically distinctive, common disorder in 1952. The displacement of otoliths from the utricle or saccule into one of the semicircular canals later proved to be the underlying mechanism, described by Schuknecht and utilised therapeutically by Semont and Epley.
BibTeX: @article{Pearce2007, author = {Pearce, J M S}, title = {Benign paroxysmal vertigo, and Bárány's caloric reactions.}, journal = {European neurology}, year = {2007}, volume = {57}, issue = {4}, pages = {246--248}, doi = {https://doi.org/10.1159/000101292}, keywords = {Austria; Caloric Tests, history; History, 20th Century; Humans; Nobel Prize; Vertigo, diagnosis, history, physiopathology}, pmid = {17389805} }
Soto Varela, A., Bartual Magro, J., Santos Pérez, S., Vélez Regueiro, M., Lechuga García, R., Pérez-Carro Ríos, A. and Caballero, L.	Benign paroxysmal vertigo: a comparative prospective study of the efficacy of Brandt and Daroff exercises, Semont and Epley maneuver. [Abstract] [BibTeX]	2001	Revue de laryngologie - otologie - rhinologie Vol. 122(3), pp. 179-183	article
Abstract: We performed a prospective study to evaluate the efficacy of three physical treatments for benign paroxysmal positional vertigo: Brandt & Daroff habituation exercises, the Semont manoevre (intended as a statoconia-detachment maneuver), and the Epley maneuver (intended as a statoconia-repositioning maneuver). A total of 106 BPPV patients were randomly assigned to one of the three treatment groups, and responses were evaluated one week, one month and three months after the initial treatment. At the one-week follow-up, similar cure rates were obtained with the Semont and Epley maneuver (74% and 71% respectively), both cure rates being significantly higher than that obtained with Brandt & Daroff exercises (24%). By the three-month follow-up, the cure rate obtained with the Epley maneuver was higher (93%) than that obtained with the Semont maneuver (77%), though both remained higher than that obtained with the Brandt & Daroff maneuver (62%). However, the proportion of initially responding patients showing subsequent relapse was lower among patients treated by the Semont maneuver than among patients treated by the Epley maneuver. In view of these findings, we propose a treatment algorithm for patients with BPPV.
BibTeX: @article{SotoVarela2001, author = {Soto Varela, A and Bartual Magro, J and Santos Pérez, S and Vélez Regueiro, M and Lechuga García, R and Pérez-Carro Ríos, A and Caballero, L}, title = {Benign paroxysmal vertigo: a comparative prospective study of the efficacy of Brandt and Daroff exercises, Semont and Epley maneuver.}, journal = {Revue de laryngologie - otologie - rhinologie}, year = {2001}, volume = {122}, issue = {3}, pages = {179--183}, keywords = {Adolescent; Adult; Aged; Algorithms; Female; Follow-Up Studies; Humans; Male; Middle Aged; Physical Therapy Modalities; Posture; Prospective Studies; Recurrence; Time Factors; Vertigo, therapy}, pmid = {11799859} }
D'Agostino, R., Melagrana, A. and Taborelli, G.	Benign positional paroxysmal vertigo of horizontal semicircular canal in the child: case report. [Abstract] [BibTeX]	2003	International journal of pediatric otorhinolaryngology Vol. 67(5), pp. 549-551	article
Abstract: The authors report on a 10-year-old with benign positional paroxysmal vertigo (BPPV) of the horizontal semicircular canal (HSC). To date, no case of BPPV of HSC in the child has been reported in the literature. The authors define the features of the disease, describe its evolution, and compare it with the other vestibular diseases affecting children.
BibTeX: @article{DAgostino2003, author = {D'Agostino, Roberto and Melagrana, Andrea and Taborelli, Giuseppe}, title = {Benign positional paroxysmal vertigo of horizontal semicircular canal in the child: case report.}, journal = {International journal of pediatric otorhinolaryngology}, year = {2003}, volume = {67}, issue = {5}, pages = {549--551}, keywords = {Child; Electronystagmography; Humans; Male; Posture, physiology; Semicircular Canals, physiopathology; Vertigo, physiopathology}, pmid = {12697359} }
Mosca, F., Sicignano, S. and Leone, C.A.	Benign positional paroxysmal vertigo: videonystagmographic study using rotatory test. [Abstract] [BibTeX]	2003	Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale Vol. 23(2), pp. 67-72	article
Abstract: Benign Peripheral Paroxysmal Vertigo is a disease of the posterior labyrinth caused by endolymphatic debris, provoking vertigo with some movements of the head. Diagnosis is usually made by finding the positional nystagmus with appropriate manoeuvres. Spontaneous resolution is frequent and in these cases diagnosis is only probable and suspected from anamnesis. Aim of the present investigation was to establish more evaluation parameters in the study of Benign Peripheral Paroxysmal Vertigo. A series of 97 selected patients presenting Benign Peripheral Paroxysmal Vertigo, have been submitted to sinusoidal kinetic test. Patients have been studied during the acute phase of the condition and after recovery. Vestibulo-oculomotor reflex has been sought by stimulating the horizontal and vertical canals. Kinetic stimulus consisted in sinusoidal rotation at 0.12 Hz and 0.05 Hz. Evaluation parameters comprised preponderance, gain and phase of provoked nystagmus, recorded by means of an Ulmer videonystagmograph. Using this same technique of stimulation, 20 normal volunteers were studied in order to establish normal values for reference. Values obtained in the patient population of patients have been compared, by Student t test, with values obtained in the same cured patients and with those in normal subjects. In the patients with Benign Peripheral Paroxysmal Vertigo of the lateral canal a nystagmus preponderance toward the healthy side was observed, as well as an increase in the phase lead, also in the canals not affected by the condition. In cured patients, disappearance of the preponderance and persistence of the phase abnormalities are observed. These results suggest a multicanal pathogenesis of Benign Peripheral Paroxysmal Vertigo.
BibTeX: @article{Mosca2003, author = {Mosca, F and Sicignano, S and Leone, C A}, title = {Benign positional paroxysmal vertigo: videonystagmographic study using rotatory test.}, journal = {Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale}, year = {2003}, volume = {23}, issue = {2}, pages = {67--72}, keywords = {Adult; Aged; Aged, 80 and over; Electronystagmography, instrumentation; Female; Humans; Male; Middle Aged; Posture; Rotation; Vertigo, diagnosis; Videotape Recording}, pmid = {14526552} }
Jahn, A.F.	Benign positional vertigo and endolymphatic hydrops: what is the connection? [Abstract] [BibTeX]	2017	The Journal of laryngology and otology Vol. 131(8), pp. 658-660	article	DOI
Abstract: Although benign paroxysmal positional vertigo and endolymphatic hydrops are considered to be distinct diagnoses, a minority of vertiginous patients exhibit features of both conditions. This coincidence has been reported previously in the literature, and is reviewed here in terms of possible aetiology. A new hypothesis to account for both conditions is offered, implicating free-floating degenerating debris from the otolithic apparatus. It is postulated that the gelatinous/proteinaceous component may account for an osmotically induced hydrops, while the calcified fragments may induce positional vertigo.
BibTeX: @article{Jahn2017, author = {Jahn, A F}, title = {Benign positional vertigo and endolymphatic hydrops: what is the connection?}, journal = {The Journal of laryngology and otology}, year = {2017}, volume = {131}, issue = {8}, pages = {658--660}, doi = {https://doi.org/10.1017/S002221511700130X}, keywords = {Aged; Benign Paroxysmal Positional Vertigo, etiology, pathology; Endolymphatic Hydrops, etiology, pathology; Female; Humans; Male; Middle Aged; Otolithic Membrane, pathology; Vestibule, Labyrinth, pathology; Benign Positional Vertigo; Endolymphatic Hydrops}, pmid = {28631586} }
Corvera-Behar, G., Corvera, J. and Hernandez, L.M.	Benign positional vertigo produces a specific pattern of abnormalities with high frequency vestibulo-ocular reflex testing. [Abstract] [BibTeX]	1994	Ear, nose, & throat journal Vol. 73(10), pp. 768-771	article
Abstract: The vestibulo-ocular reflex was studied at high frequencies of active head rotation (2 to 6 Hz) in twenty-three patients with benign positional vertigo (BPPV). Gain and phase measurements were obtained in the vertical and horizontal planes, and the results were compared to those of a control group consisting of 19 asymptomatic age-matched subjects. In the horizontal plane, the phase lead was significantly smaller in patients with BPPV as compared to controls (p < 0.01 at all frequencies). Vertical results did not differ from normals. These findings challenge "cupulolithiasis" as an explanation of the mechanism of BPPV's symptoms.
BibTeX: @article{Corvera-Behar1994, author = {Corvera-Behar, G and Corvera, J and Hernandez, L M}, title = {Benign positional vertigo produces a specific pattern of abnormalities with high frequency vestibulo-ocular reflex testing.}, journal = {Ear, nose, & throat journal}, year = {1994}, volume = {73}, issue = {10}, pages = {768--771}, keywords = {Adult; Aged; Ear, Inner, physiopathology, surgery; Female; Humans; Male; Meniere Disease, physiopathology, surgery; Middle Aged; Reflex, Vestibulo-Ocular, physiology; Vestibular Nerve, physiopathology, surgery}, pmid = {7805598} }
Tirelli, G., D'Orlando, E., Giacomarra, V. and Russolo, M.	Benign positional vertigo without detectable nystagmus. [Abstract] [BibTeX]	2001	The Laryngoscope Vol. 111(6), pp. 1053-1056	article	DOI
Abstract: To demonstrate that for treatment of benign positional vertigo it is not necessary to identify a positional nystagmus. Prospective trial of 43 patients with positional vertigo without clinical evidence of positional nystagmus who were treated with a modified canal-repositioning maneuver. Results were compared with the results obtained in the treatment of posterior semicircular cupolo-canalithiasis with typical positional nystagmus with the same repositioning maneuver. Treatment of 43 patients with positional vertigo without positional nystagmus resulted in a 60.46% (26/43) complete recovery rate and a 6% (3/43) persistence of disorder rate compared with a 90% complete recovery rate obtained in 90 patients with typical benign positional paroxysmal vertigo (with positional nystagmus). What is attempted by this work is to confirm that through clinical evaluation based on history and positioning tests alone, one can obtain acceptable results in treatment of supposed canalithiasis without having detected the pathognomonic nystagmus.
BibTeX: @article{Tirelli2001, author = {Tirelli, G and D'Orlando, E and Giacomarra, V and Russolo, M}, title = {Benign positional vertigo without detectable nystagmus.}, journal = {The Laryngoscope}, year = {2001}, volume = {111}, issue = {6}, pages = {1053--1056}, doi = {https://doi.org/10.1097/00005537-200106000-00022}, keywords = {Diagnosis, Differential; Electronystagmography; Humans; Physical Therapy Modalities; Posture; Treatment Outcome; Vertigo, diagnosis, etiology, rehabilitation; Vestibular Function Tests}, pmid = {11404620} }
Baloh, R.W., Honrubia, V. and Jacobson, K.	Benign positional vertigo: clinical and oculographic features in 240 cases. [Abstract] [BibTeX]	1987	Neurology Vol. 37(3), pp. 371-378	article
Abstract: We report the clinical and oculographic features in 240 patients with benign positional vertigo (BPV). In each case, after a rapid position change from the sitting to head-hanging position, a stereotyped torsional paroxysmal positional nystagmus was visually observed and recorded with electronystagmography (ENG). The mean age of onset was 54 years, with a range of 11 to 84 years. In slightly more than one-half of the cases (122/240) a likely diagnosis was determined. The most common identifiable causes were head trauma (17%) and viral neurolabyrinthitis (15%). Females outnumbered males approximately two to one in the idiopathic group. Abnormalities on bithermal caloric testing were found in 47% of patients. Only two patients, both with well-documented neurologic disorders, had central signs on ENG. Our data are consistent with a peripheral, posterior semicircular canal origin of BPV.
BibTeX: @article{Baloh1987, author = {Baloh, R W and Honrubia, V and Jacobson, K}, title = {Benign positional vertigo: clinical and oculographic features in 240 cases.}, journal = {Neurology}, year = {1987}, volume = {37}, issue = {3}, pages = {371--378}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Child; Craniocerebral Trauma, complications; Electronystagmography; Eye Movements; Female; Humans; Labyrinthitis, complications; Male; Middle Aged; Posture; Retrospective Studies; Vertigo, etiology, physiopathology}, pmid = {3822129} }
Del Rio, M. and Arriaga, M.A.	Benign positional vertigo: prognostic factors. [Abstract] [BibTeX]	2004	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 130(4), pp. 426-429	article	DOI
Abstract: We sought to assess prognostic factors associated with initial successful treatment and recurrence of benign paroxysmal positional vertigo (BPPV) with the canalith repositioning (CRP) maneuver with mastoid vibration. We conducted a retrospective chart review of 104 consecutive BPPV patients at a tertiary care referral center during 1999. The main outcome measures were resolution of BPPV and absence of nystagmus on Hallpike maneuver. Ninety-three patients (89.4%) experienced initial symptom resolution, and 21 of the initially successful patients had a recurrence (recurrence rate of 22.6%). Prior trauma or labyrinthitis was found to predict the lowest initial CRP success. Endolymphatic hydrops and central nervous system-related dizziness as cofactors with BPPV were associated with the highest recurrence rates. Specific concurrent otologic conditions are associated with different outcomes in BPPV.
BibTeX: @article{DelRio2004, author = {Del Rio, Maria and Arriaga, Moisés A}, title = {Benign positional vertigo: prognostic factors.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2004}, volume = {130}, issue = {4}, pages = {426--429}, doi = {https://doi.org/10.1016/j.otohns.2003.12.015}, keywords = {Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Physical Therapy Modalities; Prognosis; Recurrence; Retrospective Studies; Treatment Outcome; Vertigo, etiology, therapy}, pmid = {15100638} }
Dumas, G., Charachon, R. and Lavieille, J.P.	Benign positioning vertigo (BPV) and three-dimensional (3-D) eye movement analysis. [Abstract] [BibTeX]	1998	Acta oto-rhino-laryngologica Belgica Vol. 52(4), pp. 291-307	article
Abstract: Fifty two patients with positioning nystagmus were studied with the V.N.G. three-dimentional device of ULMER. In benign paroxysmal positional vertigo (BPPV) the torsionnal component is not pure: a vertical and a less important horizontal components also exist. They are not of the same amplitude on both eyes. The torsionnal and horizontal components are more important on the eye ipsilateral to the BPPV. The vertical component is more important on the contralateral eye. The horizontal canal B.P.V. (2% of the cases of B.P.V.) is so defined by the absence of vertical and torsionnal components. Three-D Eye Movement Analysis is helpful for differential diagnosis with the positional protocol described. The characteristics of central and peripheral paroxysmal positional nystagmus are given. The head Tilt and the ocular counter rolling reflex (O.C.R.) can be quantified with this device. It will be useful in the future to better explore the inferior root of the eighth nerve and the otolith organ. For clarity we propose to describe the torsionnal nystagmus so that the results are expressed with respect to the patient: clockwise nystagmus (in reference to the patient) would thus be also right rotatory nystagmus while left rotatory nystagmus would be also anticlockwise.
BibTeX: @article{Dumas1998, author = {Dumas, G and Charachon, R and Lavieille, J P}, title = {Benign positioning vertigo (BPV) and three-dimensional (3-D) eye movement analysis.}, journal = {Acta oto-rhino-laryngologica Belgica}, year = {1998}, volume = {52}, issue = {4}, pages = {291--307}, keywords = {Adult; Electrooculography; Eye Movements, physiology; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, diagnosis, etiology, physiopathology; Posture; Vertigo, diagnosis, etiology, physiopathology}, pmid = {9914801} }
Murdin, L., Hussain, K. and Schilder, A.G.M.	Betahistine for symptoms of vertigo. [Abstract] [BibTeX]	2016	The Cochrane database of systematic reviews(6), pp. CD010696	article	DOI
Abstract: Vertigo is a symptom in which individuals experience a false sensation of movement. This type of dizziness is thought to originate in the inner ear labyrinth or its neural connections. It is a commonly experienced symptom and can cause significant problems with carrying out normal activities. Betahistine is a drug that may work by improving blood flow to the inner ear. This review examines whether betahistine is more effective than a placebo at treating symptoms of vertigo from different causes. To assess the effects of betahistine in patients with symptoms of vertigo from different causes. The Cochrane ENT Information Specialist searched the Cochrane ENT Trials Register; Central Register of Controlled Trials (CENTRAL 2015, Issue 8); PubMed; EMBASE; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. We also contacted manufacturers and researchers in the field. The date of the search was 21 September 2015. We included randomised controlled trials of betahistine versus placebo in patients of any age with vertigo from any neurotological diagnosis in any settings. We used the standard methodological procedures expected by Cochrane. Our primary outcome was the proportion of patients with reduction in vertigo symptoms (considering together the intensity, frequency and duration those symptoms). We included 17 studies, with a total of 1025 participants; 12 studies were published (567 patients) and five were unpublished (458 patients). Sixteen studies including 953 people compared betahistine with placebo. All studies with analysable data lasted three months or less. The majority were at high risk of bias, but in some the risk of bias was unclear. One study, at high risk of bias, included 72 people with benign paroxysmal positional vertigo (BPPV) and compared betahistine with placebo; all patients also had particle repositioning manoeuvres. The studies varied considerably in terms of types of participants, their diagnoses, the dose of betahistine and the length of time it was taken for, the study methods and the way any improvement in vertigo symptoms was measured. Using the GRADE system, we judged the quality of evidence overall to be low for two outcomes (proportion of patients with improvement and proportion with adverse events).Pooled data showed that the proportion of patients reporting an overall reduction in their vertigo symptoms was higher in the group treated with betahistine than the placebo group: risk ratio (RR) 1.30, 95% confidence interval (CI) 1.05 to 1.60; 606 participants; 11 studies). This result should be interpreted with caution as the test for statistical heterogeneity as measured by the I(2) value was high.Adverse effects (mostly gastrointestinal symptoms and headache) were common but medically serious events in the study were rare and isolated: there was no difference in the frequency of adverse effects between the betahistine and placebo groups, where the rates were 16% and 15% respectively (weighted values, RR 1.03, 95% CI 0.76 to 1.40; 819 participants; 12 studies).Sixteen per cent of patients from both the betahistine and the placebo groups withdrew (dropped out) from the studies (RR 0.96, 95% CI 0.65 to 1.42; 481 participants; eight studies).Three studies looked at objective vestibular function tests as an outcome; the numbers of participants were small, techniques of measurement very diverse and reporting details sparse, so analysis of this outcome was inconclusive.We looked for information on generic quality of life and falls, but none of the studies reported on these outcomes. Low quality evidence suggests that in patients suffering from vertigo from different causes there may be a positive effect of betahistine in terms of reduction in vertigo symptoms. Betahistine is generally well tolerated with a low risk of adverse events. Future research into the management of vertigo symptoms needs to use more rigorous methodology and include outcomes that matter to patients and their families.
BibTeX: @article{Murdin2016, author = {Murdin, Louisa and Hussain, Kiran and Schilder, Anne G M}, title = {Betahistine for symptoms of vertigo.}, journal = {The Cochrane database of systematic reviews}, year = {2016}, issue = {6}, pages = {CD010696}, doi = {https://doi.org/10.1002/14651858.CD010696.pub2}, keywords = {Benign Paroxysmal Positional Vertigo, drug therapy; Betahistine, adverse effects, therapeutic use; Humans; Randomized Controlled Trials as Topic; Vertigo, drug therapy}, pmid = {27327415} }
Kaplan, D.M., Attal, U. and Kraus, M.	Bilateral benign paroxysmal positional vertigo following a tooth implantation. [Abstract] [BibTeX]	2003	The Journal of laryngology and otology Vol. 117(4), pp. 312-313	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo and may occur following recent head trauma. Bilateral involvement in BPPV is considered rare and has received little attention in the medical literature. We describe an unusual case of bilateral BPPV in a middle-aged woman that presented during a dental implantation, performed with the use of osteotomes. We discuss the diagnostic and therapeutic challenge of this entity.
BibTeX: @article{Kaplan2003, author = {Kaplan, Daniel M and Attal, Uriel and Kraus, Mordechai}, title = {Bilateral benign paroxysmal positional vertigo following a tooth implantation.}, journal = {The Journal of laryngology and otology}, year = {2003}, volume = {117}, issue = {4}, pages = {312--313}, doi = {https://doi.org/10.1258/00222150360600959}, keywords = {Dental Implantation, adverse effects; Female; Humans; Middle Aged; Posture; Vertigo, etiology, physiopathology}, pmid = {12816224} }
Kim, J.H., Kim, H.-J. and Kang, J.W.	Bilateral benign paroxysmal positional vertigo: an unusual complication of orthognathic surgery. [Abstract] [BibTeX]	2013	The British journal of oral & maxillofacial surgery Vol. 51(8), pp. e291-e292	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo of labyrinthine origin and usually idiopathic. However, 15-20% of all cases occur after trauma to the head, and it has rarely been reported after maxillofacial surgery, so to the best of our knowledge this is the first report of its bilateral occurrence after orthognathic surgery. It resolves slowly, but symptoms are incapacitating. It can be diagnosed from the history and physical examination, including the Dix-Hallpike test. Maxillofacial surgeons should be aware of it in patients who complain of dizziness after orthognathic surgery, and should know how to manage it properly.
BibTeX: @article{Kim2013, author = {Kim, Jeong Hong and Kim, Hak-Jin and Kang, Ju Wan}, title = {Bilateral benign paroxysmal positional vertigo: an unusual complication of orthognathic surgery.}, journal = {The British journal of oral & maxillofacial surgery}, year = {2013}, volume = {51}, issue = {8}, pages = {e291--e292}, doi = {https://doi.org/10.1016/j.bjoms.2013.05.151}, keywords = {Benign Paroxysmal Positional Vertigo, etiology; Dizziness, etiology; Female; Follow-Up Studies; Humans; Mandibular Osteotomy, adverse effects; Open Bite, surgery; Orthognathic Surgical Procedures, adverse effects; Osteotomy, Le Fort, adverse effects; Postoperative Complications; Prognathism, surgery; Young Adult; Zygoma, surgery; Benign paroxysmal positional vertigo; Bilateral; Orthognathic surgery}, pmid = {23791034} }
Karatayli-Ozgursoy, S., Stamper, G.C., Lundy, L.B. and Zapala, D.A.	Bilateral multicanal benign paroxysmal positional vertigo coexisting with a vestibular schwannoma: case report. [Abstract] [BibTeX]	2011	Ear, nose, & throat journal Vol. 90(1), pp. E10-E15	article
Abstract: We describe a rarely encountered case of coexisting bilateral multicanal benign paroxysmal positional vertigo (BPPV) and vestibular schwannoma in a 56-year-old woman. The patient had presented with a 10-year history of dizziness and imbalance, and her vestibular findings were perplexing. We decided on a working diagnosis of BPPV and began treatment. After several months of canalith repositioning maneuvers had failed to resolve her symptoms, we obtained magnetic resonance imaging, which revealed the presence of the vestibular schwannoma. This case serves as a reminder of the importance of differentiating between central and peripheral vestibular disorders, as well as central and anterior canal BPPV-induced down-beating nystagmus in order to establish the correct diagnosis and initiate appropriate treatment.
BibTeX: @article{Karatayli-Ozgursoy2011, author = {Karatayli-Ozgursoy, Selmin and Stamper, Greta C and Lundy, Larry B and Zapala, David A}, title = {Bilateral multicanal benign paroxysmal positional vertigo coexisting with a vestibular schwannoma: case report.}, journal = {Ear, nose, & throat journal}, year = {2011}, volume = {90}, issue = {1}, pages = {E10--E15}, keywords = {Benign Paroxysmal Positional Vertigo; Diagnosis, Differential; Ear Neoplasms, complications, diagnosis; Female; Humans; Magnetic Resonance Imaging; Middle Aged; Neurilemmoma, complications, diagnosis; Nystagmus, Pathologic, etiology; Vertigo, complications, diagnosis; Vestibular Diseases, complications, diagnosis}, pmid = {21229492} }
Longridge, N.S. and Barber, H.O.	Bilateral paroxysmal positioning nystagmus. [Abstract] [BibTeX]	1978	The Journal of otolaryngology Vol. 7(5), pp. 395-400	article
Abstract: The term "bilateral paroxysmal positioning nystagmus" (BPPN) refers to the occurrence of paroxysmal positioning nystagmus when the patient's head is placed in both right and left head-hanging positions. BPPN was found in at least 15% of 114 patients with benign positional vertigo. Head injury, central nervous system disease or both were causative in over half of patients with the finding. In some instances, paroxysmal positional nystagmus may be found when the abnormal ear (side) is uppermost rather than directed toward the floor; this fact may have important implications if singular neurectomy is to be performed.
BibTeX: @article{Longridge1978, author = {Longridge, N S and Barber, H O}, title = {Bilateral paroxysmal positioning nystagmus.}, journal = {The Journal of otolaryngology}, year = {1978}, volume = {7}, issue = {5}, pages = {395--400}, keywords = {Brain Diseases, complications; Brain Stem; Craniocerebral Trauma, complications; Electronystagmography; Humans; Inflammation, complications; Nystagmus, Pathologic, diagnosis, etiology; Posture; Vertigo, complications; Vestibular Nerve}, pmid = {739571} }
Walther, L.E., Nath, V., Krombach, G.A. and Di Martino, E.	Bilateral posterior semicircular canal aplasia and atypical paroxysmal positional vertigo: a case report. [Abstract] [BibTeX]	2008	Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale Vol. 28(2), pp. 79-82	article
Abstract: Isolated congenital malformations of semicircular canals are rare abnormalities. Most inner ear abnormalities occur in syndromes and are associated with hearing loss. Unilateral or bilateral single aplasia of one semicircular canal does not usually result in vertigo, but these become clinically important if there are clinical complaints of vertigo. Computed tomography imaging and high resolution magnetic resonance imaging may reveal inner ear abnormalities. The case is presented here of a 46-year-old male with a 10-year history of recurrent positional vertigo with strong onset when changing position to the left side. Magnetic resonance imaging of the inner ear showed a bilateral posterior semicircular canal aplasia as well as an enlarged vestibule on both sides. Dix-Hallpike positional manoeuvre revealed a positional nystagmus in the left head-hanging position of short duration and latency of a few seconds. When rising, vertigo occurred, but no nystagmus was visible. The fast phase of the nystagmus was mainly vertical down-beating with a slight torsional component to the uppermost ear. Although benign paroxysmal vertigo of the anterior canal was suspected, physical therapy was not effective using a modified liberatory manoeuvre. Brandt-Daroff therapy was effective permanently.
BibTeX: @article{Walther2008, author = {Walther, L E and Nath, V and Krombach, G A and Di Martino, E}, title = {Bilateral posterior semicircular canal aplasia and atypical paroxysmal positional vertigo: a case report.}, journal = {Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale}, year = {2008}, volume = {28}, issue = {2}, pages = {79--82}, keywords = {Humans; Magnetic Resonance Imaging; Male; Middle Aged; Semicircular Canals, diagnostic imaging, pathology, physiopathology; Severity of Illness Index; Tomography, X-Ray Computed; Vertigo, diagnosis, physiopathology}, pmid = {18669072} }
Das, S. and Rea, P.A.	Bilateral posterior semi-circular canal obliteration surgery for refractory benign paroxysmal positional vertigo (BPPV) in three patients. [BibTeX]	2017	Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery Vol. 42(2), pp. 480-483	article	DOI
BibTeX: @article{Das2017a, author = {Das, S and Rea, P A}, title = {Bilateral posterior semi-circular canal obliteration surgery for refractory benign paroxysmal positional vertigo (BPPV) in three patients.}, journal = {Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery}, year = {2017}, volume = {42}, issue = {2}, pages = {480--483}, doi = {https://doi.org/10.1111/coa.12636}, keywords = {Adult; Benign Paroxysmal Positional Vertigo, complications, diagnosis, surgery; Female; Humans; Middle Aged; Semicircular Canals, surgery}, pmid = {26878121} }
Lee, S.B., Lee, C.H., Kim, Y.J. and Kim, H.-M.	Biochemical markers of bone turnover in benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2017	PloS one Vol. 12(5), pp. e0176011	article	DOI
Abstract: Several studies have suggested a possible relationship between recurrent benign paroxysmal positional vertigo (BPPV) and altered calcium homeostasis in the endolymph of the inner ear. The present study aimed to evaluate the association between Ca2+ and vitamin D status and BPPV occurrence as well as the status of bone biochemical markers in osteoporotic patients who were diagnosed with idiopathic BPPV. The study included total 132 patients who were referred to our clinic between August 2008 and October 2013. Based on the bone mineral density (BMD) results, the subjects were divided into three groups: normal BMD (n = 34), osteopenia (n = 40) and osteoporosis (n = 58). The biochemical markers of bone turnover including serum Carboxy-terminal telopeptide of type I collagen (s-CTX), osteocalcin, alkaline phosphatase (ALP) and urinary free deoxypyridinoline (u-DPD), were analyzed, along with the serum Ca2+ and vitamin D levels. The mean serum calcium, phosphate and creatinine clearance levels were within the standard laboratory reference range. The incidence of vitamin D deficiency was 11.8% (4/34) in the normal BMD group, 15% (6/40) in the osteopenia group and 43.1% (25/58) in the osteoporosis group. There was a positive correlation between the 25(OH)D and BMD results in the patients with BPPV. Among the bone turnover markers, the osteocalcin and u-DPD levels were significantly elevated in the osteoporotic patients with BPPV. Multiple logistic regression analyses showed that osteoporosis and vitamin D deficiency were associated with BPPV. Our findings suggest that the prevalence of BPPV in osteoporotic patients is associated with vitamin D deficiency and high bone turnover rates at systemic level, which could disturb local Ca2+ homeostasis in the inner ear.
BibTeX: @article{Lee2017, author = {Lee, Sun Bin and Lee, Chang Ho and Kim, Young Ju and Kim, Hyoung-Mi}, title = {Biochemical markers of bone turnover in benign paroxysmal positional vertigo.}, journal = {PloS one}, year = {2017}, volume = {12}, issue = {5}, pages = {e0176011}, doi = {https://doi.org/10.1371/journal.pone.0176011}, keywords = {Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, metabolism; Biomarkers, metabolism; Bone Remodeling; Calcium, metabolism; Female; Humans; Male; Middle Aged; Vitamin D, metabolism}, pmid = {28467451} }
Rajguru, S.M., Ifediba, M.A. and Rabbitt, R.D.	Biomechanics of horizontal canal benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2005	Journal of vestibular research : equilibrium & orientation Vol. 15(4), pp. 203-214	article
Abstract: Horizontal canal (HC) benign paroxysmal positional vertigo (HC-BPPV) is a vestibular disorder characterized by bouts of horizontal ocular nystagmus induced during reorientation of the head relative to gravity. The present report addresses the application of a morphologically descriptive 3-canal biomechanical model of the human membranous labyrinth to study gravity-dependent semicircular canal responses during this condition. The model estimates dynamic cupular and endolymph displacements elicited during HC-BPPV provocative diagnostic maneuvers and canalith repositioning procedures (CRPs). The activation latencies in response to an HC-BPPV provocative diagnostic test were predicted to vary depending upon the initial location of the canalith debris (e.g. within the HC lumen vs. in the ampulla). Results may explain why the onset latency of ocular nystagmus evoked by the Dix-Hallpike provocative maneuver for posterior canal BPPV are typically longer than the latencies evoked by analogous tests for HC-BPPV. The model was further applied to assess the efficacy of a 360 degrees -rotation CRP for the treatment of canalithiasis HC-BPPV.
BibTeX: @article{Rajguru2005, author = {Rajguru, Suhrud M and Ifediba, Marytheresa A and Rabbitt, Richard D}, title = {Biomechanics of horizontal canal benign paroxysmal positional vertigo.}, journal = {Journal of vestibular research : equilibrium & orientation}, year = {2005}, volume = {15}, issue = {4}, pages = {203--214}, keywords = {Biomechanical Phenomena, methods; Humans; Models, Biological; Nystagmus, Pathologic, physiopathology; Nystagmus, Physiologic, physiology; Semicircular Canals, physiopathology; Vertigo, diagnosis, physiopathology; Vestibular Function Tests}, pmid = {16286702} }
Lança, S.M., Gazzola, J.M., Kasse, C.A., Branco-Barreiro, F.C.A., Vaz, D.P. and Scharlach, R.C.	Body balance in elderly patients, 12 months after treatment for BPPV. [Abstract] [BibTeX]	2013	Brazilian journal of otorhinolaryngology Vol. 79(1), pp. 39-46	article
Abstract: Benign Paroxysmal Positional Vertigo is highly prevalent in the elderly population, triggering major changes in body balance. To compare the results obtained from static posturography in the elderly before and after otoliths repositioning maneuvers and 12 months after treatment onset. longitudinal, descriptive and analytical study. Elderly patients with clinical diagnosis of BPPV submitted to Balance Rehabilitation Unit static posturography in 10 sensory conditions at three time intervals: before and after the repositioning maneuver and12 months after the treatment We studied 23 subjects with a mean age of 68.74 years. Posturography revealed that the stability limit was not significantly different when the three time intervals were compared (p = 0.405). The center of pressure (CoP) showed a significant change in condition 2 (stable surface and closed eyes), because after the repositioning maneuver, the CoP significantly differed vis-à-vis the results before and 12 months after the treatment (p = 0.003). The values of body velocity sway (BVS) were significantly different in six sensory conditions in these three time intervals. 12 months after the treatment for BPPV, the static posturography showed balance abnormalities similar to those found before treatment.
BibTeX: @article{Lanca2013, author = {Lança, Solange Martiliano and Gazzola, Juliana Maria and Kasse, Cristiane Akemi and Branco-Barreiro, Fatima Cristina Alves and Vaz, Daniela Patricia and Scharlach, Renata Coelho}, title = {Body balance in elderly patients, 12 months after treatment for BPPV.}, journal = {Brazilian journal of otorhinolaryngology}, year = {2013}, volume = {79}, issue = {1}, pages = {39--46}, keywords = {Aged; Benign Paroxysmal Positional Vertigo; Female; Humans; Longitudinal Studies; Male; Middle Aged; Postural Balance, physiology; Treatment Outcome; Vertigo, physiopathology, rehabilitation}, pmid = {23503906} }
Yang, C.J., Kim, Y., Lee, H.S. and Park, H.J.	Bone mineral density and serum 25-hydroxyvitamin D in patients with idiopathic benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2018	Journal of vestibular research : equilibrium & orientation Vol. 27(5-6), pp. 287-294	article	DOI
Abstract: The aim of this study was to evaluate the relationship between bone mineral density (BMD) and 25-hydroxyvitamin D with the occurrence and recurrence of BPPV. The records of 130 idiopathic BPPV patients (55±12 years old, 30 men and 100 women) and 130 age- and sex-matched controls who underwent bone mineral densitometry between April 2012 and September 2015 were reviewed retrospectively. We compared the BMD and serum 25-hydroxyvitamin D between the patients and controls, and also compared the BMD between recurrent and non-recurrent BPPV groups. Among the female subjects, the BPPV group showed a significantly decreased BMD compared to the controls (p < 0.05). The men in the control group had significantly higher 25-hydroxyvitamin D levels than the men with BPPV (p < 0.05). Sixty-three patients (48%) reported recurrent attacks of BPPV. The women with recurrent BPPV were significantly older and showed a significantly lower BMD than non-recurrent women (p < 0.001). However, multiple regression analysis revealed that age alone was significantly associated with the recurrence of BPPV in women. BMD in women and serum 25-hydroxyvitamin D levels in men are associated with the occurrence of BPPV. Only age is an independent predictor of recurrence, though a low BMD and age correlate with the recurrence of BPPV.
BibTeX: @article{Yang2018a, author = {Yang, Chan Joo and Kim, Yehree and Lee, Hwan Seo and Park, Hong Ju}, title = {Bone mineral density and serum 25-hydroxyvitamin D in patients with idiopathic benign paroxysmal positional vertigo.}, journal = {Journal of vestibular research : equilibrium & orientation}, year = {2018}, volume = {27}, issue = {5-6}, pages = {287--294}, doi = {https://doi.org/10.3233/VES-170625}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, blood, diagnosis; Bone Density, physiology; Female; Humans; Male; Middle Aged; Recurrence; Retrospective Studies; Vitamin D, analogs & derivatives, blood; Young Adult; 25-hydroxyvitamin D; Benign paroxysmal positional vertigo; bone mineral density; osteoporosis}, pmid = {29400685} }
Gresty, M.A.	BPPV and fitness to fly--or drive. [BibTeX]	2008	Aviation, space, and environmental medicine Vol. 79(5), pp. 541; author reply 541-541; author reply 542	article
BibTeX: @article{Gresty2008, author = {Gresty, Michael A}, title = {BPPV and fitness to fly--or drive.}, journal = {Aviation, space, and environmental medicine}, year = {2008}, volume = {79}, issue = {5}, pages = {541; author reply 541--541; author reply 542}, keywords = {Aerospace Medicine; Automobile Driving; Head, physiopathology; Humans; Movement; Physical Fitness; Recurrence; Vertigo, diagnosis}, pmid = {18500054} }
Nakayama, M. and Epley, J.M.	BPPV and variants: improved treatment results with automated, nystagmus-based repositioning. [Abstract] [BibTeX]	2005	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 133(1), pp. 107-112	article	DOI
Abstract: Although classical benign paroxysmal positional vertigo has generally been resolvable by routine manual repositioning maneuvers, nevertheless resistant cases and variants remain a significant problem. We investigated the efficacy of analyzing and treating positional vertigo with a system that provides unlimited, automated maneuverability of the patient while maintaining constant electronic monitoring of nystagmus. A power-driven, multi-axial positioning chair combined with ongoing infrared video-oculography was used to manage 986 subjects in a tertiary clinical setting with complaints of positional vertigo. A nystagmus-based strategy and condition-specific protocols were used. Significantly enhanced treatment outcomes were achieved, especially regarding intransigent and variant forms. Pertinent correlations were noted. This multi-axial positioning chair combination provided enhanced diagnostic and treatment capabilities for managing positional vertigo, apparently due to improved analytical capability, precision repeatability, and unlimited 360-degree maneuverability. This advancement should be considered for tertiary management of complicated labyrinthine lithiasis.
BibTeX: @article{Nakayama2005, author = {Nakayama, Meiho and Epley, John M}, title = {BPPV and variants: improved treatment results with automated, nystagmus-based repositioning.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2005}, volume = {133}, issue = {1}, pages = {107--112}, doi = {https://doi.org/10.1016/j.otohns.2005.03.027}, keywords = {Adult; Aged; Aged, 80 and over; Electronystagmography; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, diagnosis, etiology, physiopathology; Physical Therapy Modalities, instrumentation; Posture; Treatment Outcome; Vertigo, complications, physiopathology, therapy}, pmid = {16025062} }
Kahraman, S.S., Ozcan, O., Arli, C., Ustun, I., Erduran, R., Akoglu, E. and Gokce, C.	Calcium Homeostasis During Attack and Remission in Patients With Idiopathic Benign Paroxysmal Positional Vertigo. [Abstract] [BibTeX]	2016	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 37(9), pp. 1388-1392	article	DOI
Abstract: To evaluate changes in calcium metabolism in patients with idiopathic benign paroxysmal positional vertigo (BPPV) on initial presentation and at the follow-up visit. The study comprised a total of 31 patients aged greater than 18 years who presented at the otorhinolaryngology outpatient clinic of our hospital, newly diagnosed as idiopathic BPPV based on the history compatible with BPPV and positive provocative maneuver (either Dix-Hallpike or Roll test). The first blood sample was obtained on the day of initial presentation when the patient was found to have active unilateral BPPV. After 6 months, a blood sample was again drawn in accordance with the procedure. Blood samples were analyzed for data on 25-hydroxyvitamin D (25(OH)-D), total calcium, parathormone and ionized calcium on initial presentation, and at the follow-up visit. The patients comprised 20 (64.5%) women and 11 (35.5%) men with a mean age of 49.78 years (range, 23-75 years). During an attack a higher prevalence of decreased serum Vitamin D is less than 20 ng/ml, was determined (93.5% versus 38.7%). There were statistical differences between the Vitamin D values, parathormone, and corrected by pH ionized calcium in both periods (p < 0.05). A statistically significant association was determined between Vitamin D and calcium metabolism in patients with idiopathic BPPV. It can be considered that Vitamin D deficiency and decreased ionized Ca level may be a risk for BPPV, not only in patients with osteoporosis but also in all patients. Very low levels of 25(OH)-D seem to be associated with recurrence of BPPV. The recurrences might possibly be prevented with supplementary Vitamin D especially in those with recurrent idiopathic BPPV but further studies would be necessary to determine this.
BibTeX: @article{Kahraman2016, author = {Kahraman, Serif Samil and Ozcan, Oguzhan and Arli, Cengiz and Ustun, Ihsan and Erduran, Rana and Akoglu, Ertap and Gokce, Cumali}, title = {Calcium Homeostasis During Attack and Remission in Patients With Idiopathic Benign Paroxysmal Positional Vertigo.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2016}, volume = {37}, issue = {9}, pages = {1388--1392}, doi = {https://doi.org/10.1097/MAO.0000000000001167}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo, blood; Calcium, blood; Female; Homeostasis; Humans; Male; Middle Aged; Vitamin D, analogs & derivatives, blood; Young Adult}, pmid = {27525708} }
Yetişer, S. and İnce, D.	Caloric Analysis of Patients with Benign Paroxysmal Positional Vertigo. [Abstract] [BibTeX]	2017	The journal of international advanced otology Vol. 13(3), pp. 390-393	article	DOI
Abstract: The aim of this study is to compare nystagmus characteristics after caloric irrigation in patients with lateral canal (LC) and posterior canal (PC) benign paroxysmal positional vertigo (BPPV) and to analyze the role of symptom duration. A prospective study was conducted in 65 patients with BPPV (20 LC and 45 PC) who were subjected to caloric testing. Average slow-phase velocity and nystagmus duration were analyzed. Caloric hypo-excitability was 20.4%. It was more evident in patients with apogeotropic-type LC-BPPV. The comparison of average slow-phase velocity of the nystagmus and nystagmus duration between selected types of BPPV for pathologic, non-pathologic, and the control ears after warm and cold stimulation was not statistically significant (p>0.05). No correlation was found between caloric results and symptom duration (p>0.05). Some patients presented caloric hypo-excitability. Reliability of caloric testing to differentiate the ear with normal and abnormal vestibular function in different types of BPPV was low. No difference was found in the analysis of the impact of symptom duration. Caloric testing is not an ideal tool to study BPPV.
BibTeX: @article{Yetiser2017, author = {Yetişer, Sertaç and İnce, Dilay}, title = {Caloric Analysis of Patients with Benign Paroxysmal Positional Vertigo.}, journal = {The journal of international advanced otology}, year = {2017}, volume = {13}, issue = {3}, pages = {390--393}, doi = {https://doi.org/10.5152/iao.2017.3312}, pmid = {28639556} }
Mahringer, A. and Rambold, H.A.	Caloric test and video-head-impulse: a study of vertigo/dizziness patients in a community hospital. [Abstract] [BibTeX]	2014	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 271(3), pp. 463-472	article	DOI
Abstract: The head-impulse test (HIT) is an important test for examining unilateral vestibular hypofunction. The new video-head-impulse test (vHIT) is more sensitive and specific than the clinical bedside-head-impulse test (bHIT). Alternatively, one can test for vestibular hypofunction with the caloric irrigation test. Various studies showed that both tests may not always identify vestibular hypofunction; instead, the results of the tests might be contradictory. To evaluate the diagnostic value of these tests, we routinely measured patients exhibiting vertigo or dizziness at our community hospital with bithermal caloric irrigation, the bHIT and the vHIT. Only those patients (n = 172) with a pathological caloric irrigation test of more than 25 % unilateral weakness in the Jongkee's formula were included. Out of these patients, 41 % had a pathologic vHIT. Among the subgroup with acute symptoms (symptom onset within 5 days), 63 % had a pathological video-head-impulse, whereas only 33 % of the non-acute group (symptom onset more than 5 days) tested pathological. A pathological HIT depended on the disease stage, the amount of unilateral weakness in caloric examination and on the test itself.
BibTeX: @article{Mahringer2014, author = {Mahringer, Andrea and Rambold, Holger A}, title = {Caloric test and video-head-impulse: a study of vertigo/dizziness patients in a community hospital.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2014}, volume = {271}, issue = {3}, pages = {463--472}, doi = {https://doi.org/10.1007/s00405-013-2376-5}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo; Caloric Tests, methods; Cohort Studies; Dizziness, diagnosis, etiology; Female; Head Impulse Test, methods; Hospitals, Community; Humans; Male; Meniere Disease, complications, diagnosis; Middle Aged; Migraine Disorders, complications, diagnosis; Retrospective Studies; Sensitivity and Specificity; Somatoform Disorders, complications, diagnosis; Vertigo, complications, diagnosis, etiology; Vestibular Neuronitis, complications, diagnosis; Video Recording, methods}, pmid = {23494283} }
Tjell, C., Iglebekk, W. and Borenstein, P.	Can a Chronic BPPV With a History of Trauma be the Trigger of Symptoms in Vestibular Migraine, Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), and Whiplash Associated Disorders (WAD)? A Retrospective Cohort Study. [Abstract] [BibTeX]	2019	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 40(1), pp. 96-102	article	DOI
Abstract: In patients with chronic benign paroxysmal positional vertigo (BPPV), i.e., chronic vestibular multicanalicular canalithiasis (CVMCC), abnormal signals are transmitted from diseased labyrinths via the healthy vestibular nuclei complex to their end organs. The vestibulo-thalamo-cortical reflex as proposed in vestibular migraine is just one of these reflexes. In a group of patients diagnosed with CVMCC otolith repositioning maneuvers specific for each semicircular canal (SCC) ameliorated pain and other symptoms in 90%. Increased awareness of CVMCC may reduce suffering and continuous medication. To evaluate if CVMCC can be the trigger of symptoms in vestibular migraine, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and whiplash associated disorders (WAD). Retrospective consecutive observational cohort study. Ambulatory at a private Otoneurology Centre. One hundred sixty-three patients with CVMCC and a history of trauma. Based on the symptoms (structured symptom questionnaire), the patients are post hoc sub grouped according to the criteria of the different diagnoses. Frequency of patients with CVMCC who fulfill the criteria of the different diagnoses. 98% of all patients with CVMCC fulfill the Barany Society criteria of a probable vestibular migraine; 17% fulfill the International Classification of Headache Disorders defined vestibular migraine criteria; 63% fulfill the Fukuda criteria of ME/CFS; 100% of the patients with WAD suffer from CVMCC. This survey supports the hypothesis that CVMCC can be the trigger of symptoms in vestibular migraine, ME/CFS, and WAD. The actual diagnosis the patient receives is often in accordance with the patient's dominant symptom.
BibTeX: @article{Tjell2019, author = {Tjell, Carsten and Iglebekk, Wenche and Borenstein, Peter}, title = {Can a Chronic BPPV With a History of Trauma be the Trigger of Symptoms in Vestibular Migraine, Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), and Whiplash Associated Disorders (WAD)? A Retrospective Cohort Study.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2019}, volume = {40}, issue = {1}, pages = {96--102}, doi = {https://doi.org/10.1097/MAO.0000000000002020}, pmid = {30303941} }
Heidenreich, K.D., Beaudoin, K. and White, J.A.	Can active lateral canal benign paroxysmal positional vertigo mimic a false-positive head thrust test? [Abstract] [BibTeX]	2009	American journal of otolaryngology Vol. 30(5), pp. 353-355	article	DOI
Abstract: We present a patient with positive head thrust test (HTT) and video-oculography (VOG) findings suggestive of active lateral semicircular canal (LSCC) benign paroxysmal positional vertigo (BPPV). This patient was seen in a tertiary vestibular clinic for episodic vertigo. He exhibited robust corrective refixation saccades on HTT to the right and evidence of active contralateral LSCC BPPV on positional testing. Treatment of the LSCC BPPV led to immediate resolution of vertigo and near-normalization of the HTT on follow-up testing. The pathophysiologic basis and clinical implications of LSCC BPPV mimicking a false-positive HTT are discussed in detail.
BibTeX: @article{Heidenreich2009, author = {Heidenreich, Katherine D and Beaudoin, Kelly and White, Judith A}, title = {Can active lateral canal benign paroxysmal positional vertigo mimic a false-positive head thrust test?}, journal = {American journal of otolaryngology}, year = {2009}, volume = {30}, issue = {5}, pages = {353--355}, doi = {https://doi.org/10.1016/j.amjoto.2008.06.017}, keywords = {Diagnosis, Differential; False Positive Reactions; Head Movements; Humans; Male; Middle Aged; Posture; Semicircular Canals, physiopathology; Treatment Outcome; Vertigo, physiopathology, therapy; Vestibular Function Tests; Video Recording}, pmid = {19720258} }
Torun, M.T., Yalçın, Y. and Özkan, Ö.	Can CK-MB be used as a marker in benign paroxysmal positional vertigo attack? [Abstract] [BibTeX]	2017	The international tinnitus journal Vol. 20(2), pp. 69-72	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is one of the main causes of vertigo. More than 90% of cases of positional vertigo and nystagmus can be associated with BPPV. There is no known specific laboratory test for BPPV. Because of the possible muscle activity in BPPV (especially result of nause, vomiting and increasing heart rate) we thought the CK-MB levels may change in this situation. The purpose of this study was to investigate the relation between serum CK-MB levels and BPPV and attacks. The medical records of 35 patients with BPPV presenting to our clinic between November 2014 and November 2015 were investigated retrospectively. Thirty-two control patients with no vertigo, muscular or cardiac disease and with measured CK-MB levels were randomized into a control group. Both groups' existing CK-MB levels were obtained from the patient records. CK-MB values measured before BPPV attack from 11 patients in the patient group were also recorded. The patient and control groups were similar in terms of demographic parameters. CK-MB values at time of attack in the patient group ranged between 5.4 and 38.9 (mean: 19.67 ± 6.81), while control group values ranged between 12 and 27.9 (mean: 20.31 ± 4.54). CK-MB values in 11 patients in the patient group measured before attack ranged between 8.9 and 24 (mean: 17.02 ± 4.97), and CK-MB values during attack ranged between 9 and 34 (mean: 19.74 ± 7.64). Although CK-MB elevation at time of attack was determined in patients with BPPV, this was not statistically significant.
BibTeX: @article{Torun2017, author = {Torun, Mümtaz Taner and Yalçın, Yusuf and Özkan, Özalkan}, title = {Can CK-MB be used as a marker in benign paroxysmal positional vertigo attack?}, journal = {The international tinnitus journal}, year = {2017}, volume = {20}, issue = {2}, pages = {69--72}, doi = {https://doi.org/10.5935/0946-5448.20160013}, keywords = {MB form; biomarkers; creatine kinas; nystagmus; pathologic; pharmacological; vertigo}, pmid = {28452716} }
Cranfield, S., Mackenzie, I. and Gabbay, M.	Can GPs diagnose benign paroxysmal positional vertigo and does the Epley manoeuvre work in primary care? [BibTeX]	2010	The British journal of general practice : the journal of the Royal College of General Practitioners Vol. 60(578), pp. 698-699	article	DOI
BibTeX: @article{Cranfield2010, author = {Cranfield, Sarah and Mackenzie, Ian and Gabbay, Mark}, title = {Can GPs diagnose benign paroxysmal positional vertigo and does the Epley manoeuvre work in primary care?}, journal = {The British journal of general practice : the journal of the Royal College of General Practitioners}, year = {2010}, volume = {60}, issue = {578}, pages = {698--699}, doi = {https://doi.org/10.3399/bjgp10X515557}, keywords = {General Practice, methods; Humans; Posture; Semicircular Canals; Vertigo, diagnosis}, pmid = {20849709} }
Norré, M.E.	Can posturography contribute to the diagnosis of vertigo in patients where other tests fail to do so? [Abstract] [BibTeX]	1994	Acta oto-laryngologica Vol. 114(5), pp. 465-472	article
Abstract: In this study, patients showing abnormal posturographic results in a test-configuration upon examination of the visuo-proprioceptive-vestibular interaction (Static Posturography type III, SPGIII) are reviewed. Group I (n = 81) comprised patients for whom no clear diagnosis could be obtained (neither central nor peripheral) and with rather atypical complaints. Group II (n = 77) comprised patients in whom a well-defined peripheral disorder could be found (typical provoked vertigo as BPPV (n = 30) and Meniere's disease (n = 30)). Group I consisted of s subgroup Ia, including patients with a complete negative classical examination (n = 32), a subgroup Ib with patients showing minor central signs (n = 28), and subgroup Ic comprising patients with slight peripheral indications (n = 21). The findings in SPGIII were compared between these two groups and are discussed in the light of earlier experience with such data in typical peripheral vestibular disorders. Similar sensory interaction patterns were found in both groups, with only small differences between them, suggesting that in some of these cases, especially in subgroups Ia and Ic, vestibular disturbance might be present, which would not have been sufficiently and clearly revealed by the classical tests. Especially the negative effects, i.e. when the withdrawal of a sensory input improved stability instead of aggravating it, which is the opposite to what should be expected, suggest that the other sensory inputs, vision and proprioception, play a role in the definition of the posturographic results in typical vestibular disorders as well as in diagnosis.
BibTeX: @article{Norre1994b, author = {Norré, M E}, title = {Can posturography contribute to the diagnosis of vertigo in patients where other tests fail to do so?}, journal = {Acta oto-laryngologica}, year = {1994}, volume = {114}, issue = {5}, pages = {465--472}, keywords = {Adult; Aged; Audiometry, Pure-Tone, statistics & numerical data; Dizziness, diagnosis; Electronystagmography, statistics & numerical data; Evoked Potentials, Auditory, Brain Stem; Female; Humans; Male; Meniere Disease, diagnosis; Middle Aged; Neurologic Examination, methods, statistics & numerical data; Posture; Vertigo, diagnosis}, pmid = {7825425} }
Shim, D.B., Ko, K.M., Kim, J.H., Lee, W.-S. and Song, M.H.	Can the affected semicircular canal be predicted by the initial provoking position in benign paroxysmal positional vertigo? [Abstract] [BibTeX]	2013	The Laryngoscope Vol. 123(9), pp. 2259-2263	article	DOI
Abstract: The study evaluated the relationship between the position that initially provoked vertigo and the affected semicircular canal (SCC) in patients with benign paroxysmal positional vertigo (BPPV), and aimed to predict the side affected by BPPV through history taking regarding the provoking position. Prospective study at a tertiary hospital. A total of 521 patients with BPPV involving the posterior or horizontal SCCs performed questionnaires at initial visit asking to choose the initial provoking position among the 10 positions corresponding to one of the three planes (roll, pitch, or yaw). After excluding 45 patients showing signs of simultaneous multiple canal or anterior canal involvement, the frequency of the provoking positions and the correlation between the side of the provoking position and the ear affected by BPPV were analyzed. There were 239 patients with posterior SCC BPPV (p-BPPV) and 237 patients with horizontal SCC BPPV (h-BPPV). The waking-up position was the most common provoking position in both types of BPPV. Statistically significant correlation was demonstrated between the side of the provoking position at the onset of vertigo and the affected side by BPPV (P < .01) in patients with p-BPPV as well as h-BPPV (geotropic type [Geo]), but not in patients with h-BPPV (apogeotropic type [Apo]). History taking regarding the side of provoking position at the onset of vertigo may help predict the side affected by BPPV in p-BPPV and h-BPPV (Geo). When h-BPPV (Apo) is suspected, further detailed examinations using additional localization methods should be performed.
BibTeX: @article{Shim2013, author = {Shim, Dae Bo and Ko, Kyung Min and Kim, Ji Hong and Lee, Won-Sang and Song, Mee Hyun}, title = {Can the affected semicircular canal be predicted by the initial provoking position in benign paroxysmal positional vertigo?}, journal = {The Laryngoscope}, year = {2013}, volume = {123}, issue = {9}, pages = {2259--2263}, doi = {https://doi.org/10.1002/lary.23898}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Child; Cohort Studies; Female; Head; Humans; Male; Middle Aged; Movement; Patient Positioning, methods; Posture; Predictive Value of Tests; Prospective Studies; Risk Factors; Semicircular Canals, physiopathology; Supine Position; Tertiary Care Centers; Vertigo, diagnosis, physiopathology; Vestibular Function Tests; Young Adult; Benign paroxysmal positional vertigo; provoking position; semicircular canal}, pmid = {23794472} }
Soto-Varela, A., Rossi-Izquierdo, M. and Santos-Pérez, S.	Can we predict the efficacy of the semont maneuver in the treatment of benign paroxysmal positional vertigo of the posterior semicircular canal? [Abstract] [BibTeX]	2011	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 32(6), pp. 1008-1011	article	DOI
Abstract: To establish success- or failure-predicting factors in Semont maneuver in the treatment of benign paroxysmal positional vertigo. Prospective study. Referral center, institutional practice, ambulatory care (outpatient clinic). A consecutive sample of 135 patients diagnosed with unilateral benign paroxysmal positional vertigo of posterior semicircular canal for 3 years (September 2007 to August 2010). Semont maneuver. Duration of the latency period and nystagmus status with the Dix-Hallpike test. Presence or absence of orthotropic nystagmus in the second position of the Semont maneuver. Effectiveness of the Semont maneuver (cure versus no cure). The Semont maneuver is effective in 73% of the patients. Orthotropic nystagmus was present in 67% of the cases and absent in 33%; when we found orthotropic nystagmus, the maneuver was effective in 81% of the patients, but only in 57% if this nystagmus was not present (Fisher's exact test, p = 0.004; odds ratio, 3.308; 95% confidence interval, 1.492-7.334). The maneuver's efficacy and the presence of orthotropic nystagmus were not affected by the duration of nystagmus status in the Dix-Hallpike test. The duration of the latency period had no effect on the maneuver's efficacy, but it did affect the appearance of orthotropic nystagmus (Mann-Whitney test, p = 0.016). The presence of orthotropic nystagmus in the second position of the Semont maneuver indicates a good prognosis, but its absence does not necessarily mean that the maneuver will fail. Orthotropic nystagmus is more common in patients with shorter latency periods, suggesting that its appearance is related to cupulolithiasis mechanisms.
BibTeX: @article{Soto-Varela2011, author = {Soto-Varela, Andrés and Rossi-Izquierdo, Marcos and Santos-Pérez, Sofía}, title = {Can we predict the efficacy of the semont maneuver in the treatment of benign paroxysmal positional vertigo of the posterior semicircular canal?}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2011}, volume = {32}, issue = {6}, pages = {1008--1011}, doi = {https://doi.org/10.1097/MAO.0b013e3182267f02}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, therapy; Patient Positioning; Posture; Prospective Studies; Treatment Outcome; Vertigo, therapy}, pmid = {21725255} }
Anagnostou, E., Stamboulis, E. and Kararizou, E.	Canal conversion after repositioning procedures: comparison of Semont and Epley maneuver. [Abstract] [BibTeX]	2014	Journal of neurology Vol. 261(5), pp. 866-869	article	DOI
Abstract: Although the efficacy of Semont (SM) and Epley maneuvers (EM) for treatment of posterior canal benign paroxysmal positional vertigo (BPPV) is well established, data comparing SM and EM regarding maneuver-induced canal switch are lacking. We prospectively investigated 102 posterior canal BPPV patients after application of the Semont or the Epley maneuver and looked for the appearance of ipsilateral horizontal canal BPPV symptoms. Although treatment success was similar for SM and EM (67 and 76 %, respectively), there was a significant difference in posterior-to-horizontal canal switch rates. In particular, 4 of 51 patients (7.8 %) of the EM group converted to the geotropic type of horizontal canal BPPV, whereas none of the 51 SM patients exhibited a canal switch. All four patients were cleared with a single barbecue maneuver. Our data suggest a small but significant difference in canal switch rate between EM and SM, which could be partly explained by the higher number of maneuver steps during which the head is in the dependent position throughout the EM.
BibTeX: @article{Anagnostou2014, author = {Anagnostou, Evangelos and Stamboulis, Eleftherios and Kararizou, Evangelia}, title = {Canal conversion after repositioning procedures: comparison of Semont and Epley maneuver.}, journal = {Journal of neurology}, year = {2014}, volume = {261}, issue = {5}, pages = {866--869}, doi = {https://doi.org/10.1007/s00415-014-7290-2}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, diagnosis, physiopathology, therapy; Female; Humans; Male; Middle Aged; Physical Therapy Modalities, standards; Posture, physiology; Prospective Studies; Semicircular Canals, physiology; Treatment Outcome; Young Adult}, pmid = {24570284} }
Foster, C.A., Zaccaro, K. and Strong, D.	Canal conversion and reentry: a risk of Dix-Hallpike during canalith repositioning procedures. [Abstract] [BibTeX]	2012	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 33(2), pp. 199-203	article	DOI
Abstract: To determine the incidence, cause, and prevention of horizontal canal benign paroxysmal positional vertigo (H-BPPV) and reentry into the common crus during canalith repositioning procedures (CRPs). Prospective case series. Academic tertiary referral center. Forty-four patients with symptomatic posterior canalithiasis (P-BPPV) confirmed on Dix-Hallpike. Up to 5 CRP for initial P-BPPV and additional maneuvers for canal conversion or reentry in 1 session. Incidence and timing of onset of H-BPPV or common crus reentry and the outcome of treatment maneuvers. H-BPPV or reentry occurred during the Dix-Hallpike after a canal-clearing CRP and affected 16% (7/44) of subjects. Approximately 87% (7/8) of reentry or conversion events occurred after the very first CRP. Geotropic H-BPPV occurred in 9% (4/44) overall but in 13% (4/30) whose P-BPPV was resolved by a single CRP. All were cleared with H-BPPV maneuvers, 3 of 4 resolving with a single Gufoni maneuver. Approximately 9% (4/44) of patients developed reentry of particles into the common crus. It was treated by raising the patient to the upright position. By waiting 15 minutes after treatment of reentry, a final normal Dix-Hallpike was obtained without causing reentry into any canal in all patients. If the first CRP clears the posterior canal, there is an elevated risk of reentry or canal conversion if another Dix-Hallpike is performed immediately. These complications can be treated by additional maneuvers; if unfamiliar with these techniques, the risk can be reduced by waiting at least 15 minutes between repetitions of CRP.
BibTeX: @article{Foster2012, author = {Foster, Carol A and Zaccaro, Kathleen and Strong, Darcy}, title = {Canal conversion and reentry: a risk of Dix-Hallpike during canalith repositioning procedures.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2012}, volume = {33}, issue = {2}, pages = {199--203}, doi = {https://doi.org/10.1097/MAO.0b013e31823e274a}, keywords = {Benign Paroxysmal Positional Vertigo; Fatigue, etiology; Humans; Lithiasis, complications, pathology, surgery; Nystagmus, Pathologic, etiology; Otologic Surgical Procedures, adverse effects, methods; Postoperative Complications, epidemiology; Prospective Studies; Recurrence; Semicircular Canals, pathology, surgery; Treatment Outcome; Vertigo, etiology; Vestibular Diseases, complications, pathology, surgery}, pmid = {22143303} }
Park, S., Kim, B.G., Kim, S.H., Chu, H., Song, M.Y. and Kim, M.	Canal conversion between anterior and posterior semicircular canal in benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2013	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 34(9), pp. 1725-1728	article	DOI
Abstract: To investigate the characteristics of canal conversion between the anterior and posterior semicircular canals in benign paroxysmal positional vertigo (BPPV). Retrospective chart review. Secondary referral center. A total of 709 patients who were treated with the Epley maneuver for BPPV of the anterior or posterior semicircular canal. Vestibular examinations with videonystagmography and the canalith repositioning procedure (CRP) to treat BPPV. Canal conversion between the anterior and posterior semicircular canals was observed in 18 (2.9%) patients who underwent CRP. In 13 (2.3%) of 564 patients initially diagnosed with posterior canal BPPV (PC-BPPV), switch to anterior canal BPPV (AC-BPPV) was observed at a follow-up visit. In 5 (12.1%) of 41 patients who presented with AC-BPPV, canal switch to PC-BPPV occurred more frequently (p = 0.005). The average number of CRPs before nystagmus resolution was 3.6 in conversion cases versus 1.6 in the nonconversion group (p < 0.001). Canal conversion between the anterior and posterior semicircular canals can occur during treatment. The possibility of canal conversions should be considered for appropriate management of BPPV of the vertical semicircular canals.
BibTeX: @article{Park2013a, author = {Park, Sera and Kim, Bo Gyung and Kim, Sung Huhn and Chu, Hosuk and Song, Min Young and Kim, Minbum}, title = {Canal conversion between anterior and posterior semicircular canal in benign paroxysmal positional vertigo.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2013}, volume = {34}, issue = {9}, pages = {1725--1728}, doi = {https://doi.org/10.1097/MAO.0b013e318294227a}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Female; Humans; Male; Middle Aged; Patient Positioning, methods; Retrospective Studies; Semicircular Canals, physiopathology; Treatment Outcome; Vertigo, physiopathology, therapy}, pmid = {23928513} }
Lee, J.B. and Choi, S.J.	Canal Paresis in Benign Paroxysmal Positional Vertigo Secondary to Sudden Sensorineural Hearing Loss. [Abstract] [BibTeX]	2015	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 36(10), pp. 1708-1713	article	DOI
Abstract: To review the clinical features of benign paroxysmal positional vertigo (BPPV) secondary to sudden sensorineural hearing loss (SNHL) and to analyze the correlation between canal paresis and the effectiveness of canalith repositioning procedures (CRPs) for the treatment. Study case series with chart review. Academic university hospital. We retrospectively reviewed 277 patients with BPPV. For sudden SNHL with a recent vertigo, patients underwent electronystagmography and bithermal caloric tests. We investigated the clinical characteristics including causes, type of involved semicircular canal, frequency of CRPs, treatment results, and canal paresis (CP). The diagnosis of BPPV accompanied by same-sided sudden SNHL was based on the results of head roll and Dix-Hallpike tests. Of 277 patients with BPPV, 24 (8.7%) had sudden SNHL. Multiple-canal involvement most commonly developed in post-sudden SNHL BPPV (p < 0.01). Patients with post-sudden SNHL BPPV received a greater number of CRPs (2.95) than those with idiopathic BPPV (1.58) (p = 0.043). In patients with post-sudden SNHL BPPV, the average number of CRPs was 3.31 in the presence of CP and 2.1 sessions in the absence of CP (p = 0.030); the CP value was correlated with the frequency of CRPs (p = 0.020). In post-sudden SNHL BPPV, the worse the canal paresis becomes, the greater the number of CRPs will be needed for treatment; the simultaneous involvement of the posterior semicircular canal and horizontal semicircular canal is most common.
BibTeX: @article{Lee2015, author = {Lee, Jong Bin and Choi, Seong Jun}, title = {Canal Paresis in Benign Paroxysmal Positional Vertigo Secondary to Sudden Sensorineural Hearing Loss.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2015}, volume = {36}, issue = {10}, pages = {1708--1713}, doi = {https://doi.org/10.1097/MAO.0000000000000899}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo, etiology, therapy; Electronystagmography; Female; Hearing Loss, Sensorineural, complications; Humans; Male; Middle Aged; Paresis, complications; Patient Positioning, methods; Retrospective Studies; Semicircular Canals, pathology; Treatment Outcome}, pmid = {26595719} }
Lin, G.C., Basura, G.J., Wong, H.T. and Heidenreich, K.D.	Canal switch after canalith repositioning procedure for benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2012	The Laryngoscope Vol. 122(9), pp. 2076-2078	article	DOI
Abstract: Canal switch is a complication following canalith repositioning procedure (CRP) for posterior canal benign paroxysmal positional vertigo (BPPV). Instead of being returned to the utricle, the loose otoconia migrate into the superior or horizontal semicircular canal. Patients remain symptomatic, and treatment can be ineffective unless the switch is recognized and additional repositioning maneuvers directed toward the appropriate semicircular canal are performed. This report provides the first videographic documentation of canal switch involving conversion of unilateral posterior semicircular canal BPPV to geotropic horizontal canalithiasis.
BibTeX: @article{Lin2012, author = {Lin, Giant C and Basura, Gregory J and Wong, Hiu Tung and Heidenreich, Katherine D}, title = {Canal switch after canalith repositioning procedure for benign paroxysmal positional vertigo.}, journal = {The Laryngoscope}, year = {2012}, volume = {122}, issue = {9}, pages = {2076--2078}, doi = {https://doi.org/10.1002/lary.23315}, keywords = {Adult; Benign Paroxysmal Positional Vertigo; Female; Follow-Up Studies; Humans; Nystagmus, Pathologic, diagnosis; Otolithic Membrane, physiopathology, surgery; Otologic Surgical Procedures, adverse effects, methods; Risk Assessment; Semicircular Canals, physiopathology, surgery; Treatment Outcome; Vertigo, diagnosis, surgery; Vestibular Diseases, diagnosis, surgery; Vestibular Function Tests}, pmid = {22549695} }
Dispenza, F., DE Stefano, A., Costantino, C., Rando, D., Giglione, M., Stagno, R. and Bennici, E.	Canal switch and re-entry phenomenon in benign paroxysmal positional vertigo: difference between immediate and delayed occurrence. [Abstract] [BibTeX]	2015	Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale Vol. 35(2), pp. 116-120	article
Abstract: This prospective study was designed to evaluate the differences between immediate and delayed canal re-entry of otoliths after therapeutic manoeuvres in patients with benign paroxysmal positional vertigo (BPPV). A total of 196 patients with BPPV were visited and 127 matched our inclusion criteria. The mean age was 54.74 years. The horizontal semicircular canal (HSC) was involved in 30 cases and the posterior semicircular canal (PSC) in 97 patients. Patients with hearing loss in the ear affected by BPPV have a more recurrent form, compared to those with normal hearing. An immediate canal re-entry was recorded in 3 patients with HSC BPPV, all with geotropic nystagmus. In 7 patients with PSC BPPV, the immediate canal re-entry was detected and the delayed form was noted in 5 patients. The patients with the delayed canal re-entry underwent more than 2 previous manoeuvres. The canal re-entry was not related to the manoeuvre performed. The timing of the Dix-Hallpike test to verify the resolution of the BPPV had a significant role in immediate canal re-entry. A recurrence in the follow-up at least one month after treatment was recorded in 20 patients and was more frequent in patients that had canal re-entry. The canal re-entry or canal switch is a clinical entity that should be kept in mind of the neurotologist when approaching BPPV patients. It is important to distinguish it from recurrence when delayed and from manoeuvre failure when immediate. The timing of manoeuvre performing, in particular the final verification test after therapeutic sessions, is important to prevent the immediate reflux of particles into canals.
BibTeX: @article{Dispenza2015, author = {Dispenza, F and DE Stefano, A and Costantino, C and Rando, D and Giglione, M and Stagno, R and Bennici, E}, title = {Canal switch and re-entry phenomenon in benign paroxysmal positional vertigo: difference between immediate and delayed occurrence.}, journal = {Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale}, year = {2015}, volume = {35}, issue = {2}, pages = {116--120}, keywords = {Benign Paroxysmal Positional Vertigo, physiopathology, therapy; Female; Humans; Male; Middle Aged; Otolithic Membrane, physiopathology; Prospective Studies; Time Factors; Benign paroxysmal positional vertigo; Canal conversion; Dizziness; Vertigo; canal switch}, pmid = {26019396} }
Asawavichianginda, S., Isipradit, P., Snidvongs, K. and Supiyaphun, P.	Canalith repositioning for benign paroxysmal positional vertigo: a randomized, controlled trial. [Abstract] [BibTeX]	2000	Ear, nose, & throat journal Vol. 79(9), pp. 732-4, 736-7	article
Abstract: We assessed the efficacy of the canalith repositioning maneuver by comparing it with no treatment in a population of patients with benign paroxysmal positional vertigo (BPPV). In this randomized, controlled, 6-month efficacy trial, outcomes were measured subjectively by patients' reports of symptom status and objectively by Hallpike testing. During the first month of the study, the treated group experienced significantly better outcomes than did the control group, but this trend was not sustained at 3 and 6 months.
BibTeX: @article{Asawavichianginda2000, author = {Asawavichianginda, S and Isipradit, P and Snidvongs, K and Supiyaphun, P}, title = {Canalith repositioning for benign paroxysmal positional vertigo: a randomized, controlled trial.}, journal = {Ear, nose, & throat journal}, year = {2000}, volume = {79}, issue = {9}, pages = {732--4, 736-7}, keywords = {Adult; Aged; Exercise Therapy; Female; Head Movements; Humans; Male; Meniere Disease, complications, physiopathology, therapy; Middle Aged; Otolithic Membrane; Posture; Recurrence; Semicircular Canals, physiopathology; Time Factors; Treatment Outcome; Vertigo, etiology, physiopathology, rehabilitation}, pmid = {11011494} }
White, J., Savvides, P., Cherian, N. and Oas, J.	Canalith repositioning for benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2005	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 26(4), pp. 704-710	article
Abstract: To evaluate the efficacy of canalith repositioning maneuvers (Semont, Epley, and modified maneuvers) in the treatment of posterior canal benign paroxysmal positional vertigo (BPPV) in comparison to the rate of resolution in the untreated control cohort. Source articles were identified by a MEDLINE search of English language sources before 2004 plus manual crosschecks of bibliographies from identified articles, selected national meeting abstracts, review article references, and textbook chapters. Each controlled trial that compared canalith repositioning patients to untreated control subjects in posterior canal benign positional vertigo (blinded and unblinded) was reviewed for inclusion. Data were abstracted systematically, scaled on validity and comparability, and cross-checked independently by another author. Studies were combined with fixed effects meta-analysis to estimate spontaneous resolution, 95% confidence intervals (CI) of effect size, and heterogeneity. Canalith repositioning is more effective than observation alone for the treatment of benign paroxysmal positional vertigo, despite spontaneous resolution rates of one in three at 3 weeks. Public health implications are discussed, based on the high frequency of unrecognized BPPV reported in elderly patients, and the improvements after canalith repositioning in postural control and health-related quality of life (SF 36 Health Survey) documented in the literature.
BibTeX: @article{White2005a, author = {White, Judith and Savvides, Panos and Cherian, Neil and Oas, John}, title = {Canalith repositioning for benign paroxysmal positional vertigo.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2005}, volume = {26}, issue = {4}, pages = {704--710}, keywords = {Humans; Posture; Semicircular Canals; Vertigo, rehabilitation}, pmid = {16015173} }
Hwang, M., Kim, S.-H., Kang, K.-W., Lee, D., Lee, S.-Y., Kim, M.-K. and Lee, S.-H.	Canalith repositioning in apogeotropic horizontal canal benign paroxysmal positional vertigo: Do we need faster maneuvering? [Abstract] [BibTeX]	2015	Journal of the neurological sciences Vol. 358(1-2), pp. 183-187	article	DOI
Abstract: A correct diagnosis and a proper treatment may yield a rapid and simple cure for benign paroxysmal positional vertigo (BPPV). Although the Gufoni maneuver is widely used to treat apogeotropic horizontal-canal BPPV (HC-BPPV), few studies have clarified the relationship between the speed and intensity of maneuver execution and successful canalith reposition. To evaluate the effect of accelerated execution of the Gufoni maneuver, a prospective randomized controlled study was conducted with HC-BPPV patients in a single dizziness clinic. The patients had been diagnosed with apogeotropic HC-BPPV and were undergoing treatment at the dizziness clinic of a tertiary university hospital from January 2013 to August 2014. Two groups were treated with the maneuver performed at different speeds and the resolution rate was compared. The accelerated maneuver group was subjected to faster position changing-within 1s-during the reposition maneuver, while the non-accelerated maneuver group underwent slower maneuvers. Therapeutic efficacy was defined as dizziness relief or resolution of nystagmus within 1h. Fifty patients with apogeotropic HC-BPPV were enrolled and treated with the Gufoni maneuver in two groups of 25 patients. The overall resolution rate was 48% (24 of 50; p=1.00), regardless of acceleration. Our results suggest that a faster, more intense execution of the Gufoni maneuver provides little benefit in treating apogeotropic HC-BPPV. Detachment of the otolith from the cupula or the gravitational force-when the otolith is in the anterior arm of the HC-may be more important contributors to treatment efficacy.
BibTeX: @article{Hwang2015, author = {Hwang, Minho and Kim, Sang-Hoon and Kang, Kyung-Wook and Lee, Dasom and Lee, Sae-Young and Kim, Myeong-Kyu and Lee, Seung-Han}, title = {Canalith repositioning in apogeotropic horizontal canal benign paroxysmal positional vertigo: Do we need faster maneuvering?}, journal = {Journal of the neurological sciences}, year = {2015}, volume = {358}, issue = {1-2}, pages = {183--187}, doi = {https://doi.org/10.1016/j.jns.2015.08.1534}, keywords = {Acceleration; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, physiopathology, therapy; Female; Head Movements, physiology; Humans; Male; Middle Aged; Patient Positioning, methods; Posture; Prospective Studies; Semicircular Canals, physiopathology; Treatment Outcome; Acceleration; Benign paroxysmal positional vertigo; Canalith repositioning maneuver; Nystagmus; Semicircular canal; Treatment outcome}, pmid = {26341154} }
Munoz, J.E., Miklea, J.T., Howard, M., Springate, R. and Kaczorowski, J.	Canalith repositioning maneuver for benign paroxysmal positional vertigo: randomized controlled trial in family practice. [Abstract] [BibTeX]	2007	Canadian family physician Medecin de famille canadien Vol. 53(6), pp. 1049-53, 1048	article
Abstract: To determine whether the canalith repositioning maneuver (CRM) is effective for treating benign paroxysmal positional vertigo when it is used by family physicians in primary care settings. Randomized, prospective, double-blind, sham-controlled trial. An academic family practice in Hamilton, Ont. Eighty-one patients 18 years or older whose dizziness was confirmed by the Dix-Hallpike (DH) vertigo-triggering maneuver and who had no contraindications to the CRM. At the first visit, the intervention group received the CRM and the control group received a sham maneuver. Both groups received the CRM at the second and third visits 1 and 2 weeks later. Negative results of the DH test or self-reported resolution of vertigo after the initial treatment. Eighty-one patients were randomized and received the first treatment. After the first treatment, 34.2% of patients in the intervention group and 14.6% of patients in the control group had negative DH test results (relative risk 2.3, 95% confidence interval 1.03 to 5.2, P = .04); and 31.6% of patients in the intervention group and 24.4% of patients in the control group reported resolution of dizziness (relative risk 1.2, 95% confidence interval 0.7 to 1.9, P = .48). One week later, patients in both intervention and control groups received the CRM, and 61.8% and 57.1% of them, respectively, had negative DH test results (P = .81). By week 3, approximately 75% of patients in both groups had improved. A statistically significant proportion of patients in the CRM group returned to a negative response to the DH maneuver immediately after the first treatment. Family physicians can use the CRM to treat benign paroxysmal positional vertigo and potentially avoid delays in treatment and unnecessary referrals. NCT00182273 (ClinicalTrials.gov).
BibTeX: @article{Munoz2007, author = {Munoz, Juan E and Miklea, Jonel T and Howard, Michelle and Springate, Russ and Kaczorowski, Janusz}, title = {Canalith repositioning maneuver for benign paroxysmal positional vertigo: randomized controlled trial in family practice.}, journal = {Canadian family physician Medecin de famille canadien}, year = {2007}, volume = {53}, issue = {6}, pages = {1049--53, 1048}, keywords = {Double-Blind Method; Family Practice, methods; Female; Follow-Up Studies; Humans; Male; Middle Aged; Posture; Prospective Studies; Semicircular Canals, physiopathology; Treatment Outcome; Vertigo, physiopathology, therapy}, pmid = {17872784} }
Collison, P.J. and Kolberg, A.	Canalith repositioning procedure for relief of post-stapedectomy benign paroxysmal positional vertigo. [Abstract] [BibTeX]	1998	South Dakota journal of medicine Vol. 51(3), pp. 85-87	article
Abstract: A 41-year-old woman underwent a successful stapedectomy for relief of conductive hearing loss due to otosclerosis. Post-operatively, she developed persistent symptoms of benign paroxysmal positional vertigo (BPPV). Eight weeks later, a canalith repositioning procedure was performed in the office, with immediate complete resolution of her vertigo. Anatomic and pathophysiologic implications of these observations will be discussed.
BibTeX: @article{Collison1998, author = {Collison, P J and Kolberg, A}, title = {Canalith repositioning procedure for relief of post-stapedectomy benign paroxysmal positional vertigo.}, journal = {South Dakota journal of medicine}, year = {1998}, volume = {51}, issue = {3}, pages = {85--87}, keywords = {Adult; Female; Head Movements; Humans; Posture; Saccule and Utricle; Semicircular Canals; Stapes Surgery, adverse effects; Vertigo, etiology, therapy}, pmid = {9550927} }
Prokopakis, E., Vlastos, I.M., Tsagournisakis, M., Christodoulou, P., Kawauchi, H. and Velegrakis, G.	Canalith repositioning procedures among 965 patients with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2013	Audiology & neuro-otology Vol. 18(2), pp. 83-88	article	DOI
Abstract: Canalith repositioning procedure (CRP) has increasingly been utilized for the last 15 years for the treatment of benign paroxysmal positional vertigo (BPPV). We assess the short- and long-term efficacy of CRP on the treatment of patients with BPPV. Nine hundred sixty-five patients (481 men and 484 women, from 18 to 87 years of age) were enrolled in this prospective study during 1995-2010. Inclusion criteria were a patient history compatible with BPPV and a positive provocative maneuver (either Dix-Hallpike or Roll test). Reported duration of symptoms at the time of their first examination varied from 1 day to 18 months. Variants of the Epley and Barbeque maneuver were used for posterior and anterior canal involvement, and horizontal canal involvement, respectively. Short-term follow-up was obtained 48 h and 7 days after initial treatment, whereas long-term follow-up was obtained at repeated 6-month intervals. Symptoms subsided immediately in 819 patients (85%) by the first CRP. Only 19 patients (2%) required CRP more than 3 times. Patients' mean follow-up was 74 months; symptom recurrence was noted in 139 patients. A statistically significantly higher recurrence rate was noted in elderly people or those with head trauma or a history of vestibular neuropathy (p<0.001). This study provides class IV evidence that CRP remains an efficient and long-lasting noninvasive treatment for BPPV, especially for younger patients without a history of head trauma or vestibular neuropathy. Elderly people have a significantly higher recurrence rate requiring additional education to minimize potential morbidity of their falls.
BibTeX: @article{Prokopakis2013, author = {Prokopakis, E and Vlastos, I M and Tsagournisakis, M and Christodoulou, P and Kawauchi, H and Velegrakis, G}, title = {Canalith repositioning procedures among 965 patients with benign paroxysmal positional vertigo.}, journal = {Audiology & neuro-otology}, year = {2013}, volume = {18}, issue = {2}, pages = {83--88}, doi = {https://doi.org/10.1159/000343579}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Female; Follow-Up Studies; Humans; Incidence; Kaplan-Meier Estimate; Male; Middle Aged; Morbidity; Patient Positioning, methods; Prospective Studies; Recurrence; Semicircular Canals, physiopathology; Treatment Outcome; Vertigo, epidemiology, physiopathology, therapy; Young Adult}, pmid = {23147839} }
Cohen, H.S. and Sangi-Haghpeykar, H.	Canalith repositioning variations for benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2010	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 143(3), pp. 405-412	article	DOI
Abstract: To determine if variations in common treatments for benign paroxysmal positional vertigo (BPPV) affected efficacy. Prospective, pseudo-randomized study. Outpatient practice in a tertiary care facility. Patients (n = 118) with unilateral BPPV of the posterior canal, including 13 patients with BPPV of the lateral canal, were tested at a tertiary care center on one of five interventions: canalith repositioning maneuver (CRP), CRP plus home exercise, modified CRP, CRP for patients with involvement of two semicircular canals, and self-CRP home exercise. Self-CRP was also compared to previously published data on efficacy of the Brandt Daroff exercise. Main outcome measures were vertigo intensity and frequency, presence/absence of Dix-Hallpike responses, Vestibular Disorders Activities of Daily Living Scale (VADL), and computerized dynamic posturography. Vertigo intensity and frequency and Dix-Hallpike responses decreased significantly, and posturography and VADL improved significantly from pre- to post tests. No other significant changes were found. The groups did not differ significantly. Vertigo intensity and frequency were not strongly related at pretest but were related at post-test. Length of illness and age did not influence the results. However the head is moved, as long as it is moved rapidly enough and through the correct planes in space, repositioning treatments are likely to be effective. Therefore, clinicians have a range of choices in selecting the treatment best suited for each patient's unique needs.
BibTeX: @article{Cohen2010, author = {Cohen, Helen S and Sangi-Haghpeykar, Haleh}, title = {Canalith repositioning variations for benign paroxysmal positional vertigo.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2010}, volume = {143}, issue = {3}, pages = {405--412}, doi = {https://doi.org/10.1016/j.otohns.2010.05.022}, keywords = {Activities of Daily Living; Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Musculoskeletal Manipulations, methods; Patient Positioning; Prospective Studies; Recovery of Function; Self Care; Semicircular Canals; Treatment Outcome; Vertigo, physiopathology, therapy}, pmid = {20723779} }
Korres, S., Riga, M., Sandris, V., Danielides, V. and Sismanis, A.	Canalithiasis of the anterior semicircular canal (ASC): treatment options based on the possible underlying pathogenetic mechanisms. [Abstract] [BibTeX]	2010	International journal of audiology Vol. 49(8), pp. 606-612	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) of the anterior semicircular canal (ASC) is an uncommon disorder currently diagnosed with the Dix-Hallpike (D-H) examination. According to the literature, nystagmus and vertigo may be more pronounced when the affected ear is either up or down. In some patients, both right and left D-H tests can trigger nystagmus with the same direction. The proposed treatment options with the addition of a different manoeuvre applied by the authors of the present study in cases of ASC lithiasis, seem to present a respective variety regarding the position of the affected ASC during the procedure of canalith repositioning. The aim of this study is to analyse the mechanisms underlying both the proposed treatment options and the clinical findings in the D-H examination. The results of this analysis stimulate further investigation, since they probably imply that repositioning manoeuvres might vary in their effectiveness when applied to different clinical subgroups of ASC BPPV.
BibTeX: @article{Korres2010, author = {Korres, Stavros and Riga, Maria and Sandris, Vasilios and Danielides, Vasilios and Sismanis, Aristides}, title = {Canalithiasis of the anterior semicircular canal (ASC): treatment options based on the possible underlying pathogenetic mechanisms.}, journal = {International journal of audiology}, year = {2010}, volume = {49}, issue = {8}, pages = {606--612}, doi = {https://doi.org/10.3109/14992021003753490}, keywords = {Head Movements; Humans; Labyrinth Diseases, diagnosis, physiopathology, therapy; Lithiasis, diagnosis, physiopathology, therapy; Neurologic Examination, methods; Nystagmus, Pathologic, diagnosis, physiopathology, therapy; Semicircular Canals, physiopathology}, pmid = {20553103} }
Schratzenstaller, B., Wagner-Manslau, C., Strasser, G. and Arnold, W.	Canalolithiasis of the superior semicircular canal: an anomaly in benign paroxysmal vertigo. [Abstract] [BibTeX]	2005	Acta oto-laryngologica Vol. 125(10), pp. 1055-1062	article	DOI
Abstract: According to the canalolithiasis theory, benign paroxysmal vertigo (BPPV) is caused by gravity-dependent movements of otoconial debris that collects in the endolymph of the posterior semicircular canal. Other parts of the vestibular organ are rarely affected, and it is mainly the horizontal canal that is affected by this atypical form of BPPV. Canalolithiasis of the superior semicircular canal must be considered an anomaly because the superior semicircular canal is the highest point of the vestibular organ and debris normally cannot collect in this special location. Until now, BPPV of the superior canal has mainly been dealt with theoretically in the literature. The authors present three patients with canalolithiasis of the superior semicircular canal and offer direct proof of the condition using high-resolution 3D MRI.
BibTeX: @article{Schratzenstaller2005, author = {Schratzenstaller, Bruno and Wagner-Manslau, Carola and Strasser, Gerhard and Arnold, Wolfgang}, title = {Canalolithiasis of the superior semicircular canal: an anomaly in benign paroxysmal vertigo.}, journal = {Acta oto-laryngologica}, year = {2005}, volume = {125}, issue = {10}, pages = {1055--1062}, doi = {https://doi.org/10.1080/00016480510037023}, keywords = {Adult; Endolymph; Female; Humans; Imaging, Three-Dimensional; Lithiasis, pathology; Magnetic Resonance Imaging; Male; Middle Aged; Otolithic Membrane; Semicircular Canals, pathology; Vertigo, pathology}, pmid = {16298786} }
Lakhani, R. and Bleach, N.	Carbon monoxide poisoning: an unusual cause of dizziness. [Abstract] [BibTeX]	2010	The Journal of laryngology and otology Vol. 124(10), pp. 1103-1105	article	DOI
Abstract: We report an unusual case of dizziness caused by carbon monoxide poisoning. A 55-year-old man was referred to an ENT surgeon with dizziness. The patient described vague, non-specific symptoms not consistent with a diagnosis of benign paroxysmal positional vertigo, labyrinthitis or Ménière's disease. It emerged later that the patient had been suffering from carbon monoxide poisoning from a leaky gas hot water boiler in his house. After having the boiler fixed, the patient's symptoms completely resolved. When the more common causes of dizziness cannot be found, less common but important differential diagnoses, such as carbon monoxide poisoning, should be considered.
BibTeX: @article{Lakhani2010, author = {Lakhani, R and Bleach, N}, title = {Carbon monoxide poisoning: an unusual cause of dizziness.}, journal = {The Journal of laryngology and otology}, year = {2010}, volume = {124}, issue = {10}, pages = {1103--1105}, doi = {https://doi.org/10.1017/S0022215110000800}, keywords = {Carbon Monoxide Poisoning, complications; Dizziness, chemically induced; Environmental Exposure, adverse effects; Humans; Male; Middle Aged}, pmid = {20388241} }
Korkmaz, M. and Korkmaz, H.	Cases requiring increased number of repositioning maneuvers in benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2016	Brazilian journal of otorhinolaryngology Vol. 82(4), pp. 452-457	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is a clinical syndrome that is proposed to be caused by dislocated utricular debris into semicircular canals. Although the majority of patients are treated by one or two repositioning maneuvers, some of the patients need repeated maneuvers for relief. The goal of this study was to investigate the factors associated with patients with benign paroxysmal positional vertigo who required multiple repositioning procedures for treatment. Data were obtained from the clinical records of 153 patients diagnosed with benign paroxysmal positional vertigo. Patients were treated by repositioning maneuvers. Demographic data and the factors including age, sex, canal type, duration of symptoms, comorbidities and number of repositioning maneuvers for relief were documented for statistical analysis. Age, sex, canal type and the duration of symptoms had no impact on the number of maneuvers. The most common comorbidity was spine problems. Hypertension was the only comorbidity that significantly associated with increased number of maneuvers. The presence of hypertension is a risk factor for repeated maneuvers in benign paroxysmal positional vertigo treatment. Physicians should be aware of the increased probability of repeated repositioning maneuvers in these group of patients. The role of comorbidities and vascular factors need to be further clarified in the course of benign paroxysmal positional vertigo.
BibTeX: @article{Korkmaz2016, author = {Korkmaz, Mukadder and Korkmaz, Hakan}, title = {Cases requiring increased number of repositioning maneuvers in benign paroxysmal positional vertigo.}, journal = {Brazilian journal of otorhinolaryngology}, year = {2016}, volume = {82}, issue = {4}, pages = {452--457}, doi = {https://doi.org/10.1016/j.bjorl.2015.08.018}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, therapy; Female; Humans; Hypertension, complications; Male; Middle Aged; Patient Positioning, methods; Physical Therapy Modalities; Retrospective Studies; Treatment Outcome; Young Adult; Benign paroxysmal positional vertigo; Comorbidade; Comorbidity; Hipertensão; Hypertension; Manobra de reposicionamento; Repositioning maneuver; Vertigem posicional paroxística benigna}, pmid = {26614043} }
Lechner, C., Taylor, R.L., Todd, C., Macdougall, H., Yavor, R., Halmagyi, G.M. and Welgampola, M.S.	Causes and characteristics of horizontal positional nystagmus. [Abstract] [BibTeX]	2014	Journal of neurology Vol. 261(5), pp. 1009-1017	article	DOI
Abstract: Direction changing horizontal positional nystagmus can be observed in a variety of central and peripheral vestibular disorders. We tested sixty subjects with horizontal positional nystagmus and vertigo on the Epley Omniax(®) rotator. Monocular video recordings were performed with the right or left ear down, in the supine and prone positions. Nystagmus slow-phase velocity (SPV) was plotted as a function of time. Thirty-one subjects diagnosed with horizontal canalolithiasis had paroxysmal horizontal geotropic nystagmus with the affected ear down (onset 0.8 ± 1 s, range 0-4.9 s, duration 11.7-47.9 s, peak SPV 79 ± 67°/s). The SPV peaked at 5-20 s and declined to 0 by 60 s; at 40 s from onset, the average SPV was 1.8 % of the peak. Nine subjects diagnosed with cupulolithiasis had persistent apogeotropic horizontal nystagmus (onset 0.7 ± 1.4 s, range 0-4.3 s). Peak SPV was 54.2 ± 31.8°/s and 26.6 ± 12.2°/s with unaffected and affected ears down, respectively. At 40 s, the average SPV had decayed to only 81 % (unaffected ear down) and 65 % (affected ear down) of the peak. Twenty subjects were diagnosed with disorders other than benign positional vertigo (BPV) [vestibular migraine (VM), Ménière's Disease, vestibular schwannoma, unilateral or bilateral peripheral vestibular loss]. Subjects with VM (n = 13) had persistent geotropic or apogeotropic horizontal nystagmus. On average, at 40 s from nystagmus onset, the SPV was 61 % of the peak. Two patients with Ménière's Disease had persistent apogeotropic horizontal nystagmus; the peak SPV at 40 s ranged between 28.6 and 49.5 % of the peak. Symptomatic horizontal positional nystagmus can be observed in canalolithiasis, cupulolithiasis and diverse central and peripheral vestibulopathies; its temporal and intensity profile could be helpful in the separation of these entities.
BibTeX: @article{Lechner2014, author = {Lechner, Corinna and Taylor, Rachael L and Todd, Chris and Macdougall, Hamish and Yavor, Robbie and Halmagyi, G Michael and Welgampola, Miriam S}, title = {Causes and characteristics of horizontal positional nystagmus.}, journal = {Journal of neurology}, year = {2014}, volume = {261}, issue = {5}, pages = {1009--1017}, doi = {https://doi.org/10.1007/s00415-013-7223-5}, keywords = {Aged; Aged, 80 and over; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nystagmus, Pathologic, diagnosis, physiopathology; Nystagmus, Physiologic, physiology}, pmid = {24676938} }
Isaradisaikul, S., Navacharoen, N., Hanprasertpong, C., Kangsanarak, J. and Panyathong, R.	Causes and time-course of vertigo in an ear, nose, and throat clinic. [Abstract] [BibTeX]	2010	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 267(12), pp. 1837-1841	article	DOI
Abstract: The purpose of this study is to review etiologies and identify the time-course of vertigo presenting in an ear, nose, and throat clinic, and serve as a reference guide for other clinics. The study includes retrospective chart review in a tertiary care, university hospital. The patient data with reported ICD-10 codes as causes of vertigo between April 2005 and December 2007 were extracted from the database. At each visit, the main diagnosis as to etiology, characteristics of the vertigo, its time-course, and patient demographic data were recorded. Of 547 cases, 17 diagnoses were made in 73.9%. Diagnostic categories included peripheral vertigo 72.9%, central vertigo 0.8%, psychogenic cause 0.2%, and unknown 26.1%. Common causes of vertigo were benign paroxysmal positional vertigo (BPPV) 52.5%, Meniere's disease 14.6%, and sudden idiopathic hearing loss 2.9%. Less common diagnoses were benign paroxysmal vertigo of childhood 0.7%, labyrinthitis 0.7%, and vestibular schwannoma 0.3%. Rare conditions were delayed endolymphatic hydrops, Ramsey Hunt syndrome, otosyphilis, vestibular neuritis, temporal bone fracture, post-concussion syndrome, cerebellar infarction, epilepsy, cervical vertigo, Streptococcus suis meningitis, and psychogenic vertigo. Ninety-nine cases who reported remission of vertigo during the study period had median onset of the remission at 4 weeks. In the ear, nose, and throat clinic at Chiang Mai University, a tertiary university hospital, peripheral vestibular disorders were the main etiology of vertigo. The three most common causes were BPPV, Meniere's disease, and sudden idiopathic hearing loss. Half of the cases who returned for follow up had remitted symptoms within 4 weeks.
BibTeX: @article{Isaradisaikul2010, author = {Isaradisaikul, Suwicha and Navacharoen, Niramon and Hanprasertpong, Charuk and Kangsanarak, Jaran and Panyathong, Rapeepun}, title = {Causes and time-course of vertigo in an ear, nose, and throat clinic.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2010}, volume = {267}, issue = {12}, pages = {1837--1841}, doi = {https://doi.org/10.1007/s00405-010-1309-9}, keywords = {Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Child; Cohort Studies; Female; Humans; Male; Middle Aged; Otorhinolaryngologic Diseases, complications, diagnosis, therapy; Outpatient Clinics, Hospital; Retrospective Studies; Risk Factors; Sex Distribution; Time Factors; Vertigo, diagnosis, epidemiology, therapy; Young Adult}, pmid = {20567978} }
Luryi, A.L., Schutt, C.A., Bojrab, D.I., LaRouere, M., Zappia, J., Sargent, E.W. and Babu, S.	Causes of Persistent Positional Vertigo Following Posterior Semicircular Canal Occlusion for Benign Paroxysmal Positional Vertigo. [Abstract] [BibTeX]	2018	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 39(10), pp. e1078-e1083	article	DOI
Abstract: To report causes of persistent recalcitrant positional vertigo (PRPV) after posterior semicircular canal occlusion (PSCO) for benign paroxysmal positional vertigo (BPPV). Retrospective chart review. Single high-volume otology practice. Patients diagnosed with BPPV from 2007 to 2017. PSCO and follow-up care including diagnostic and particle repositioning maneuvers for recurrent BPPV. PRPV, defined as recalcitrant positional vertigo for any reason following PSCO. Twenty seven PSCO operations were performed in 26 patients. Twenty five patients (96.2%) had resolution of the Dix-Hallpike test in the operated ear. Eleven patients (42.3%) developed BPPV postoperatively, three (11.5%) in the operated ear and eight (30.8%) in the contralateral ear. Five of eight patients (62.5%) who developed contralateral BPPV had unilateral BPPV preoperatively. Eight patients (30.8%) developed BPPV at least twice after surgery or did not resolve, qualifying as PRPV, and all but one of these events occurred in the nonsurgical ear. No instances of cerebrospinal fluid leak, postoperative infection, facial palsy, clinically significant hearing loss, or death occurred. PSCO is a safe and effective option for recalcitrant BPPV. However, 30.8% of patients, including patients with initially unilateral BPPV, had recalcitrant positional vertigo postoperatively, usually due to contralateral BPPV. Patients considering PSCO should be counseled regarding this risk to ensure realistic expectations.
BibTeX: @article{Luryi2018a, author = {Luryi, Alexander L and Schutt, Christopher A and Bojrab, Dennis I and LaRouere, Michael and Zappia, John and Sargent, Eric W and Babu, Seilesh}, title = {Causes of Persistent Positional Vertigo Following Posterior Semicircular Canal Occlusion for Benign Paroxysmal Positional Vertigo.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2018}, volume = {39}, issue = {10}, pages = {e1078--e1083}, doi = {https://doi.org/10.1097/MAO.0000000000001990}, pmid = {30239433} }
Cho, B.-H., Kim, S.-H., Kim, S.-S., Choi, Y.-J. and Lee, S.-H.	Central positional nystagmus associated with cerebellar tumors: Clinical and topographical analysis. [Abstract] [BibTeX]	2017	Journal of the neurological sciences Vol. 373, pp. 147-151	article	DOI
Abstract: Positional nystagmus is usually caused by peripheral vestibular disorder, mostly benign paroxysmal positional vertigo (BPPV). However, positional nystagmus is also encountered in central lesions. We aimed to determine clinical characteristics of the structures responsible for central positional nystagmus (CPN) associated with brain tumors. All four patients (3 men; range=19-77years) had an evaluation of spontaneous and positional nystagmus using video-oculography. Brain MRIs were performed in all patients. All patients showed apogeotropic positional nystagmus during supine roll tests, and had an initial diagnosis of BPPV. Except for the positional nystagmus, findings of neurological examination were normal. Because all subjects were initially diagnosed with BPPV, canalith repositioning maneuvers were applied repeatedly but without a success. Brain MRI finally disclosed brain tumors involving the midline cerebellar structures around the fourth ventricle and the nodulus. The pathological diagnosis was hemangioblastoma in two and metastatic tumor in the others. An apogeotropic type of CPN may be an isolated finding in patients with a cerebellar tumor. Even in patients with isolated apogeotropic positional nystagmus, a central lesion should be sought especially when refractory to repeated canalith repositioning maneuvers.
BibTeX: @article{Cho2017a, author = {Cho, Bang-Hoon and Kim, Sang-Hoon and Kim, Sung-Sik and Choi, Yun-Ju and Lee, Seung-Han}, title = {Central positional nystagmus associated with cerebellar tumors: Clinical and topographical analysis.}, journal = {Journal of the neurological sciences}, year = {2017}, volume = {373}, pages = {147--151}, doi = {https://doi.org/10.1016/j.jns.2016.12.050}, keywords = {Aged; Breast Neoplasms, complications, pathology; Cerebellar Neoplasms, complications, diagnostic imaging, physiopathology, secondary; Cerebellum, diagnostic imaging, pathology, physiopathology; Eye Movement Measurements; Female; Hemangioblastoma, complications, diagnostic imaging, pathology, physiopathology; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neurologic Examination; Nystagmus, Pathologic, diagnostic imaging, etiology, pathology, physiopathology; Nystagmus, Physiologic; Vertigo, diagnostic imaging, etiology, pathology, physiopathology; Young Adult; Cerebellum; Nystagmus; Positional vertigo; Tumor}, pmid = {28131175} }
Mostafa, B.E., Kahky, A.O.E., Kader, H.M.A. and Rizk, M.	Central vestibular dysfunction in an otorhinolaryngological vestibular unit: incidence and diagnostic strategy. [Abstract] [BibTeX]	2014	International archives of otorhinolaryngology Vol. 18(3), pp. 235-238	article	DOI
Abstract: Introduction Vertigo can be due to a variety of central and peripheral causes. The relative incidence of central causes is underestimated. This may have an important impact of the patients' management and prognosis. Objective The objective of this work is to determine the incidence of central vestibular disorders in patients presenting to a vestibular unit in a tertiary referral academic center. It also aims at determining the best strategy to increase the diagnostic yield of the patients' visit. Methods This is a prospective observational study on 100 consecutive patients with symptoms suggestive of vestibular dysfunction. All patients completed a structured questionnaire and received bedside and vestibular examination and neuroimaging as required. Results There were 69 women and 31 men. Their ages ranged between 28 and 73 (mean 42.48 years). Provisional videonystagmography (VNG) results were: 40% benign paroxysmal positional vertigo (BPPV), 23% suspicious of central causes, 18% undiagnosed, 15% Meniere disease, and 4% vestibular neuronitis. Patients with an unclear diagnosis or central features (41) had magnetic resonance imaging (MRI) and Doppler studies. Combining data from history, VNG, and imaging studies, 23 patients (23%) were diagnosed as having a central vestibular lesion (10 with generalized ischemia/vertebra basilar insufficiency, 4 with multiple sclerosis, 4 with migraine vestibulopathy, 4 with phobic postural vertigo, and 1 with hyperventilation-induced nystagmus). Conclusions Combining a careful history with clinical examination, VNG, MRI, and Doppler studies decreases the number of undiagnosed cases and increases the detection of possible central lesions.
BibTeX: @article{Mostafa2014, author = {Mostafa, Badr E and Kahky, Ayman O El and Kader, Hisham M Abdel and Rizk, Michael}, title = {Central vestibular dysfunction in an otorhinolaryngological vestibular unit: incidence and diagnostic strategy.}, journal = {International archives of otorhinolaryngology}, year = {2014}, volume = {18}, issue = {3}, pages = {235--238}, doi = {https://doi.org/10.1055/s-0034-1370884}, keywords = {central vestibular disorders; dizziness; vertigo; videonystagmography}, pmid = {25992098} }
Hesselbrock, R.R.	Cerebellar Infarction Presenting with Acute Vestibular Syndrome in Two U.S. Air Force Pilots. [Abstract] [BibTeX]	2017	Aerospace medicine and human performance Vol. 88(9), pp. 880-883	article	DOI
Abstract: Cerebellar infarction is an uncommon but serious cause of isolated acute vestibular symptoms, particularly in young, healthy individuals, and can easily be overlooked. We present two cases of cerebellar infarction in U.S. Air Force pilots, one of which occurred during flight. A 41-yr-old man developed acute vertigo, disequilibrium, nausea, and headache, with progressive slow symptomatic improvement, and presented to medical attention 4 d after symptom onset. Brain magnetic resonance imaging showed right inferomedial cerebellar infarction. Echocardiography discovered patent foramen ovale and atrial septal aneurysm. A 40-yr-old man developed severe vertigo, nausea, and vomiting during initial aircraft descent. Head computed tomography scan was performed acutely and was normal. Initial assessment was benign paroxysmal positional vertigo. Brain magnetic resonance imaging 1 mo after symptom onset showed a small right inferior cerebellar infarction. Patent foramen ovale and bilateral atrial enlargement were seen on echocardiography. Both pilots made full neurological recoveries and were eventually returned to flight status. Central causes of isolated acute vestibular symptoms are uncommon and are often not considered in otherwise healthy individuals. Cerebellar infarction is one of these uncommon but increasingly recognized causes of acute vestibular symptoms. As evaluation and management of central causes are much different from peripheral conditions, prompt localization confirmation is paramount. Accurate evidence-based bedside screening methods are available for rapid localization. Awareness of the possibility of central etiologies and careful clinical evaluation with application of bedside screening methods in patients with acute vestibular symptoms will reduce the number of inaccurate diagnoses.Hesselbrock RR. Cerebellar infarction presenting with acute vestibular syndrome in two U.S. Air Force pilots. Aerosp Med Hum Perform. 2017; 88(9):880-883.
BibTeX: @article{Hesselbrock2017, author = {Hesselbrock, Roger R}, title = {Cerebellar Infarction Presenting with Acute Vestibular Syndrome in Two U.S. Air Force Pilots.}, journal = {Aerospace medicine and human performance}, year = {2017}, volume = {88}, issue = {9}, pages = {880--883}, doi = {https://doi.org/10.3357/AMHP.4897.2017}, keywords = {Adult; Cerebellar Diseases, diagnostic imaging, drug therapy; Diagnosis, Differential; Foramen Ovale, Patent, diagnostic imaging; Humans; Infarction, Middle Cerebral Artery, diagnostic imaging, drug therapy; Magnetic Resonance Imaging; Male; Military Personnel; Pilots; Platelet Aggregation Inhibitors, therapeutic use; Syndrome; Vestibular Diseases, diagnostic imaging, drug therapy}, pmid = {28818149} }
Shoman, N. and Longridge, N.	Cerebellar vermis lesions and tumours of the fourth ventricle in patients with positional and positioning vertigo and nystagmus. [Abstract] [BibTeX]	2007	The Journal of laryngology and otology Vol. 121(2), pp. 166-169	article	DOI
Abstract: Positional and positioning vertigo and nystagmus syndromes are usually due to peripheral vestibular dysfunction. The most common form is benign paroxysmal positioning. In this paper, we discuss more serious aetiologies in the differential diagnosis for patients presenting with a history suggestive of benign paroxysmal positioning vertigo. We draw attention to the diagnosis of cerebellar vermis lesions and tumours of the fourth ventricle by presenting two cases of patients with positional nystagmus of so called benign paroxysmal type. We review the literature on positional nystagmus, highlighting key findings on history and physical examination to aid in the correct diagnosis of benign paroxysmal positioning vertigo, and to differentiate it from the rare yet sinister central aetiologies that can present with positional vertigo of the benign positional type. This is with the aim to avoid over-investigating a common presentation without missing a serious diagnosis.
BibTeX: @article{Shoman2007, author = {Shoman, N and Longridge, N}, title = {Cerebellar vermis lesions and tumours of the fourth ventricle in patients with positional and positioning vertigo and nystagmus.}, journal = {The Journal of laryngology and otology}, year = {2007}, volume = {121}, issue = {2}, pages = {166--169}, doi = {https://doi.org/10.1017/S0022215106004063}, keywords = {Adult; Cerebellar Neoplasms, complications, diagnosis; Diagnosis, Differential; Humans; Male; Nystagmus, Pathologic, diagnosis, etiology; Treatment Outcome; Vertigo, diagnosis, etiology}, pmid = {17059627} }
Shin, J.E., Jeong, K.-H., Ahn, S.H. and Kim, C.-H.	Change of nystagmus direction during a head-roll test in lateral semicircular canal cupulolithiasis. [Abstract] [BibTeX]	2017	Auris, nasus, larynx Vol. 44(2), pp. 227-231	article	DOI
Abstract: To demonstrate positional nystagmus during a head-roll test in two patients with lateral semicircular canal (LSCC) cupulolithiasis who presented with spontaneous detachment of otoliths from the LSCC cupula, and to confirm that otoliths may adhere to both the utricle and canal sides of the cupula. Using video nystagmography, positional nystagmus was evaluated in two patients with LSCC cupulolithiasis who showed the change of nystagmus direction during a head-roll test. Both patients presented with persistent left-beating and right-beating nystagmus when the head was bent forward and backward, respectively. This suggests the presence of either cupulolithiasis on the right side or light cupula on the left side of the LSCC. In Case 1, transformation from cupulolithiasis to canalolithiasis occurred, implicating the detachment of otoliths from the canal side of the right LSCC cupula. In Case 2, vigorous right-beating nystagmus was followed by persistent left-beating nystagmus when the head was rolled to the left. Following this, direction-fixed left-beating nystagmus was observed at all positions, which may indicate that otoliths attached on utricle side of the right LSCC cupula were detached and fell into the utricle under the influence of gravity. A conversion of nystagmus direction may be explained by an expression of short-term adaptation of vestibular tone. Otoliths can be attached to either side of the cupula in LSCC cupulolithiasis. Because it is difficult to determine the attached side at the time of diagnostic maneuver, the therapeutic approach should include maneuvers designed to detach otolith particles from both the utricle and canal side.
BibTeX: @article{Shin2017, author = {Shin, Jung Eun and Jeong, Kyung-Hwa and Ahn, Sung Hwan and Kim, Chang-Hee}, title = {Change of nystagmus direction during a head-roll test in lateral semicircular canal cupulolithiasis.}, journal = {Auris, nasus, larynx}, year = {2017}, volume = {44}, issue = {2}, pages = {227--231}, doi = {https://doi.org/10.1016/j.anl.2016.04.001}, keywords = {Adult; Benign Paroxysmal Positional Vertigo, diagnosis, physiopathology; Humans; Male; Middle Aged; Nystagmus, Pathologic, diagnosis, physiopathology; Nystagmus, Physiologic; Otolithic Membrane, physiopathology; Patient Positioning; Saccule and Utricle, physiopathology; Semicircular Canals, physiopathology; Vestibular Function Tests; Benign paroxysmal positional vertigo; Cupulolithiasis; Direction-changing positional nystagmus; Lateral semicircular canal; Otolith particles}, pmid = {27102718} }
Imai, T., Takeda, N., Sato, G., Sekine, K., Ito, M., Nakamae, K. and Kubo, T.	Changes in slow phase eye velocity and time constant of positional nystagmus at transform from cupulolithiasis to canalolithiasis. [Abstract] [BibTeX]	2008	Acta oto-laryngologica Vol. 128(1), pp. 22-28	article	DOI
Abstract: Changes in slow phase eye velocity (SPEV) and time constant (TC) of benign paroxysmal positional nystagmus in horizontal canal type were examined at transitional period from cupulolithiasis (apogeotropic nystagmus) into canalolithiasis (geotropic nystagmus) in two patients. SPEV and TC of positional nystagmus were tri-dimensionally analyzed. The first patient showed an apogeotropic nystagmus. Head rotation to the left in supine position induced a right-beating nystagmus with an initial SPEVof 15.3 degrees/s and a TC of 133 s. The nystagmus then gradually declined with a TC of 31.3 s after reaching a maximum SPEV of 28.8 degrees/s. After the nystagmus disappeared, he showed a geotropic nystagmus. The second patient showed a left-beating nystagmus with an initial SPEV of 2.5 degrees/s and a TC of 141 s when his head was rotated to the right in supine position. The nystagmus then gradually declined with a TC of 8.05 s after reaching a maximum SPEV of 16.7 degrees/s. After the nystagmus disappeared, he showed a geotropic nystagmus. The present findings suggested that in both patients, at the period of an increase of SPEV of the positional nystagmus with the shortening of its TC, cupulolithiasis transformed into canalolithiasis.
BibTeX: @article{Imai2008, author = {Imai, Takao and Takeda, Noriaki and Sato, Go and Sekine, Kazunori and Ito, Mahito and Nakamae, Koji and Kubo, Takeshi}, title = {Changes in slow phase eye velocity and time constant of positional nystagmus at transform from cupulolithiasis to canalolithiasis.}, journal = {Acta oto-laryngologica}, year = {2008}, volume = {128}, issue = {1}, pages = {22--28}, doi = {https://doi.org/10.1080/00016480701283752}, keywords = {Aged, 80 and over; Electronystagmography; Head Movements, physiology; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Male; Middle Aged; Nystagmus, Physiologic, physiology; Otolithic Membrane, physiopathology; Semicircular Canals, physiopathology; Supine Position, physiology; Vertigo, diagnosis, physiopathology; Videotape Recording}, pmid = {17851914} }
Naguib, M.B., Madian, Y., Refaat, M., Mohsen, O., El Tabakh, M. and Abo-Setta, A.	Characterisation and objective monitoring of balance disorders following head trauma, using videonystagmography. [Abstract] [BibTeX]	2012	The Journal of laryngology and otology Vol. 126(1), pp. 26-33	article	DOI
Abstract: To characterise balance disorders occurring after head trauma, using videonystagmography, and to test the efficiency of videonystagmography as a diagnostic and monitoring tool. Prospective, cohort analysis of 126 head trauma patients managed with vestibular evaluation, monitoring and treatment, in a tertiary referral centre. Analytical parameters included: head injury severity; balance disorder type, severity and time of onset; and patient recovery and outcome. Head trauma was minor in 31.7 per cent, mild in 36.6 per cent, moderate in 19 per cent and severe in 12.7 per cent. Balance disorder symptoms included vertigo in 42.9 per cent, unsteadiness in 15.9 per cent, dizziness in 9.5 per cent and none in 31.7 per cent. Videonystagmographic balance disorder diagnosis type was peripheral vestibular in 23.8 per cent, central in 7.9 per cent, mixed in 12.7 per cent, benign paroxysmal positional vertigo in 4.8 per cent and no findings in 50.8 per cent. Balance disorder was immediate in 47.6 per cent (this included all moderate and severe trauma cases). Benign paroxysmal positional vertigo developed within the first week in two-thirds of cases. More severe trauma cases had longer recovery times. Peripheral, mixed and central balance disorders recovered within the first three months. Early rehabilitation of acute balance disorders led to early recovery regardless of diagnosis. Videonystagmography enables precise, simple, cost-effective monitoring of balance disorders after head trauma, and improves care and outcomes.
BibTeX: @article{Naguib2012, author = {Naguib, M B and Madian, Y and Refaat, M and Mohsen, O and El Tabakh, M and Abo-Setta, A}, title = {Characterisation and objective monitoring of balance disorders following head trauma, using videonystagmography.}, journal = {The Journal of laryngology and otology}, year = {2012}, volume = {126}, issue = {1}, pages = {26--33}, doi = {https://doi.org/10.1017/S002221511100291X}, keywords = {Adolescent; Adult; Caloric Tests; Craniocerebral Trauma, complications, physiopathology, rehabilitation; Diagnosis, Differential; Dizziness, diagnosis, etiology, physiopathology; Electronystagmography, methods; Eye Movements, physiology; Female; Humans; Injury Severity Score; Male; Middle Aged; Postural Balance, physiology; Prospective Studies; Recovery of Function; Severity of Illness Index; Time Factors; Vertigo, diagnosis, etiology, physiopathology; Vestibule, Labyrinth, physiopathology; Video Recording; Young Adult}, pmid = {22035505} }
Choi, J.-Y., Glasauer, S., Kim, J.H., Zee, D.S. and Kim, J.-S.	Characteristics and mechanism of apogeotropic central positional nystagmus. [Abstract] [BibTeX]	2018	Brain : a journal of neurology	article	DOI
Abstract: Here we characterize persistent apogeotropic type of central positional nystagmus, and compare it with the apogeotropic nystagmus of benign paroxysmal positional vertigo involving the lateral canal. Nystagmus was recorded in 27 patients with apogeotropic type of central positional nystagmus (22 with unilateral and five with diffuse cerebellar lesions) and 20 patients with apogeotropic nystagmus of benign paroxysmal positional vertigo. They were tested while sitting, while supine with the head straight back, and in the right and left ear-down positions. The intensity of spontaneous nystagmus was similar while sitting and supine in apogeotropic type of central positional nystagmus, but greater when supine in apogeotropic nystagmus of benign paroxysmal positional vertigo. In central positional nystagmus, when due to a focal pathology, the lesions mostly overlapped in the vestibulocerebellum (nodulus, uvula, and tonsil). We suggest a mechanism for apogeotropic type of central positional nystagmus based on the location of lesions and a model that uses the velocity-storage mechanism. During both tilt and translation, the otolith organs can relay the same gravito-inertial acceleration signal. This inherent ambiguity can be resolved by a 'tilt-estimator circuit' in which information from the semicircular canals about head rotation is combined with otolith information about linear acceleration through the velocity-storage mechanism. An example of how this mechanism works in normal subjects is the sustained horizontal nystagmus that is produced when a normal subject is rotated at a constant speed around an axis that is tilted away from the true vertical (off-vertical axis rotation). We propose that when the tilt-estimator circuit malfunctions, for example, with lesions in the vestibulocerebellum, the estimate of the direction of gravity is erroneously biased away from true vertical. If the bias is toward the nose, when the head is turned to the side while supine, there will be sustained, unwanted, horizontal positional nystagmus (apogeotropic type of central positional nystagmus) because of an inappropriate feedback signal indicating that the head is rotating when it is not.
BibTeX: @article{Choi2018b, author = {Choi, Jeong-Yoon and Glasauer, Stefan and Kim, Ji Hyun and Zee, David S and Kim, Ji-Soo}, title = {Characteristics and mechanism of apogeotropic central positional nystagmus.}, journal = {Brain : a journal of neurology}, year = {2018}, doi = {https://doi.org/10.1093/brain/awx381}, keywords = {nodulus; nystagmus; positional nystagmus; velocity-storage mechanism; vertigo}, pmid = {29373699} }
Akin, F.W., Riska, K.M., Williams, L., Rouse, S.B. and Murnane, O.D.	Characteristics and Treatment Outcomes of Benign Paroxysmal Positional Vertigo in a Cohort of Veterans. [Abstract] [BibTeX]	2017	American journal of audiology Vol. 26(4), pp. 473-480	article	DOI
Abstract: The Mountain Home Veterans Affairs (VA) Medical Center has been diagnosing and treating veterans with benign paroxysmal positional vertigo (BPPV) for almost 2 decades. The clinic protocol includes a 2-week follow-up visit to determine the treatment outcome of the canalith repositioning treatment (CRT). To date, the characteristics of BPPV and treatment efficacy have not been reported in a cohort of veterans with BPPV. To determine the prevalence and characteristics of veterans diagnosed with BPPV in a Veterans Affairs Medical Center Audiology Clinic and to examine treatment outcomes. Retrospective chart review. A total of 102 veterans who tested positive for BPPV in the Vestibular Clinic at the Mountain Home VA Medical Center from March 2010 to August 2011. In 102 veterans who were diagnosed with BPPV, the posterior semicircular canal was most often involved (75%), motion-provoked vertigo was the most common symptom (84%), and the majority (43%) were diagnosed with BPPV in their sixth decade. The prevalence of BPPV in the Audiology Vestibular Clinic was 15.6%. Forty-one percent of veterans reported a symptom onset within 12 months of treatment for BPPV; however, 36% reported their symptoms began > 36 months prior to treatment. CRT was effective (negative Dix-Hallpike/roll test) in most veterans (86%) following 1 treatment appointment (M = 1.6), but more than half reported incomplete symptom resolution (residual dizziness) at the follow-up appointment. Eighteen percent of veterans experienced a recurrence (M = 1.8 years; SD = 1.7 years). The characteristics and treatment outcomes of BPPV in our veteran cohort was similar to what has been reported in the general population. Future work should focus on improving the timeliness of evaluation and treatment of BPPV and examining the time course and management of residual dizziness.
BibTeX: @article{Akin2017a, author = {Akin, Faith W and Riska, Kristal M and Williams, Laura and Rouse, Stephanie B and Murnane, Owen D}, title = {Characteristics and Treatment Outcomes of Benign Paroxysmal Positional Vertigo in a Cohort of Veterans.}, journal = {American journal of audiology}, year = {2017}, volume = {26}, issue = {4}, pages = {473--480}, doi = {https://doi.org/10.1044/2017_AJA-16-0118}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, epidemiology, therapy; Cohort Studies; Drosophila Proteins; Female; Humans; Male; Middle Aged; Patient Positioning, methods; Prevalence; Protein-Serine-Threonine Kinases; Recurrence; Retrospective Studies; Treatment Outcome; United States, epidemiology; Veterans}, pmid = {28973090} }
Kentala, E.	Characteristics of six otologic diseases involving vertigo. [Abstract] [BibTeX]	1996	The American journal of otology Vol. 17(6), pp. 883-892	article
Abstract: To characterize otologic causes for vertigo, data on 564 patients with the six most common diseases involving vertigo were retrieved from the database of a computer-aided diagnostic system for neurotologic diseases. The diseases were Meniere's disease, vestibular schwannoma, benign paroxysmal positional vertigo, vestibular neuritis, sudden deafness, and traumatic vertigo. The prevalence of tinnitus in the study population was 76%. The most severe forms of vertigo and nausea were found in vestibular neuritis, whereas the most severe case of tinnitus appeared in Meniere's disease. Of the patients with vestibular schwannoma, 49% had had vertigo. A linear discrimination analysis using case history classified 90% of the patients into correct groups. The key questions discriminating between the diseases concerned the frequency and duration of vertigo attacks, the duration of hearing loss and vertigo, and the occurrence of head injury. Making a correct diagnosis during the first office visit can be difficult, especially for sudden deafness, vestibular schwannoma, and Meniere's disease. Neurotologic and audiometric information was of minor value in distinguishing between these six diseases. Vestibular schwannoma had significantly greater asymmetry in electronystagmography and smaller gains in smooth pursuit in comparison with the other disease. Factorial analysis did not aid the clustering of these diseases.
BibTeX: @article{Kentala1996, author = {Kentala, E}, title = {Characteristics of six otologic diseases involving vertigo.}, journal = {The American journal of otology}, year = {1996}, volume = {17}, issue = {6}, pages = {883--892}, keywords = {Adolescent; Adult; Aged; Deafness, diagnosis, etiology; Diagnosis, Differential; Ear Neoplasms, complications, diagnosis, pathology; Ear, Inner, physiopathology; Female; Humans; Male; Meniere Disease, complications, diagnosis, physiopathology; Middle Aged; Neurilemmoma, complications, diagnosis, pathology; Neuritis, diagnosis, physiopathology; Statistics, Nonparametric; Surveys and Questionnaires; Vertigo, diagnosis, etiology, physiopathology; Vestibule, Labyrinth, pathology, physiopathology}, pmid = {8915417} }
Nørregaard, A.R., Lauridsen, H.H. and Hartvigsen, J.	Chiropractic management of a patient with benign paroxysmal positional vertigo: a case report. [Abstract] [BibTeX]	2009	Journal of manipulative and physiological therapeutics Vol. 32(5), pp. 387-390	article	DOI
Abstract: This article describes and discusses the case of a patient with benign paroxysmal positional vertigo (BPPV) characterized by severe vertigo with dizziness, nausea, and nystagmus, treated without the use of spinal manipulation by a doctor of chiropractic. A 46-year-old woman presented for care with complaints of acute vertigo and dizziness. The patient was examined and diagnosed with left posterior canalolithiasis by means of the Dix-Hallpike maneuver. She was treated successfully with the Epley maneuver once and subsequently discharged without further treatment. This case demonstrates the importance of correctly identifying patients with BPPV. This case also demonstrates the successful treatment of BPPV.
BibTeX: @article{Noerregaard2009, author = {Nørregaard, Anette R and Lauridsen, Henrik H and Hartvigsen, Jan}, title = {Chiropractic management of a patient with benign paroxysmal positional vertigo: a case report.}, journal = {Journal of manipulative and physiological therapeutics}, year = {2009}, volume = {32}, issue = {5}, pages = {387--390}, doi = {https://doi.org/10.1016/j.jmpt.2009.04.008}, keywords = {Acute Disease; Chiropractic, methods; Female; Head, physiology; Humans; Middle Aged; Movement, physiology; Nystagmus, Physiologic, physiology; Vertigo, therapy}, pmid = {19539122} }
Sajko, S.S., Stuber, K. and Welsh, T.N.	Chiropractic management of benign paroxysmal positional vertigo using the Epley maneuver: a case series. [Abstract] [BibTeX]	2013	Journal of manipulative and physiological therapeutics Vol. 36(2), pp. 119-126	article	DOI
Abstract: The purpose of this case series is to describe the management of benign paroxysmal positional vertigo in a chiropractic clinical setting. Eight patients (4 women, 4 men) with symptoms of persistent benign paroxysmal positional vertigo presented for chiropractic care. The outcome measures included self-reported resolution of vertigo, a Short Form 12 Health Survey, Measure Yourself Medical Outcome Profile, and the Dix-Hallpike maneuver. Outcome measures were assessed at initial assessment, 6 days, 30 days, and 3 months postintervention. The patients underwent one or more canalith repositioning procedures (Epley maneuver). Scores in each of the categories decreased from the initial to 6-day assessment and then again at the 30-day assessment. The effects of the treatment on the Short Form 12 scores showed changes between the initial assessment and 30 days posttreatment. The patients in this case series demonstrated reduction in symptoms with chiropractic management.
BibTeX: @article{Sajko2013, author = {Sajko, Sandy S and Stuber, Kent and Welsh, Tim N}, title = {Chiropractic management of benign paroxysmal positional vertigo using the Epley maneuver: a case series.}, journal = {Journal of manipulative and physiological therapeutics}, year = {2013}, volume = {36}, issue = {2}, pages = {119--126}, doi = {https://doi.org/10.1016/j.jmpt.2012.12.011}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo; Female; Humans; Male; Manipulation, Chiropractic, methods; Middle Aged; Retrospective Studies; Vertigo, therapy}, pmid = {23499147} }
Molvær, O.I.	Chronic Benign Paroxysmal Positional Vertigo (BPPV): A possible cause of chronic, otherwise unexplained neck-pain, headache, and widespread pain and fatigue, which may respond positively to repeated particle repositioning manoeuvres (PRM). [BibTeX]	2013	Scandinavian journal of pain Vol. 4(4), pp. 231-232	article	DOI
BibTeX: @article{Molvaer2013, author = {Molvær, Otto Inge}, title = {Chronic Benign Paroxysmal Positional Vertigo (BPPV): A possible cause of chronic, otherwise unexplained neck-pain, headache, and widespread pain and fatigue, which may respond positively to repeated particle repositioning manoeuvres (PRM).}, journal = {Scandinavian journal of pain}, year = {2013}, volume = {4}, issue = {4}, pages = {231--232}, doi = {https://doi.org/10.1016/j.sjpain.2013.06.005}, pmid = {29913647} }
Gazzola, J.M., Ganança, F.F., Aratani, M.C., Perracini, M.R. and Ganança, M.M.	Circumstances and consequences of falls in elderly people with vestibular disorder. [Abstract] [BibTeX]	2006	Brazilian journal of otorhinolaryngology Vol. 72(3), pp. 388-392	article
Abstract: To investigate the circumstances and consequences of falls in the chronically dizzy elderly and to correlate them with the number of falls (one/two and more). Transversal descriptive analytic study with 64 patients aged 65 or over, with history of falls and diagnostic of chronic vestibular dysfunction. We performed a descriptive analysis and Chi-Square test (x2<0.05). The sample was constituted by a female majority (76.6%) with a mean age of 73.62+/-5.69 years. The vestibular examination showed peripheral vestibulopathy in 81.5% of the cases and the most prevalent diagnostic hypothesis were benign paroxysmal positional vertigo (43.8%) and metabolic inner ear disease (42.2%). Recurrent falls were seen in 35 elderly (53.1%). In relation to the last fall, 39.1% of the patients had fallen in their homes, 51.6% of them occurred during the morning, 51.6% with some propulsion mechanism, 53.1% when walking, 25.0% caused by dizziness and 23.4% by stumbling. Activity restriction was significantly greater in patients that have already had two and more falls, when compared with those who had fallen only once (p=0.031). We found a significant association between the number of falls and their causes (p<0.001). Falls that have happened by slipping were more frequent in the elderly that reported one fall (p=0.0265) and falls that had happened because of dizziness were more frequent in the elderly that complained of two or more falls (p=0.0012). Fear and tendency to fall are referred by the majority of chronically dizzy elderly. Fall are more frequent in the morning, in the home and during walking. The propulsion direction is mentioned by half of the elderly and the most common cause for falls are dizziness and stumbling. The number of falls is significantly associated with activity restrictions after the last fall and with the causes for falling (slipping and dizziness).
BibTeX: @article{Gazzola2006a, author = {Gazzola, Juliana Maria and Ganança, Fernando Freitas and Aratani, Mayra Cristina and Perracini, Monica Rodrigues and Ganança, Maurício Malavasi}, title = {Circumstances and consequences of falls in elderly people with vestibular disorder.}, journal = {Brazilian journal of otorhinolaryngology}, year = {2006}, volume = {72}, issue = {3}, pages = {388--392}, keywords = {Accidental Falls, statistics & numerical data; Aged; Aged, 80 and over; Chi-Square Distribution; Chronic Disease; Cross-Sectional Studies; Female; Humans; Male; Vestibular Diseases, complications}, pmid = {17119777} }
Welling, D.B.	Classics from the laryngoscope. [BibTeX]	2015	The Laryngoscope Vol. 125(5), pp. 1031-1032	article	DOI
BibTeX: @article{Welling2015, author = {Welling, D Bradley}, title = {Classics from the laryngoscope.}, journal = {The Laryngoscope}, year = {2015}, volume = {125}, issue = {5}, pages = {1031--1032}, doi = {https://doi.org/10.1002/lary.25289}, keywords = {Benign Paroxysmal Positional Vertigo, history; Cochlea, innervation; Cochlear Implants, history; Deafness, history; Endolymph; Ganglia, cytology, pathology; Humans; Otologic Surgical Procedures, history; Semicircular Canals, pathology}, pmid = {25917653} }
Imai, T., Takeda, N., Ikezono, T., Shigeno, K., Asai, M., Watanabe, Y., Suzuki, M. and for Standards in Diagnosis of Japan Society for Equilibrium Research, C.	Classification, diagnostic criteria and management of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2017	Auris, nasus, larynx Vol. 44(1), pp. 1-6	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vertigo and the posterior and/or lateral semicircular canals are usually affected. BPPV is characterized by brief attacks of rotatory vertigo associated with positional and/or positioning nystagmus, which are elicited by specific head positions or changes in head position relative to gravity. In patients with the posterior-canal-type of BPPV, torsional nystagmus is induced by the Dix-Hallpike maneuver. In patients with the lateral-canal-type of BPPV, horizontal geotropic or apogeotropic nystagmus is induced by the supine roll test. The pathophysiology of BPPV is canalolithiasis comprising free-floating otoconial debris within the endolymph of a semicircular canal, or cupulolithiasis comprising otoconial debris adherent to the cupula. The observation of positional and/or positioning nystagmus is essential for the diagnosis of BPPV. BPPV is treated with the canalith repositioning procedure (CRP). Through a series of head position changes, the CRP moves otoconial debris from the affected semicircular canal to the utricle. In this review, we provide the classification, diagnostic criteria, and examinations for the diagnosis, and specific and non-specific treatments of BPPV in accordance with the Japanese practical guidelines on BPPV published by the Japan Society for Equilibrium Research.
BibTeX: @article{Imai2017, author = {Imai, Takao and Takeda, Noriaki and Ikezono, Tetsuo and Shigeno, Kohichiro and Asai, Masatsugu and Watanabe, Yukio and Suzuki, Mamoru and Committee for Standards in Diagnosis of Japan Society for Equilibrium Research}, title = {Classification, diagnostic criteria and management of benign paroxysmal positional vertigo.}, journal = {Auris, nasus, larynx}, year = {2017}, volume = {44}, issue = {1}, pages = {1--6}, doi = {https://doi.org/10.1016/j.anl.2016.03.013}, keywords = {Benign Paroxysmal Positional Vertigo, classification, diagnosis, physiopathology, therapy; Disease Management; Endolymph; Humans; Japan; Nystagmus, Pathologic, diagnosis, physiopathology; Otolithic Membrane, physiopathology; Patient Positioning; Saccule and Utricle; Semicircular Canals, physiopathology; Benign paroxysmal positional vertigo; Canalith repositioning procedure; Canalolithiasis; Cupulolithiasis}, pmid = {27174206} }
Heide, G., Freitag, S., Wollenberg, I., Iro, H., Schimrigk, K. and Dillmann, U.	Click evoked myogenic potentials in the differential diagnosis of acute vertigo. [Abstract] [BibTeX]	1999	Journal of neurology, neurosurgery, and psychiatry Vol. 66(6), pp. 787-790	article
Abstract: In response to loud clicks, a vestibular evoked potential can be recorded from sternocleidomastoid muscles, called "click evoked myogenic potential" (CEMP). This paper reports on the usefulness of CEMP in the differential diagnosis of acute vertigo of presumed vestibular origin. CEMP was examined in 40 patients with acute vertigo of vestibular origin (26 with acute peripheral vestibulopathy, five with Ménière's disease, three with benign paroxysmal positioning vertigo (BPPV), six with psychogenic vertigo) and the results compared with standard caloric reaction (CR). For CEMPs, clicks were delivered unilaterally via a pair of headphones. EMG activity was collected by surface electrodes placed on the sternocleidomastoid belly and averaged. In 29 patients, CR was unilaterally abnormal, pointing to a peripheral vestibular lesion. Seventeen of them had a corresponding loss of CEMPs; the other 12 patients had a normal CEMP. The remaining 11 patients had normal results in both tests. In comparison with CR, CEMP showed a sensitivity of 59% and a specificity of 100% for peripheral vestibular disorders. CR is a test of the horizontal canal whereas CEMP is thought to be a sacculus test. Different results of CR and CEMP may be due to this difference between target organs stimulated and may be of prognostic value.
BibTeX: @article{Heide1999, author = {Heide, G and Freitag, S and Wollenberg, I and Iro, H and Schimrigk, K and Dillmann, U}, title = {Click evoked myogenic potentials in the differential diagnosis of acute vertigo.}, journal = {Journal of neurology, neurosurgery, and psychiatry}, year = {1999}, volume = {66}, issue = {6}, pages = {787--790}, keywords = {Acoustic Stimulation; Adult; Aged; Evoked Potentials, Auditory, physiology; Female; Humans; Male; Meniere Disease, physiopathology; Middle Aged; Vertigo, physiopathology; Vestibule, Labyrinth, physiology}, pmid = {10329757} }
Saeed, B.M.N. and Omari, A.F.	Climatic variations and benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2016	Journal of otology Vol. 11(1), pp. 33-37	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is probably the most common diagnosis at vertigo clinics. Seasonal cycles of several human illnesses could be attributed variously to changes in atmospheric or weather conditions. In this retrospective study, patients with BPPV from January 2010 to December 2012 were studied, and their charts were reviewed. Statistical analysis revealed a statistically significant difference in patients' numbers among different months of the year. Also there is a significant statistical correlation between the numbers of patients with climatic variations especially the temperature. The present paper discusses the possible explanations for these results which confirms the seasonal variations in BPPV, together with a review of literature to view the possible associations with other disorders that causes such seasonality.
BibTeX: @article{Saeed2016, author = {Saeed, Basil M N and Omari, Alyaa Farouk}, title = {Climatic variations and benign paroxysmal positional vertigo.}, journal = {Journal of otology}, year = {2016}, volume = {11}, issue = {1}, pages = {33--37}, doi = {https://doi.org/10.1016/j.joto.2016.03.002}, keywords = {Atmospheric pressure; Benign paroxysmal positional vertigo; Climate; Humidity; Temperature}, pmid = {29937808} }
Hong, S.M. and Yeo, S.G.	Clinical analysis of patients with idiopathic sudden sensorineural hearing loss and benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2013	Acta oto-laryngologica Vol. 133(5), pp. 439-442	article	DOI
Abstract: Thirteen (5.4%) of patients with idiopathic sudden sensorineural hearing loss (ISSNHL) had benign paroxysmal positional vertigo (BPPV). Most of the patients showed profound hearing loss and had BPPV of the lateral canal. BPPV in patients with ISSNHL may have no influence on hearing recovery. BPPV occurs in 8.6-12.7% of patients with ISSNHL; however, the role of BPPV in hearing recovery remains controversial. Therefore, we investigated hearing outcomes in the patients, including the distribution of initial hearing threshold, the type of canal involved, and the number of repositioning maneuvers performed. Of 241 patients with ISSNHL who presented to a dizziness clinic between March 2008 and May 2012, 13 with both ISSNHL and BPPV were recruited for this study. The patients were evaluated for their initial hearing threshold, type of canal involved, response to repositioning maneuvers, and hearing outcome. Age- and hearing threshold-matched patients with ISSNHL but without BPPV were randomly sampled and included for a hearing outcome comparison. Of 13 patients with ISSNHL and BPPV, 11 showed profound hearing loss. The lateral canal was involved in 11 patients, including 3 who had multi-canal involvement. Ten patients underwent a single repositioning maneuver. Those patients did not display a significant difference in hearing recovery compared with those patients having ISSNHL only.
BibTeX: @article{Hong2013, author = {Hong, Seok Min and Yeo, Seung Geun}, title = {Clinical analysis of patients with idiopathic sudden sensorineural hearing loss and benign paroxysmal positional vertigo.}, journal = {Acta oto-laryngologica}, year = {2013}, volume = {133}, issue = {5}, pages = {439--442}, doi = {https://doi.org/10.3109/00016489.2012.754996}, keywords = {Auditory Threshold; Benign Paroxysmal Positional Vertigo; Female; Hearing Loss, Sensorineural, complications; Hearing Loss, Sudden, complications; Humans; Male; Middle Aged; Patient Positioning; Recovery of Function; Retrospective Studies; Treatment Outcome; Vertigo, complications, therapy}, pmid = {23294198} }
Agus, S., Benecke, H., Thum, C. and Strupp, M.	Clinical and Demographic Features of Vertigo: Findings from the REVERT Registry. [Abstract] [BibTeX]	2013	Frontiers in neurology Vol. 4, pp. 48	article	DOI
Abstract: Despite being a common disease, data on vertigo management in a real-world setting are scarce. To provide information on the vertigo and its management in a real-world setting. Data were collected from 4,294 patients with vertigo in 13 countries over 28 months via a multi-national, non-interventional observational study (the so-called REVERT registry). Data included medical history and details of anti-vertigo therapy. "Clinical global impression" (CGI) of severity (CGI-S) was assessed at baseline (V1) and then at 6 months follow-up (V2) along with CGI change (CGI-C). All variables were analyzed descriptively. The majority of patients were female, >40 years of age, and almost half had co-morbid cardio-vascular disease. Diagnoses were split into four categories: 37.2% "other vertigo of peripheral vestibular origin," 26.9% benign paroxysmal positional vertigo (BPPV), 20.5% "peripheral vestibular vertigo of unknown origin," and 15.4% Ménière's disease (MD). Betahistine was the most commonly prescribed therapy prior to and after enrollment, and was followed by piracetam, ginkgo biloba, and diuretics. MD had the highest proportion of betahistine treated patients. Almost half of patients were "moderately ill" at V1 based on CGI-S. At V2, patient distribution moved toward "less severe illness" (91.0% improved). The greatest improvements were in the more severely ill, and those with BPPV or "other vertigo of peripheral origin." There was a reduction in illness severity over the course of the study, some of which is likely to be due to pharmacological intervention. Further studies are needed to confirm these results.
BibTeX: @article{Agus2013, author = {Agus, Sam and Benecke, Heike and Thum, Cornelia and Strupp, Michael}, title = {Clinical and Demographic Features of Vertigo: Findings from the REVERT Registry.}, journal = {Frontiers in neurology}, year = {2013}, volume = {4}, pages = {48}, doi = {https://doi.org/10.3389/fneur.2013.00048}, keywords = {betahistine; treatment; vertigo; “observational study,” “registry”}, pmid = {23675366} }
Vaz, D.P., Gazzola, J.M., Lança, S.M., Dorigueto, R.S. and Kasse, C.A.	Clinical and functional aspects of body balance in elderly subjects with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2013	Brazilian journal of otorhinolaryngology Vol. 79(2), pp. 150-157	article
Abstract: Benign paroxysmal positional vertigo (BPPV) may compromise the balance of elderly subjects. To observe the effects of the Epley maneuver in elderly subjects with BPPV and assess clinical and functional aspects of body balance. This is a prospective clinical study. Patients diagnosed with BPPV (Dix-Hallpike test) were submitted to the Timed Up & Go (TUG) test, the Clinical Test of Sensory Interaction and Balance (CTSIB), and lower limb testing before and after they were repositioned using the modified Epley maneuver. Most subjects were females, and the group's mean age was 70.10 years (SD = 7.00). All patients had canalithiasis of the posterior canal. The following symptoms improved after the maneuver: postural instability (p = 0.006), nausea and vomiting (p = 0.021), and tinnitus (p = 0.003). Subjects improved their times significantly in the TUG and lower limb tests after the Epley maneuver (p < 0.001). Patients performed better on the CTSIB after the Epley maneuver on condition 2 (p < 0.003), condition 3 (p < 0.001), condition 4 (p < 0.001), condition 5 (p < 0.001), and condition 6 (p < 0.001). Clinical and functional aspects of body balance in elderly with BPPV improved after treatment with the modified Epley maneuver.
BibTeX: @article{Vaz2013, author = {Vaz, Daniela Patricia and Gazzola, Juliana Maria and Lança, Solange Martiliano and Dorigueto, Ricardo Schaffeln and Kasse, Cristiane Akemi}, title = {Clinical and functional aspects of body balance in elderly subjects with benign paroxysmal positional vertigo.}, journal = {Brazilian journal of otorhinolaryngology}, year = {2013}, volume = {79}, issue = {2}, pages = {150--157}, keywords = {Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Female; Humans; Male; Middle Aged; Postural Balance, physiology; Prospective Studies; Sensation Disorders, physiopathology, therapy; Treatment Outcome; Vertigo, physiopathology, therapy}, pmid = {23670318} }
Murofushi, T.	Clinical application of vestibular evoked myogenic potential (VEMP). [Abstract] [BibTeX]	2016	Auris, nasus, larynx Vol. 43(4), pp. 367-376	article	DOI
Abstract: The author reviewed clinical aspects of vestibular evoked myogenic potentials (VEMPs). Now two types of VEMPs are available. The first one is cervical VEMP, which is recorded in the sternocleidomastoid muscle and predominantly reflects sacculo-collic reflex. The other is ocular VEMP, which is usually recorded below the lower eye lid and predominantly reflects utriculo-ocular reflex. VEMPs play important roles not only for assessment of common vestibular diseases but also for establishment of new clinical entities. Clinical application in Meniere's disease, vestibular neuritis, benign paroxysmal positional vertigo, vestibular migraine, idiopathic otolithic vertigo, and central vertigo/dizziness was reviewed.
BibTeX: @article{Murofushi2016, author = {Murofushi, Toshihisa}, title = {Clinical application of vestibular evoked myogenic potential (VEMP).}, journal = {Auris, nasus, larynx}, year = {2016}, volume = {43}, issue = {4}, pages = {367--376}, doi = {https://doi.org/10.1016/j.anl.2015.12.006}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis, physiopathology; Endolymphatic Hydrops, diagnosis, physiopathology; Humans; Meniere Disease, diagnosis, physiopathology; Migraine Disorders, diagnosis, physiopathology; Neck Muscles; Oculomotor Muscles; Vertigo, diagnosis, physiopathology; Vestibular Diseases, diagnosis, physiopathology; Vestibular Evoked Myogenic Potentials; Vestibular Neuronitis, diagnosis, physiopathology; Endolymphatic hydrops; Inferior vestibular nerve; Otolith organ; Otolithic vertigo; Saccule; Utricle; Vestibular migraine}, pmid = {26791591} }
Yetiser, S. and Gokmen, M.H.A.	Clinical aspects of benign paroxysmal positional vertigo associated with migraine. [Abstract] [BibTeX]	2015	The international tinnitus journal Vol. 19(2), pp. 64-68	article	DOI
Abstract: Whether clinical features in patients with BPPV and migraine differ from patients with BPPV without migraine is unknown. The aim of this study is to compare clinical aspects of patients with or without migraine. 263 patients with BPPV were enrolled. Patients were investigated in terms of age, gender, symptoms, affected side, type of BPPV and the cure rate. Data were compared in patients with and without migraine. Mean values and standard deviations (± SD) were calculated. One way ANOVA test was used for the analysis. Significance was set at p < 0.005. 32 patients had migraine (11.4%). Gender ratio difference between groups was significant (4.2 vs. 1.3). Comparative analysis of average age between groups was not significant (p = 0.069; 38.50 ± 11.52, 43.38 ± 13.83). Majority of patients had symptoms less than 2 months and the difference was not significant (78.1% vs. 76%). Comparative analysis of cure rate of the therapeutic maneuvers between 2 groups was not significant (77% vs. 84%). Patients with BPPV may have associated migraine. However, this study does not indicate that the presence of migraine is a risk factor for BPPV for the cure since the therapeutic outcome is similar.
BibTeX: @article{Yetiser2015, author = {Yetiser, Sertaç and Gokmen, Meltem Hale Alpsan}, title = {Clinical aspects of benign paroxysmal positional vertigo associated with migraine.}, journal = {The international tinnitus journal}, year = {2015}, volume = {19}, issue = {2}, pages = {64--68}, doi = {https://doi.org/10.5935/0946-5448.20150011}, pmid = {27186935} }
Lee, H.-K., Ahn, S.-K., Jeon, S.-Y., Kim, J.-P., Park, J.J., Hur, D.G., Kim, D.W., Woo, S.H. and Kang, H.-S.	Clinical characteristics and natural course of recurrent vestibulopathy: a long-term follow-up study. [Abstract] [BibTeX]	2012	The Laryngoscope Vol. 122(4), pp. 883-886	article	DOI
Abstract: To investigate the clinical characteristics and the natural course of recurrent vestibulopathy (RV). Retrospective study. During the period April 2002 to February 2008, we reviewed the clinical records of 98 patients diagnosed with RV. All patients were approached by telephone and using a questionnaire. The analysis included age, sex distribution, natural history, pure-tone audiometry, caloric response, age at onset, and the characteristics of vertigo. Median follow-up was 63.1 months (range, 24-103 months). Patients had a mean age at onset of 39 years and a mean duration of 4.2 years. An obvious female predilection was found, and unilateral caloric paresis (≥ 25%) was seen in 35%. Of the 98 patients, symptoms resolved in 82% but were unchanged in 12%. RV developed to Ménière's disease in four patients and to migraine in two. No patient with RV developed a central nervous system disease or benign paroxysmal positional vertigo during follow-up. The study suggests that in the majority of cases, vertigo spontaneously resolves and that the risks of development to Ménière's disease or migraine are low.
BibTeX: @article{Lee2012c, author = {Lee, Hong-Kyoung and Ahn, Seong-Ki and Jeon, Sea-Yuong and Kim, Jin-Pyeong and Park, Jung Je and Hur, Dong Gu and Kim, Dae Woo and Woo, Seung Hoon and Kang, Hung-Soo}, title = {Clinical characteristics and natural course of recurrent vestibulopathy: a long-term follow-up study.}, journal = {The Laryngoscope}, year = {2012}, volume = {122}, issue = {4}, pages = {883--886}, doi = {https://doi.org/10.1002/lary.23188}, keywords = {Adult; Audiometry, Pure-Tone; Caloric Tests; Diagnosis, Differential; Disease Progression; Female; Follow-Up Studies; Humans; Male; Prognosis; Retrospective Studies; Surveys and Questionnaires; Time Factors; Vestibular Neuronitis, diagnosis, physiopathology; Vestibule, Labyrinth, physiopathology}, pmid = {22374685} }
Ahn, S.-K., Jeon, S.-Y., Kim, J.-P., Park, J.J., Hur, D.G., Kim, D.-W., Woo, S.-H., Kwon, O.-J. and Kim, J.-Y.	Clinical characteristics and treatment of benign paroxysmal positional vertigo after traumatic brain injury. [Abstract] [BibTeX]	2011	The Journal of trauma Vol. 70(2), pp. 442-446	article	DOI
Abstract: Traumatic brain injury (TBI) has been reported to be a common cause of benign paroxysmal positional vertigo (BPPV). However, only a few studies have investigated BPPV after TBI. The aim of this study was to identify the clinical characteristics of BPPV after TBI and to determine whether there are clinical differences between BPPV after TBI and idiopathic BPPV. The authors reviewed the medical records of 192 consecutive patients with positional vertigo after head injury during the period 2003 to 2009 and investigated 112 patients with idiopathic BPPV treated over the same period. The clinical characteristics of BPPV after TBI and the clinical differences between the traumatic BPPV and idiopathic BPPV groups were investigated. A total of 32 patients with BPPV after TBI fulfilled the inclusion criteria. Twenty-four patients in the traumatic BPPV group had posterior semicircular canal-BPPV and 11 patients lateral semicircular canal-BPPV. A total of 58 repositioning maneuver sessions were performed in these 32 patients. Members of the traumatic BPPV group required more treatment sessions than members of the idiopathic group (p<0.05), but no tendency to recur was observed in the traumatic group (p>0.05). Recurrence rates in the traumatic and idiopathic BPPV groups were 15.6% and 18.8%, respectively (p>0.05). It is likely that BPPV after TBI is more difficult to treat than idiopathic BPPV, but no tendency to recur was observed in patients who developed BPPV after TBI compared with idiopathic BPPV. Further prospective clinical meta-analytic studies are needed to investigate the outcome of BPPV after TBI.
BibTeX: @article{Ahn2011, author = {Ahn, Seong-Ki and Jeon, Sea-Yuong and Kim, Jin-Pyeong and Park, Jung Je and Hur, Dong Gu and Kim, Dae-Woo and Woo, Seung-Hoon and Kwon, Oh-Jin and Kim, Jin-Yong}, title = {Clinical characteristics and treatment of benign paroxysmal positional vertigo after traumatic brain injury.}, journal = {The Journal of trauma}, year = {2011}, volume = {70}, issue = {2}, pages = {442--446}, doi = {https://doi.org/10.1097/TA.0b013e3181d0c3d9}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Brain Injuries, complications, physiopathology; Child; Female; Humans; Male; Middle Aged; Posture, physiology; Retrospective Studies; Vertigo, etiology, physiopathology, therapy; Young Adult}, pmid = {20489667} }
Tan, J., Deng, Y., Zhang, T. and Wang, M.	Clinical characteristics and treatment outcomes for benign paroxysmal positional vertigo comorbid with hypertension. [Abstract] [BibTeX]	2017	Acta oto-laryngologica Vol. 137(5), pp. 482-484	article	DOI
Abstract: Patients with BPPV comorbid with hypertension (h-BPPV) tend to receive a delayed diagnosis of BPPV. Comorbidity with hypertension did not influence the efficacy of the repositioning maneuver; however, comorbidity with hypertension was associated with an increased recurrence rate of BPPV. To determine the clinical characteristics and outcomes of h-BPPV, as well as the clinical differences between h-BPPV and idiopathic BPPV (i-BPPV). The authors reviewed the medical records of 41 consecutive patients with h-BPPV (the h-BPPV group) from March to December 2014 and 47 patients with i-BPPV (the i-BPPV group) during the same period. There were no significant differences in age, sex ratio, or the affected side between the h-BPPV and i-BPPV groups. The proportion of patients reporting an initial episode of positional vertigo was significantly lower in the h-BPPV group (51.22% vs 74.47%; p = .024). Patients in the h-BPPV group reported a longer median episode duration than did those in the i-BPPV group (60 days vs 15 days; p = .017). The results of treatment using repositioning maneuvers were similar between the two groups. At follow-up, 13 patients in the h-BPPV group were diagnosed with recurrent BPPV compared with six in the i-BPPV group (p = .031).
BibTeX: @article{Tan2017, author = {Tan, Jun and Deng, Yuxiao and Zhang, Tianyu and Wang, Menghong}, title = {Clinical characteristics and treatment outcomes for benign paroxysmal positional vertigo comorbid with hypertension.}, journal = {Acta oto-laryngologica}, year = {2017}, volume = {137}, issue = {5}, pages = {482--484}, doi = {https://doi.org/10.1080/00016489.2016.1247985}, keywords = {Adult; Benign Paroxysmal Positional Vertigo, complications, therapy; Female; Humans; Hypertension, complications; Male; Middle Aged; Retrospective Studies; Treatment Outcome; Benign paroxysmal positional vertigo; hypertension; recurrence}, pmid = {27841099} }
Moon, S.Y., Kim, J.S., Kim, B.K., Kim, J.I., Lee, H., Son, S.I., Kim, K.S., Rhee, C.K., Han, G.C. and Lee, W.S.	Clinical characteristics of benign paroxysmal positional vertigo in Korea: a multicenter study. [Abstract] [BibTeX]	2006	Journal of Korean medical science Vol. 21(3), pp. 539-543	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is characterized by episodic vertigo and nystagmus provoked by head motions. To study the characteristics of BPPV in a large group of patients in Korea, we retrospectively analyzed clinical features of 1,692 patients (women: 1,146, 67.7%; men: 54.6, 32.3%; mean age: 54.8+/-14.0 yr), who had been diagnosed as BPPV by trained neuro-otologists Dizziness Clinics. The diagnosis of BPPV was based on typical nystagmus elicited by positioning maneuvers. Posterior semicircular canal was involved in 60.9% of the patients, horizontal canal in 31.9%, anterior canal in 2.2%, and mixed canals in 5.0%. The horizontal canal type of BPPV (HC-BPPV) comprised 49.5% of geotropic and 50.5% of apogeotropic types. We could observe significant negative correlation between the proportion of HC-BPPV of each clinic and the mean time interval between the symptom onset and the first visit to the clinics (r=-0.841, p<0.05). Most patients were successfully treated with canalith repositioning maneuvers (86.9%). The high incidence of HC-BPPV in this study may be explained by relatively shorter time interval between the symptom onset and visit to the Dizziness Clinics in Korea, compared with previous studies in other countries.
BibTeX: @article{Moon2006, author = {Moon, So Young and Kim, Ji Soo and Kim, Byung Kun and Kim, Jae Il and Lee, Hyung and Son, Sung Il and Kim, Kyu Sung and Rhee, Chung Ku and Han, Gyu Cheol and Lee, Won Sang}, title = {Clinical characteristics of benign paroxysmal positional vertigo in Korea: a multicenter study.}, journal = {Journal of Korean medical science}, year = {2006}, volume = {21}, issue = {3}, pages = {539--543}, doi = {https://doi.org/10.3346/jkms.2006.21.3.539}, keywords = {Aged; Female; Head Movements; Humans; Korea; Male; Middle Aged; Nystagmus, Physiologic; Retrospective Studies; Semicircular Canals, pathology; Vertigo, diagnosis; Vestibular Function Tests}, pmid = {16778402} }
Chihara, Y., Iwasaki, S., Murofushi, T., Yagi, M., Inoue, A., Fujimoto, C., Egami, N., Ushio, M., Karino, S., Sugasawa, K. and Yamasoba, T.	Clinical characteristics of inferior vestibular neuritis. [Abstract] [BibTeX]	2012	Acta oto-laryngologica Vol. 132(12), pp. 1288-1294	article	DOI
Abstract: Inferior vestibular neuritis (IVN) is a relatively minor subtype of vestibular neuritis (VN) and its clinical characteristics are unique. To clarify clinical characteristics of IVN in comparison with conventional VN. This was a retrospective case series review. Caloric responses and cervical vestibular evoked myogenic potential (cVEMP) responses were measured in 71 patients with VN. The patients were classified into three groups: (1) IVN group, who showed only asymmetrical cVEMP responses; (2) superior VN (SVN) group, who showed only asymmetrical caloric responses; (3) total VN (TVN) group, who showed asymmetrical responses in both tests. The clinical records of time course of subjective symptoms (duration of attack, duration of hospitalization, and time to remission) were reviewed and other profiles (age, sex, affected side, acute symptoms, and sequelae) were evaluated. Of the 71 patients with VN, 13 (18%) were classified as having IVN. The mean age and time to remission of patients with IVN (44.2 ± 4.8 years, 0.9 ± 0.5 months) were significantly lower and shorter, respectively, than those of patients with TVN (57.3 ± 2.5 years, 4.9 ± 4.7 months). There were no significant differences in other symptoms and profiles among the three groups. No patients with IVN showed benign paroxysmal positional vertigo as a sequela.
BibTeX: @article{Chihara2012, author = {Chihara, Yasuhiro and Iwasaki, Shinichi and Murofushi, Toshihisa and Yagi, Masato and Inoue, Aki and Fujimoto, Chisato and Egami, Naoya and Ushio, Munetaka and Karino, Shotaro and Sugasawa, Keiko and Yamasoba, Tatsuya}, title = {Clinical characteristics of inferior vestibular neuritis.}, journal = {Acta oto-laryngologica}, year = {2012}, volume = {132}, issue = {12}, pages = {1288--1294}, doi = {https://doi.org/10.3109/00016489.2012.701326}, keywords = {Adult; Caloric Tests; Diagnosis, Differential; Female; Humans; Male; Meniere Disease, diagnosis; Middle Aged; Otolithic Membrane, physiopathology; Prognosis; Remission, Spontaneous; Retrospective Studies; Saccule and Utricle, physiopathology; Semicircular Canals, physiopathology; Vestibular Evoked Myogenic Potentials, physiology; Vestibular Nerve, physiopathology; Vestibular Neuronitis, classification, diagnosis, physiopathology}, pmid = {23039337} }
Iwasaki, S., Fujimoto, C., Kinoshita, M., Kamogashira, T., Egami, N. and Yamasoba, T.	Clinical characteristics of patients with abnormal ocular/cervical vestibular evoked myogenic potentials in the presence of normal caloric responses. [Abstract] [BibTeX]	2015	The Annals of otology, rhinology, and laryngology Vol. 124(6), pp. 458-465	article	DOI
Abstract: To investigate the clinical features and vestibular symptoms of patients with abnormal ocular vestibular evoked myogenic potentials (oVEMPs) and/or cervical VEMPs (cVEMPs) in the presence of normal caloric responses. Retrospective chart review. Tertiary referral center. One thousand five hundred twenty-one consecutive patients with balance problems who underwent the caloric, cVEMP, and oVEMP tests were included, and patients who showed abnormal oVEMPs and/or cVEMPs in the presence of normal caloric responses were selected. Clinical characteristics, diagnoses, and vestibular symptoms of the patients were analyzed. Of the 1521 patients, 227 (15%) were found to have abnormal oVEMPs and/or cVEMP responses with normal caloric responses. Benign paroxysmal positional vertigo (BBPV), Meniere's disease, and vestibular migraine were the common diagnoses of these patients. Eighty-one patients (36%) could not be diagnosed with a recognizable disease. Multiple episodes of spinning vertigo with a duration of seconds to hours were their most common vestibular symptoms. BPPV, Meniere's disease, and vestibular migraine are the most frequent diagnoses showing abnormal oVEMP and/or cVEMPs without canal paresis. Apart from these clinical entities, a portion of undiagnosed patients with multiple episodes of vertigo might have a disease that involves the otolith organs only.
BibTeX: @article{Iwasaki2015a, author = {Iwasaki, Shinichi and Fujimoto, Chisato and Kinoshita, Makoto and Kamogashira, Teru and Egami, Naoya and Yamasoba, Tatsuya}, title = {Clinical characteristics of patients with abnormal ocular/cervical vestibular evoked myogenic potentials in the presence of normal caloric responses.}, journal = {The Annals of otology, rhinology, and laryngology}, year = {2015}, volume = {124}, issue = {6}, pages = {458--465}, doi = {https://doi.org/10.1177/0003489414564997}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis, physiopathology; Caloric Tests, methods; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Male; Meniere Disease, diagnosis, physiopathology; Middle Aged; Reproducibility of Results; Retrospective Studies; Vestibular Evoked Myogenic Potentials, physiology; otolith; saccule; utricle; vestibular; vestibular evoked myogenic potential}, pmid = {25533509} }
Kim, M.B., Chang, S.W., Lim, G.C. and Song, C.I.	Clinical Characteristics of Patients with Dizziness after Motor Vehicle Accident. [Abstract] [BibTeX]	2017	The journal of international advanced otology Vol. 13(3), pp. 374-378	article	DOI
Abstract: The purpose of this study was to identify the clinical characteristics of dizziness occurring after a motor vehicle accident. We retrospectively analyzed 217 patients who had visited a tertiary medical center complaining of dizziness after a motor vehicle accident between January 2009 and December 2014. Of the 217 patients, we enrolled 54 patients who had undergone a vestibular function test and had no definite evidence of fracture of the temporal bone or intracranial lesions. Patients were divided into two groups: the dizziness group (group A, 29 patients) and the dizziness with audiological symptoms (hearing disturbance, tinnitus, ear fullness) group (group B, 25 patients). The prevalence of benign paroxysmal positional vertigo was higher in group A. Apart from this finding, the clinical features did not differ significantly between the two groups. Group B had a higher number of patients who exhibited asymmetric hearing on pure tone audiometry, but the difference was not statistically significant. There were no notable characteristics in patients with dizziness after motor vehicle accidents, although patients without hearing symptoms tended to have benign paroxysmal positional vertigo, whereas other patients tended to have hearing disturbance. This information may be helpful for clinicians in counseling and managing patients with dizziness and audiological symptoms after motor vehicle accidents.
BibTeX: @article{Kim2017a, author = {Kim, Min Bum and Chang, Suk Won and Lim, Gil Chai and Song, Chan Il}, title = {Clinical Characteristics of Patients with Dizziness after Motor Vehicle Accident.}, journal = {The journal of international advanced otology}, year = {2017}, volume = {13}, issue = {3}, pages = {374--378}, doi = {https://doi.org/10.5152/iao.2017.3424}, pmid = {29165309} }
Suarez, H., Alonso, R., Arocena, M., Suarez, A. and Geisinger, D.	Clinical characteristics of positional vertigo after mild head trauma. [Abstract] [BibTeX]	2011	Acta oto-laryngologica Vol. 131(4), pp. 377-381	article	DOI
Abstract: This study showed that a population with benign paroxysmal positional vertigo related to mild head trauma (BPPVAT) was younger and more frequently presented with bilateral canalithiasis than another population with idiopathic etiology (IBPPV). In both groups, females presented a higher risk of BPPV. To compare the clinical features of a population with BPPVAT and another with IBBPV. We carried out statistical analysis of a population of 51 subjects with BPPVAT and another of 325 subjects with IBPPV, comparing age, gender, recurrence of symptoms, associated chronic dizziness (CD), and clinical presentation. Kolmogorov Smirnov test, Student's t test, Mann-Whitney test, 95% binomial confidence interval for proportions, chi-squared, and Fisher's test were used as statistical tools. A significance level of p < 0.05 was considered in all cases. The population affected with BPPVAT was younger and bilateral canalithiasis was also more frequent. No differences were found in gender distribution, semicircular canals involved in the symptoms, recurrence after repositioning maneuvers, or associated CD.
BibTeX: @article{Suarez2011, author = {Suarez, Hamlet and Alonso, Rafael and Arocena, Mariana and Suarez, Alejo and Geisinger, Dario}, title = {Clinical characteristics of positional vertigo after mild head trauma.}, journal = {Acta oto-laryngologica}, year = {2011}, volume = {131}, issue = {4}, pages = {377--381}, doi = {https://doi.org/10.3109/00016489.2010.534113}, keywords = {Adult; Age Factors; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Craniocerebral Trauma, complications, epidemiology; Dizziness, epidemiology; Female; Humans; Incidence; Male; Middle Aged; Recurrence; Retrospective Studies; Sex Factors; Uruguay, epidemiology; Vertigo, epidemiology, etiology, therapy; Young Adult}, pmid = {21189053} }
Staab, J.P.	Clinical clues to a dizzying headache. [Abstract] [BibTeX]	2011	Journal of vestibular research : equilibrium & orientation Vol. 21(6), pp. 331-340	article	DOI
Abstract: Recent years have witnessed an upsurge of interest in migraine as a cause of vestibular symptoms. Starting with 1970s case reports linking migraine to childhood vertigo, neurotologists worldwide have increasingly diagnosed migraine. Various syndromes of vestibular migraine (VM) have been described, diagnostic criteria proposed, epidemiologic data collected, and neurophysiologic models developed. Yet, the concept that migraine causes vestibular symptoms rests on a surprisingly thin research database. Current concepts of VM are based on expert opinion, not empirical data. No general consensus exists about the definition of VM. No studies have analyzed its essential features. Just one well-controlled medication trial has been published. No biomarkers are known. To stimulate more rigorous research, this paper poses three questions about clinical investigations into migraine and vestibular symptoms: What variables should be measured? What patients should be studied? How might clinical trials yield both clinically useful results and greater insights into pathophysiologic processes? Using these questions, the limits of current knowledge are explored. Applicable research methods from epidemiology to genetics are examined. Pilot data demonstrating pharmacologic and genetic dissection techniques are presented. Ambitious, but practical, near-term clinical research goals are enumerated, including rigorous validation of diagnostic criteria and development of empirically derived management guidelines.
BibTeX: @article{Staab2011, author = {Staab, Jeffrey P}, title = {Clinical clues to a dizzying headache.}, journal = {Journal of vestibular research : equilibrium & orientation}, year = {2011}, volume = {21}, issue = {6}, pages = {331--340}, doi = {https://doi.org/10.3233/VES-2011-0426}, keywords = {Adult; Age of Onset; Benign Paroxysmal Positional Vertigo; Child; Comorbidity; Diagnosis, Differential; Diagnostic Techniques, Neurological; Dizziness, epidemiology, etiology, physiopathology; Female; Genome-Wide Association Study; Goals; Humans; Kinesthesis, physiology; Male; Middle Aged; Migraine Disorders, classification, complications, diagnosis, epidemiology, genetics, physiopathology; Migraine with Aura, complications, physiopathology; Posture; Prevalence; Research Design; Time Factors; Vertigo, epidemiology, etiology, physiopathology; Vestibular Diseases, epidemiology, etiology, physiopathology}, pmid = {22348938} }
Moore, B.M.	Clinical decision-making to address poor outcomes in persistent horizontal semicircular canal benign paroxysmal positional vertigo: A case study. [Abstract] [BibTeX]	2017	Physiotherapy theory and practice Vol. 33(5), pp. 429-438	article	DOI
Abstract: Horizontal semicircular canal BPPV (HSC-BPPV) can occur in 10-30% of BPPV cases. Lower success rates are reported for HSC-BPPV. The apogeotropic form of HSC-BPPV is more difficult to treat, as 5-40% of cases are described to be refractory to repositioning maneuvers. To describe the assessment and treatment of a patient presenting with HSC-BPPV and to demonstrate the potential use of Forced-Prolonged Positioning (FPP) as a home exercise program (HEP) for persistent HSC-BPPV in an elderly patient. An 89-year-old female referred to physical therapy with a diagnosis of BPPV. She experienced dizziness with positional changes and was found to have apogeotropic form of HSC-BPPV. To supplement maneuvers performed in the clinic, the patient was provided instructions for the FPP as her HEP. With continued symptoms and positive positional tests by week four of treatment, the patient was instructed to switch the FPP with the opposing ear directed toward the floor. Following 2 weeks of performing FPP on the opposite side, the patient reported symptoms had resolved and positional testing confirmed resolution of HSC-BPPV. There is a potential benefit of using FPP as a HEP to supplement maneuvers used in the clinic to improve outcomes in patients with HSC-BPPV that are refractory to traditional repositioning maneuvers. Prescribing the FPP maneuver as a HEP is feasible, and clinicians should consider the FPP technique as a HEP to adjunct repositioning maneuvers performed in the clinic to address persistent HSC-BPPV.
BibTeX: @article{Moore2017, author = {Moore, Brian M}, title = {Clinical decision-making to address poor outcomes in persistent horizontal semicircular canal benign paroxysmal positional vertigo: A case study.}, journal = {Physiotherapy theory and practice}, year = {2017}, volume = {33}, issue = {5}, pages = {429--438}, doi = {https://doi.org/10.1080/09593985.2017.1318426}, keywords = {Aged, 80 and over; Benign Paroxysmal Positional Vertigo, diagnosis, physiopathology, therapy; Clinical Decision-Making; Exercise Therapy, methods; Female; Home Care Services; Humans; Nystagmus, Physiologic; Patient Positioning; Posture; Remission Induction; Semicircular Canals, physiopathology; Time Factors; Treatment Outcome; Benign paroxysmal positional vertigo; forced prolonged positioning; horizontal semicircular canal}, pmid = {28481172} }
Gazzola, J.M., Ganança, F.F., Aratani, M.C., Perracini, M.R. and Ganança, M.M.	Clinical evaluation of elderly people with chronic vestibular disorder. [Abstract] [BibTeX]	2006	Brazilian journal of otorhinolaryngology Vol. 72(4), pp. 515-522	article
Abstract: Dizziness is common among the elderly. To characterize social, demographic, clinical, functional and otoneurological data in elderly patients with chronic vestibular disorder. A sequential study of 120 patients with chronic vestibular disorder. Simple descriptive analyses were undertaken. Most of the patients were female (68.3%) with a mean age of 73.40+/-5.77 years. The average number of illnesses associated with the vestibular disorder was 3.83+/-1.84; the patients were taking on average 3.86+/-2.27 different medications. The most prevalent diagnosis on the vestibular exam was unilateral vestibular loss (29.8%) and the most prevalent etiology was metabolic vestibulopathy (40.0%) followed by benign paroxysmal positional vertigo (36.7%). Fifty-two patients (43.3%) had experienced dizziness for 5 years or more. Sixty-four patients (53.3%) had at least one fall in the last year and thirty-five (29.2%) had recurrent falls. Most of the sample included females with associated diseases, and using many different drugs. The most prevalent vestibular diseases were metabolic and vascular labyrinth conditions. Dizziness is a chronic symptom in elderly patients. The association of two vestibular diseases is common. Falls are prevalent in chronic dizzy elderly patients.
BibTeX: @article{Gazzola2006, author = {Gazzola, Juliana Maria and Ganança, Fernando Freitas and Aratani, Mayra Cristina and Perracini, Monica Rodrigues and Ganança, Maurício Malavasi}, title = {Clinical evaluation of elderly people with chronic vestibular disorder.}, journal = {Brazilian journal of otorhinolaryngology}, year = {2006}, volume = {72}, issue = {4}, pages = {515--522}, keywords = {Accidental Falls, statistics & numerical data; Aged; Aged, 80 and over; Brazil, epidemiology; Chronic Disease; Cross-Sectional Studies; Dizziness, epidemiology, etiology; Drug Utilization, statistics & numerical data; Female; Humans; Male; Prevalence; Retrospective Studies; Socioeconomic Factors; Vestibular Diseases, classification, complications, epidemiology}, pmid = {17143431} }
Ibekwe, T.S. and Rogers, C.	Clinical evaluation of posterior canal benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2012	Nigerian medical journal : journal of the Nigeria Medical Association Vol. 53(2), pp. 94-101	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is a mechanical peripheral vestibular disorder which may involve any of the three semicircular canals but principally the posterior. In as much as the literature has described theories to explain the mechanism of BPPV and also contains scholarly works that elucidate BPPV; its management remains an enigma to most clinicians. To this end, this work was aimed at outlining an evidence-based best practice for most common form of BPPV. A systematic review of the literature was conducted between 1948 and June 2011 in PubMed, Embase, Ovid, and Cochrane database through the online Library of the University of Cape Town. Seventy-nine worthy articles that addressed the study were selected on consensus of the two authors. There is consensus for the use of canalith repositioning procedures as the best form of treatment for posterior canal canalolithiasis. However, successful treatment is dependent on accurate identification of the implicated canal and the form of lithiasis. Furthermore, clinicians should note that there is no place for pharmacological treatment of BPPV; unless it is to facilitate repositioning.
BibTeX: @article{Ibekwe2012, author = {Ibekwe, Titus S and Rogers, C}, title = {Clinical evaluation of posterior canal benign paroxysmal positional vertigo.}, journal = {Nigerian medical journal : journal of the Nigeria Medical Association}, year = {2012}, volume = {53}, issue = {2}, pages = {94--101}, doi = {https://doi.org/10.4103/0300-1652.103550}, keywords = {Benign paroxysmal positional vertigo; canalith repositioning procedures; canalolithiasis; cupulolithiasis; nystagmus; vertigo}, pmid = {23271854} }
Sandhu, J.S. and Rea, P.A.	Clinical examination and management of the dizzy patient. [Abstract] [BibTeX]	2016	British journal of hospital medicine (London, England : 2005) Vol. 77(12), pp. 692-698	article	DOI
Abstract: Dizziness is the commonest reason for a GP appointment over the age of 75 years and many dizzy patients will end up in hospital. This article introduces the range of vestibular disorders commonly seen in hospital practice with a symptom-based approach and discusses the range of treatments that might be considered.
BibTeX: @article{Sandhu2016, author = {Sandhu, Jaswinder S and Rea, Peter A}, title = {Clinical examination and management of the dizzy patient.}, journal = {British journal of hospital medicine (London, England : 2005)}, year = {2016}, volume = {77}, issue = {12}, pages = {692--698}, doi = {https://doi.org/10.12968/hmed.2016.77.12.692}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis, therapy; Brain Infarction, complications, diagnosis, therapy; Disease Management; Dizziness, diagnosis, etiology, therapy; Head Impulse Test; Humans; Labyrinthitis, complications, diagnosis, therapy; Meniere Disease, diagnosis, therapy; Migraine Disorders, diagnosis, therapy; Neurologic Examination, methods; Physical Examination; Vertigo, diagnosis, therapy; Vestibular Diseases, complications, diagnosis, therapy; Vestibular Function Tests; Vestibular Neuronitis, diagnosis, therapy}, pmid = {27937029} }
Kao, C.-L., Hsieh, W.-L., Chern, C.-M., Chen, L.-K., Lin, M.-H. and Chan, R.-C.	Clinical features of benign paroxysmal positional vertigo (BPPV) in Taiwan: differences between young and senior age groups. [Abstract] [BibTeX]	2009	Archives of gerontology and geriatrics Vol. 49 Suppl 2, pp. S50-S54	article	DOI
Abstract: BPPV is a common cause of vertigo. Several treatment procedures can facilitate recovery. In this study, we aimed to identify the demographic features, resolution and recurrence rates and impacts on daily activities in BPPV patient between young and senior age groups in Taiwan. This retrospective study recruited 218 patients of BPPV. Medical history, canal involvement, treatment required for complete resolution, symptom free period and recurrence rates were evaluated between the two age groups. Up to 80.7% of patients were successfully treated by a single treatment. For patients aged more than 65 years, the recurrence rate was 1.7 times higher than that in the younger age group (p = 0.07). The symptom-free period before recurrence was nearly 2.2 times longer in the senior age group (p = 0.03). Work-related activities were influenced more by BPPV in the younger age group (p = 0.03). We conclude that BPPV is prone to occur and recur in people of senior age. Clinicians should have the knowledge to diagnose different types of BPPV and treat it accordingly to prevent further complications.
BibTeX: @article{Kao2009, author = {Kao, Chung-Lan and Hsieh, Wan-Ling and Chern, Chang-Ming and Chen, Liang-Kung and Lin, Ming-Hsien and Chan, Rai-Chi}, title = {Clinical features of benign paroxysmal positional vertigo (BPPV) in Taiwan: differences between young and senior age groups.}, journal = {Archives of gerontology and geriatrics}, year = {2009}, volume = {49 Suppl 2}, pages = {S50--S54}, doi = {https://doi.org/10.1016/S0167-4943(09)70014-7}, keywords = {Adult; Age Factors; Aged; Aged, 80 and over; Ear Canal, physiopathology; Female; Hospitals, Veterans; Humans; Male; Middle Aged; Recurrence; Retrospective Studies; Taiwan; Treatment Outcome; Vertigo, diagnosis, physiopathology, therapy}, pmid = {20005428} }
Celebisoy, N., Polat, F. and Akyurekli, O.	Clinical features of benign paroxysmal positional vertigo in Western Turkey. [Abstract] [BibTeX]	2008	European neurology Vol. 59(6), pp. 315-319	article	DOI
Abstract: It was the aim of this study to analyze the clinical manifestations, the incidence of each variant and the comorbid conditions of benign paroxysmal positional vertigo (BPPV) as well as the response to treatment. One hundred and fifty-seven patients with BPPV were reviewed prospectively. An extensive neurotologic examination was performed. All patients were treated with an appropriate canalith repositioning maneuver (CRM). In 138 patients, the posterior canal (PC) was involved, in 14 patients, the horizontal canal (HC), in 2 patients, the anterior canal (AC), and in 3 patients, both the PC and HC. A history of head trauma was identified in 17 patients. In 1 patient sensorineural hearing loss on the affected side and in another bilateral peripheral vestibular loss was present. A history of migraine was reported in 21 cases. A resolution attributable to the first CRM was achieved in 132 patients. PC involvement was the most frequent type constituting 87.9% of all BPPV cases. HC, AC and mixed canal types were relatively rare constituting 8.9, 1.3 and 1.9% of the cases, respectively. Response to the first CRM was recorded in 84.1%. Association with migraine was recorded in 13.4% of the patients.
BibTeX: @article{Celebisoy2008, author = {Celebisoy, Neşe and Polat, Fatma and Akyurekli, Onder}, title = {Clinical features of benign paroxysmal positional vertigo in Western Turkey.}, journal = {European neurology}, year = {2008}, volume = {59}, issue = {6}, pages = {315--319}, doi = {https://doi.org/10.1159/000121422}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Comorbidity; Craniocerebral Trauma, epidemiology; Female; Hearing Loss, epidemiology; Humans; Incidence; Male; Middle Aged; Migraine Disorders, epidemiology; Posture; Prospective Studies; Recurrence; Turkey, epidemiology; Vertigo, diagnosis, epidemiology, therapy}, pmid = {18408373} }
Ciorba, A., Cogliandolo, C., Bianchini, C., Aimoni, C., Pelucchi, S., Skarżyński, P.H. and Hatzopoulos, S.	Clinical features of benign paroxysmal positional vertigo of the posterior semicircular canal. [Abstract] [BibTeX]	2019	SAGE open medicine Vol. 7, pp. 2050312118822922	article	DOI
Abstract: The aim of this study was to evaluate the relationship between age, gender and affected ear, in patients presenting benign paroxysmal positional vertigo. This was a retrospective study. Data from benign paroxysmal positional vertigo clinical reports (January 2009-December 2014) were analysed. A total of 174 patients affected by benign paroxysmal positional vertigo of the posterior semicircular canal have been identified. Pearson chi-square test has been used to evaluate the probability of benign paroxysmal positional vertigo occurrence in relation to gender and side, within the studied groups. The level of significance was set at a p < 0.05. Considering age as a discriminant factor, three groups of patients were identified: group 1: 16 patients with an age <40 years; group 2: 79 patients with an age between 40 and 65 years and group 3: 79 patients with an age >65 years. In each group, the right posterior semicircular canal was involved in the majority of cases (group 1 incidence: 12/16; group 2 incidence: 49/79 and group 3 incidence: 52/79). In all three groups, female patients were significantly more affected (9/16 in group 1, 61/79 in group 2 and 55/79 in group 3). Benign paroxysmal positional vertigo is most prevalent in female subjects having an age>40 years and mainly involves the right posterior semicircular canal.
BibTeX: @article{Ciorba2019, author = {Ciorba, Andrea and Cogliandolo, Cristina and Bianchini, Chiara and Aimoni, Claudia and Pelucchi, Stefano and Skarżyński, Piotr Henryk and Hatzopoulos, Stavros}, title = {Clinical features of benign paroxysmal positional vertigo of the posterior semicircular canal.}, journal = {SAGE open medicine}, year = {2019}, volume = {7}, pages = {2050312118822922}, doi = {https://doi.org/10.1177/2050312118822922}, keywords = {Benign paroxysmal positional vertigo; dizziness; elderly}, pmid = {30637105} }
Caldas, M.A., Ganança, C.F., Ganança, F.F., Ganança, M.M. and Caovilla, H.H.	Clinical features of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2009	Brazilian journal of otorhinolaryngology Vol. 75(4), pp. 502-506	article
Abstract: Benign paroxysmal positioning vertigo (BPPV) is considered as the most common vestibular disease. to evaluate the age, gender, type and site of the lesion, association with other vestibular diseases, progression, and recurrence in these patients. A retrospective series study. Data from medical reports of BPPV patients examined in series during the past six years were analyzed. prevalences of BPPV were: at age 41-60 years (42.2 %); in females (62.8 %), wit nystagmus and positioning vertigo (81.3%); affecting the posterior canal (87%), unilateral (91.8 %), the right labyrinth (60.2%) - p<0.001). Due to canalithiasis (97.5%), idiopathic (74.8%), association with Menière's disease compared to other affections (55.4%); healing or recovery by means of the particle repositioning maneuver (77.9%); and possible recurrence (21.8% in a one-year follow-up period). BPPV is characterized by its prevalence at age 41 to 60 years, in females, with nystagmus and positioning vertigo, involving mostly the posterior canal of the right labyrinth, associated with canalithiasis or idiopathic, associated with Menière's disease compared to other affections, healing or recovery by means of particle repositioning maneuver, and possible recurrence.
BibTeX: @article{Caldas2009, author = {Caldas, Mariana Azevedo and Ganança, Cristina Freitas and Ganança, Fernando Freitas and Ganança, Maurício Malavasi and Caovilla, Heloisa Helena}, title = {Clinical features of benign paroxysmal positional vertigo.}, journal = {Brazilian journal of otorhinolaryngology}, year = {2009}, volume = {75}, issue = {4}, pages = {502--506}, keywords = {Adult; Aged; Disease Progression; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, diagnosis, physiopathology; Recurrence; Retrospective Studies; Vertigo, diagnosis, physiopathology; Young Adult}, pmid = {19784417} }
Fujimoto, C., Suzuki, S., Kinoshita, M., Egami, N., Sugasawa, K. and Iwasaki, S.	Clinical features of otolith organ-specific vestibular dysfunction. [Abstract] [BibTeX]	2018	Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology Vol. 129(1), pp. 238-245	article	DOI
Abstract: To elucidate the clinical features and vestibular symptoms of patients with otolith organ dysfunction in the presence of normal function of the semicircular canals. We reviewed the clinical records of 277 consecutive new patients with balance disorders who underwent testing of cervical and ocular vestibular evoked myogenic potentials (cVEMPs and oVEMPs) as well as caloric testing and video head impulse testing (vHIT). We identified 76 patients who showed normal caloric responses and normal vHIT findings in each SCC plane, but abnormal responses in cVEMP and/or oVEMP testing. Benign paroxysmal positional vertigo (BPPV) was the most common diagnosis. 37% of patients could not be categorized into any of the established clinical entities that could cause a balance disorder and did not show sensorineural hearing loss. The most common clinical manifestation in the idiopathic cases was recurrent rotatory vertigo with a duration of 1-12 h. The most common diagnosis of otolith organ-specific vestibular dysfunction was BPPV. The most common clinical manifestation in the idiopathic cases was recurrent rotatory vertigo. Specific dysfunction of the otolith organs occurs in association with some of the undiagnosed patients with recurrent rotatory vertigo.
BibTeX: @article{Fujimoto2018a, author = {Fujimoto, Chisato and Suzuki, Sayaka and Kinoshita, Makoto and Egami, Naoya and Sugasawa, Keiko and Iwasaki, Shinichi}, title = {Clinical features of otolith organ-specific vestibular dysfunction.}, journal = {Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology}, year = {2018}, volume = {129}, issue = {1}, pages = {238--245}, doi = {https://doi.org/10.1016/j.clinph.2017.11.006}, keywords = {Adult; Aged; Aged, 80 and over; Caloric Tests; Female; Humans; Labyrinth Diseases, classification, diagnosis; Male; Middle Aged; Otolithic Membrane, pathology, physiopathology; Postural Balance; Vestibular Evoked Myogenic Potentials; Saccule; Utricle; Vertigo; Vestibular diseases; Vestibule}, pmid = {29207275} }
Suzuki, M., Yukawa, K., Horiguchi, S., Ichimura, A., Kitamura, K., Okamoto, N. and Hayashi, K.	Clinical features of paroxysmal positional vertigo presenting combined lesions. [Abstract] [BibTeX]	1999	Acta oto-laryngologica Vol. 119(2), pp. 117-120	article
Abstract: Benign paroxysmal positional vertigo (BPPV) is one of the common vestibular disorders. Canalolithiasis is thought to be a likely lesion. A canalith repositioning procedure (CRP by Epley) generally yields good resolution of vertigo and nystagmus. The authors confirmed the efficacy of this procedure on typical BPPV of the posterior semicircular canal type. We designed a new procedure for BPPV of the lateral canal type, which also yielded satisfactory results. BPPV sometimes presents a nystagmus pattern, which suggests multiple lesions. We have seen eight cases of BPPV showing nystagmus that combines both the posterior and the lateral canal types. Combined CRP was performed on these cases, which again gave good clinical results. Other BPPV cases were associated with central lesions. We must be aware that BPPV may involve multiple canals and may be associated with central lesions.
BibTeX: @article{Suzuki1999, author = {Suzuki, M and Yukawa, K and Horiguchi, S and Ichimura, A and Kitamura, K and Okamoto, N and Hayashi, K}, title = {Clinical features of paroxysmal positional vertigo presenting combined lesions.}, journal = {Acta oto-laryngologica}, year = {1999}, volume = {119}, issue = {2}, pages = {117--120}, keywords = {Aged; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, physiopathology; Physical Therapy Modalities; Posture, physiology; Semicircular Canals, physiopathology; Vertigo, diagnosis, physiopathology, rehabilitation}, pmid = {10320057} }
Kim, S.Y., Han, S.H., Kim, Y.H. and Park, M.-H.	Clinical features of recurrence and osteoporotic changes in benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2017	Auris, nasus, larynx Vol. 44(2), pp. 156-161	article	DOI
Abstract: Several previous studies have demonstrated that comorbidities, secondary causes, physical inactivity, and osteoporosis may cause recurrence of benign paroxysmal positional vertigo (BPPV). However, there has also been some controversy over the clinical course(s) and cause(s) of recurrent BPPV (rBPPV). We identified clinical features and associated factors, including decreased bone mineral density, in the recurrence of BPPV. In total, 198 patients with idiopathic BPPV, diagnosed at the otolaryngology clinics of Seoul National University Boramae Medical Center, were enrolled. The medical data of these patients were reviewed retrospectively. Recurrent BPPV was defined as the recurrence of BPPV after at least 1 month of a symptom-free interval following previous successful treatment. Of the BPPV patients, 67 (33.8%) were classified as rBPPV. Among them, about 16% showed changes in the involved semicircular canals and about 6% showed multiple semicircular canal involvement. rBPPV was more common in patients with comorbidities (P<0.001). Involved semicircular canals showed no statistically significant difference according to the recurrence of BPPV. The mean symptom-free interval of the rBPPV group varied from 1 to 50.2 (mean, 11.6) months; however, 90% of BPPV recurrence occurred within 24 months. Bone mineral density in dual-energy X-ray absorptiometry (DEXA) was markedly decreased in BPPV patients versus normal controls, but there were no significant differences according to BPPV recurrence. The incidence of rBPPV in idiopathic BPPV patients was 33.8% in the present study. The mean period of recurrence after a symptom-free interval was about 11.6 months; most patients showed recurrence within 2 years after the first attack of BPPV. Furthermore, about 16% of patients suffered from rBPPV at a different kind or type of canal from the semicircular canal of the initial BPPV attack. Comorbidities, but not age, gender, or the involved semicircular canal, might be correlated with BPPV recurrence. Decreased bone mineral density did not show significant association with BPPV recurrence, but showed a significant relation with BPPV occurrence.
BibTeX: @article{Kim2017c, author = {Kim, So Young and Han, Seung Hoon and Kim, Young Ho and Park, Min-Hyun}, title = {Clinical features of recurrence and osteoporotic changes in benign paroxysmal positional vertigo.}, journal = {Auris, nasus, larynx}, year = {2017}, volume = {44}, issue = {2}, pages = {156--161}, doi = {https://doi.org/10.1016/j.anl.2016.06.006}, keywords = {Absorptiometry, Photon; Aged; Benign Paroxysmal Positional Vertigo, epidemiology, physiopathology; Comorbidity; Diabetes Mellitus, epidemiology; Female; Humans; Hypertension, epidemiology; Incidence; Male; Middle Aged; Osteoporosis, diagnostic imaging, epidemiology; Recurrence; Republic of Korea, epidemiology; Retrospective Studies; Semicircular Canals, physiopathology; Benign paroxysmal positional vertigo; Bone mineral density; Recurrence; Semicircular canal}, pmid = {27423924} }
Choi, S.J., Lee, J.B., Lim, H.J., Park, H.Y., Park, K., In, S.M., Oh, J.H. and Choung, Y.-H.	Clinical features of recurrent or persistent benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2012	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 147(5), pp. 919-924	article	DOI
Abstract: To identify clinical features and causes of recurrent or persistent benign paroxysmal positional vertigo (BPPV) and to analyze the effectiveness of frequently repeated canalith repositioning procedures (CRPs). Case series with chart review. Academic university hospital. The authors retrospectively reviewed the clinical records of 120 patients who were diagnosed with BPPV at the Dizziness Clinic in Ajou University Hospital, Korea, between 2004 and 2008. "Persistent" and "recurrent" BPPV were respectively defined as BPPV continuing more than 2 weeks and recurring BPPV in the same canals after at least 2 weeks of a symptom-free interval following previous successful treatments. The authors treated patients with frequently repeated CRPs such as the modified Epley maneuver or a barbecue rotation every 2 or 3 days in the outpatient clinic. Among 120 patients with BPPV, 93 (77.5%) were typical, 15 (12.5%) were persistent, and 12 (10.0%) were recurrent. Although the most common cause was idiopathic in both recurrent and persistent BPPV, secondary causes, including trauma, were much more common in recurrent and persistent BPPV than in typical BPPV. Typical and recurrent BPPV developed most commonly in the posterior semicircular canals. Persistent BPPV was most commonly detected in the lateral semicircular canals. After frequently repeated CRPs, 91.7% and 86.7% of the patients with recurrent or persistent BPPV, respectively, had resolution of nystagmus and vertigo. Recurrent and persistent BPPV are not rare diseases and occur with a higher incidence than expected, especially in patients with secondary causes. However, they can be successfully treated with frequently repeated CRPs.
BibTeX: @article{Choi2012, author = {Choi, Seong Jun and Lee, Jong Bin and Lim, Hye Jin and Park, Hun Yi and Park, Keehyun and In, Seung Min and Oh, Jeong Hyun and Choung, Yun-Hoon}, title = {Clinical features of recurrent or persistent benign paroxysmal positional vertigo.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2012}, volume = {147}, issue = {5}, pages = {919--924}, doi = {https://doi.org/10.1177/0194599812454642}, keywords = {Benign Paroxysmal Positional Vertigo; Female; Humans; Male; Middle Aged; Recurrence; Retrospective Studies; Vertigo, diagnosis, therapy}, pmid = {22807487} }
Chang, M.Y., Shin, J.H., Oh, K.H., Hong, Y.H. and Mun, S.-K.	Clinical implication of cervical vestibular evoked myogenic potentials in benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2017	Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology Vol. 128(2), pp. 351-356	article	DOI
Abstract: To evaluate the value of cervical vestibular evoked myogenic potential (cVEMP) as a prognostic factor for benign paroxysmal positional vertigo (BPPV). We reviewed 65 patients with BPPV who underwent cVEMP. Patients were divided into two groups according to resistance to the repositioning maneuver. Univariable and multivariable analyses were performed with age, gender, affected semicircular canal, affected side and cVEMP parameters to find the associated factors for resistance to the repositioning maneuver. From univariable analysis, cVEMP interaural amplitude difference (IAD) ratio, the affected semicircular canal and the affected side showed a better association (p<0.10) with resistance to the repositioning maneuver. With multivariable analysis, decreased cVEMP IAD ratio at the affected side (⩽-25%) (p=0.043, OR=4.934) and the posterior semicircular canal (p=0.049, OR=3.780) remained as associated factors. Decreased cVEMP IAD ratio at the affected side is associated with resistance to the repositioning maneuver. BPPV patients with decreased cVEMP IAD ratio at the affected side have a higher likelihood of their BPPV persisting after a single repositioning maneuver. cVEMP test may provide a prognosis of BPPV. A decreased cVEMP IAD ratio at the affected side may be prognostic of BPPV not resolving after a single repositioning maneuver.
BibTeX: @article{Chang2017, author = {Chang, Mun Young and Shin, Ji Ho and Oh, Kyung Hyun and Hong, Young Ho and Mun, Seog-Kyun}, title = {Clinical implication of cervical vestibular evoked myogenic potentials in benign paroxysmal positional vertigo.}, journal = {Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology}, year = {2017}, volume = {128}, issue = {2}, pages = {351--356}, doi = {https://doi.org/10.1016/j.clinph.2016.12.004}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo, diagnosis, physiopathology; Female; Humans; Male; Middle Aged; Semicircular Canals, physiopathology; Vestibular Evoked Myogenic Potentials; Benign paroxysmal positional vertigo; Interaural amplitude difference; cVEMP}, pmid = {28063321} }
Hain, T.C., Squires, T.M. and Stone, H.A.	Clinical implications of a mathematical model of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2005	Annals of the New York Academy of Sciences Vol. 1039, pp. 384-394	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most commonly diagnosed vertigo syndrome. It is caused by movement of detached otoconia within the inner ear (canalithiasis) or otoconia adherent to the cupula (cupulolithiasis). A mathematical model incorporating fluid dynamics of BPPV, which results in the following insights, has been developed recently: (1) The characteristic latency of BPPV is explained by movement of detached otoconia through the ampulla, as pressure caused by moving otoconia is negligible until otoconia enter the narrow duct of the semicircular canal. Typical otoconia move at a rate of 0.2 mm/s, or about 1% of the circumference of the canal each second. (2) Particle-wall interactions can account for the considerable variability in duration and latency of BPPV. (3) Dispersion of a clump of otoconia creates more rather than less nystagmus. Thus, dispersion is not a viable explanation of fatigability. (4) Cupulolithiasis is predicted to cause a far weaker nystagmus than canalithiasis. (5) Inertial effects of treatment maneuvers cause negligible movement of otoconia.
BibTeX: @article{Hain2005, author = {Hain, Timothy C and Squires, Todd M and Stone, Howard A}, title = {Clinical implications of a mathematical model of benign paroxysmal positional vertigo.}, journal = {Annals of the New York Academy of Sciences}, year = {2005}, volume = {1039}, pages = {384--394}, doi = {https://doi.org/10.1196/annals.1325.036}, keywords = {Ear, Inner, physiopathology; Humans; Mathematics; Models, Neurological; Posture; Reaction Time; Semicircular Canals, anatomy & histology, physiopathology; Vertigo, physiopathology}, pmid = {15826991} }
Clinch, C.R., Kahill, A., Klatt, L.A. and Stewart, D.	Clinical inquiries. What is the best approach to benign paroxysmal positional vertigo in the elderly? [Abstract] [BibTeX]	2010	The Journal of family practice Vol. 59(5), pp. 295-297	article
Abstract: A canalith repositioning maneuver (CRM), such as the Epley or Semont maneuver, should be the first-line treatment for benign paroxysmal positional vertigo (BPPV) in the elderly. Following the Epley maneuver with self-treatment at home using a modified Epley procedure improves outcomes. Postural restrictions are not necessary after CRM treatment. Medications do not work as well as a CRM, but studies comparing treatments are limited.
BibTeX: @article{Clinch2010, author = {Clinch, C Randall and Kahill, Ailisa and Klatt, Laura A and Stewart, David}, title = {Clinical inquiries. What is the best approach to benign paroxysmal positional vertigo in the elderly?}, journal = {The Journal of family practice}, year = {2010}, volume = {59}, issue = {5}, pages = {295--297}, keywords = {Aged; Antiemetics, therapeutic use; Head Movements; Humans; Musculoskeletal Manipulations, methods; Posture; Randomized Controlled Trials as Topic; Vertigo, therapy}, pmid = {20544052} }
Strickland, C., Russell, R. and Hoekzema, G.	Clinical inquiries. What is the best way to manage benign paroxysmal positional vertigo? [BibTeX]	2003	The Journal of family practice Vol. 52(12), pp. 971-973	article
BibTeX: @article{Strickland2003, author = {Strickland, Carmen and Russell, Roger and Hoekzema, Grant}, title = {Clinical inquiries. What is the best way to manage benign paroxysmal positional vertigo?}, journal = {The Journal of family practice}, year = {2003}, volume = {52}, issue = {12}, pages = {971--973}, keywords = {Family Practice; Humans; Randomized Controlled Trials as Topic; Vertigo, etiology, rehabilitation}, pmid = {14653985} }
Johnson, E.G.	Clinical management of a patient with chronic recurrent vertigo following a mild traumatic brain injury. [Abstract] [BibTeX]	2009	Case reports in medicine Vol. 2009, pp. 910596	article	DOI
Abstract: Vertigo, was provoked and right torsional up-beat nystagmus was observed in a 47-year-old patient when she was placed into the right Hallpike-Dix test position using infrared goggle technology. The clinical diagnosis was benign paroxysmal positional vertigo (BPPV), specifically right posterior canalithiasis, resulting from a mild traumatic brain injury (TBI) suffered approximately six-months earlier. Previous medical consultations did not include vestibular system examination, and Meclizine was prescribed to suppress her chief complaint of vertigo. Ultimately, the patient was successfully managed by performing two canalith repositioning maneuvers during a single clinical session. The patient reported 100% resolution of symptoms upon reexamination the following day, and the Hallpike-Dix test was negative. Continued symptom resolution was subjectively reported 10 days postintervention via telephone consultation. This case report supports previous publications concerning the presence of BPPV following TBI and the need for inclusion of vestibular system examination during medical consultation.
BibTeX: @article{Johnson2009, author = {Johnson, Eric G}, title = {Clinical management of a patient with chronic recurrent vertigo following a mild traumatic brain injury.}, journal = {Case reports in medicine}, year = {2009}, volume = {2009}, pages = {910596}, doi = {https://doi.org/10.1155/2009/910596}, pmid = {19826635} }
Ishikawa, K., Edo, M. and Togawa, K.	Clinical observation of 32 cases of vestibular neuronitis. [Abstract] [BibTeX]	1993	Acta oto-laryngologica. Supplementum Vol. 503, pp. 13-15	article
Abstract: Clinical observations were made on 32 patients with vestibular neuronitis in the last 5 years: 14 male and 18 female, ranging from 15-76 years, the average being 46.3. Within the age distribution of the cases, two peaks were observed: a younger and an older group. Five patients (15%) had recently contracted infection of the upper respiratory tract before the onset of the disease, and two developed benign paroxysmal positional vertigo during the recovery period. Spontaneous nystagmus was observed in 19 cases (59%) in the first medical examination. There were several patients in whom there was the possibility of central lesions based upon the findings of equilibrium examinations. No relation was found between the degree of canal paresis and the time required for recuperation; however, the older patients took much longer to recover from the disease. Our results showed that there were considerable individual variations regarding the clinical findings, which may suggest that the pathological entity that creates this disease is not simple.
BibTeX: @article{Ishikawa1993, author = {Ishikawa, K and Edo, M and Togawa, K}, title = {Clinical observation of 32 cases of vestibular neuronitis.}, journal = {Acta oto-laryngologica. Supplementum}, year = {1993}, volume = {503}, pages = {13--15}, keywords = {Adolescent; Adult; Aged; Caloric Tests; Diagnosis, Differential; Female; Functional Laterality, physiology; Humans; Male; Meniere Disease, diagnosis, etiology, physiopathology; Middle Aged; Neuritis, diagnosis, etiology, physiopathology; Nystagmus, Physiologic, physiology; Vestibular Nerve, physiopathology; Vestibulocochlear Nerve Diseases, diagnosis, etiology, physiopathology}, pmid = {8470478} }
Bhattacharyya, N., Gubbels, S.P., Schwartz, S.R., Edlow, J.A., El-Kashlan, H., Fife, T., Holmberg, J.M., Mahoney, K., Hollingsworth, D.B., Roberts, R., Seidman, M.D., Prasaad Steiner, R.W., Tsai Do, B., Voelker, C.C.J., Waguespack, R.W. and Corrigan, M.D.	Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update) Executive Summary. [Abstract] [BibTeX]	2017	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 156(3), pp. 403-416	article	DOI
Abstract: The American Academy of Otolaryngology-Head and Neck Surgery Foundation has published a supplement to this issue of Otolaryngology-Head and Neck Surgery featuring the "Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update)." To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose, and key action statements. The 14 recommendations developed emphasize diagnostic accuracy and efficiency, reducing the inappropriate use of vestibular suppressant medications, decreasing the inappropriate use of ancillary testing, and increasing the appropriate therapeutic repositioning maneuvers. An updated guideline is needed due to new clinical trials, new systematic reviews, and the lack of consumer participation in the initial guideline development group.
BibTeX: @article{Bhattacharyya2017b, author = {Bhattacharyya, Neil and Gubbels, Samuel P and Schwartz, Seth R and Edlow, Jonathan A and El-Kashlan, Hussam and Fife, Terry and Holmberg, Janene M and Mahoney, Kathryn and Hollingsworth, Deena B and Roberts, Richard and Seidman, Michael D and Prasaad Steiner, Robert W and Tsai Do, Betty and Voelker, Courtney C J and Waguespack, Richard W and Corrigan, Maureen D}, title = {Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update) Executive Summary.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2017}, volume = {156}, issue = {3}, pages = {403--416}, doi = {https://doi.org/10.1177/0194599816689660}, keywords = {Adult; Algorithms; Benign Paroxysmal Positional Vertigo, diagnosis, therapy; Humans; BPPV; benign paroxysmal positional vertigo}, pmid = {28248602} }
Bhattacharyya, N., Gubbels, S.P., Schwartz, S.R., Edlow, J.A., El-Kashlan, H., Fife, T., Holmberg, J.M., Mahoney, K., Hollingsworth, D.B., Roberts, R., Seidman, M.D., Steiner, R.W.P., Do, B.T., Voelker, C.C.J., Waguespack, R.W. and Corrigan, M.D.	Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). [Abstract] [BibTeX]	2017	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 156(3_suppl), pp. S1-S47	article	DOI
Abstract: Objective This update of a 2008 guideline from the American Academy of Otolaryngology-Head and Neck Surgery Foundation provides evidence-based recommendations to benign paroxysmal positional vertigo (BPPV), defined as a disorder of the inner ear characterized by repeated episodes of positional vertigo. Changes from the prior guideline include a consumer advocate added to the update group; new evidence from 2 clinical practice guidelines, 20 systematic reviews, and 27 randomized controlled trials; enhanced emphasis on patient education and shared decision making; a new algorithm to clarify action statement relationships; and new and expanded recommendations for the diagnosis and management of BPPV. Purpose The primary purposes of this guideline are to improve the quality of care and outcomes for BPPV by improving the accurate and efficient diagnosis of BPPV, reducing the inappropriate use of vestibular suppressant medications, decreasing the inappropriate use of ancillary testing such as radiographic imaging, and increasing the use of appropriate therapeutic repositioning maneuvers. The guideline is intended for all clinicians who are likely to diagnose and manage patients with BPPV, and it applies to any setting in which BPPV would be identified, monitored, or managed. The target patient for the guideline is aged ≥18 years with a suspected or potential diagnosis of BPPV. The primary outcome considered in this guideline is the resolution of the symptoms associated with BPPV. Secondary outcomes considered include an increased rate of accurate diagnoses of BPPV, a more efficient return to regular activities and work, decreased use of inappropriate medications and unnecessary diagnostic tests, reduction in recurrence of BPPV, and reduction in adverse events associated with undiagnosed or untreated BPPV. Other outcomes considered include minimizing costs in the diagnosis and treatment of BPPV, minimizing potentially unnecessary return physician visits, and maximizing the health-related quality of life of individuals afflicted with BPPV. Action Statements The update group made strong recommendations that clinicians should (1) diagnose posterior semicircular canal BPPV when vertigo associated with torsional, upbeating nystagmus is provoked by the Dix-Hallpike maneuver, performed by bringing the patient from an upright to supine position with the head turned 45° to one side and neck extended 20° with the affected ear down, and (2) treat, or refer to a clinician who can treat, patients with posterior canal BPPV with a canalith repositioning procedure. The update group made a strong recommendation against postprocedural postural restrictions after canalith repositioning procedure for posterior canal BPPV. The update group made recommendations that the clinician should (1) perform, or refer to a clinician who can perform, a supine roll test to assess for lateral semicircular canal BPPV if the patient has a history compatible with BPPV and the Dix-Hallpike test exhibits horizontal or no nystagmus; (2) differentiate, or refer to a clinician who can differentiate, BPPV from other causes of imbalance, dizziness, and vertigo; (3) assess patients with BPPV for factors that modify management, including impaired mobility or balance, central nervous system disorders, a lack of home support, and/or increased risk for falling; (4) reassess patients within 1 month after an initial period of observation or treatment to document resolution or persistence of symptoms; (5) evaluate, or refer to a clinician who can evaluate, patients with persistent symptoms for unresolved BPPV and/or underlying peripheral vestibular or central nervous system disorders; and (6) educate patients regarding the impact of BPPV on their safety, the potential for disease recurrence, and the importance of follow-up. The update group made recommendations against (1) radiographic imaging for a patient who meets diagnostic criteria for BPPV in the absence of additional signs and/or symptoms inconsistent with BPPV that warrant imaging, (2) vestibular testing for a patient who meets diagnostic criteria for BPPV in the absence of additional vestibular signs and/or symptoms inconsistent with BPPV that warrant testing, and (3) routinely treating BPPV with vestibular suppressant medications such as antihistamines and/or benzodiazepines. The guideline update group provided the options that clinicians may offer (1) observation with follow-up as initial management for patients with BPPV and (2) vestibular rehabilitation, either self-administered or with a clinician, in the treatment of BPPV.
BibTeX: @article{Bhattacharyya2017, author = {Bhattacharyya, Neil and Gubbels, Samuel P and Schwartz, Seth R and Edlow, Jonathan A and El-Kashlan, Hussam and Fife, Terry and Holmberg, Janene M and Mahoney, Kathryn and Hollingsworth, Deena B and Roberts, Richard and Seidman, Michael D and Steiner, Robert W Prasaad and Do, Betty Tsai and Voelker, Courtney C J and Waguespack, Richard W and Corrigan, Maureen D}, title = {Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update).}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2017}, volume = {156}, issue = {3_suppl}, pages = {S1--S47}, doi = {https://doi.org/10.1177/0194599816689667}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis, prevention & control, therapy; Diagnosis, Differential; Humans; Patient Positioning, methods; BPPV; benign paroxysmal positional vertigo}, pmid = {28248609} }
Bhattacharyya, N., Baugh, R.F., Orvidas, L., Barrs, D., Bronston, L.J., Cass, S., Chalian, A.A., Desmond, A.L., Earll, J.M., Fife, T.D., Fuller, D.C., Judge, J.O., Mann, N.R., Rosenfeld, R.M., Schuring, L.T., Steiner, R.W.P., Whitney, S.L., Haidari, J., of Otolaryngology-Head, A.A. and Foundation, N.S.	Clinical practice guideline: benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2008	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 139(5 Suppl 4), pp. S47-S81	article	DOI
Abstract: This guideline provides evidence-based recommendations on managing benign paroxysmal positional vertigo (BPPV), which is the most common vestibular disorder in adults, with a lifetime prevalence of 2.4 percent. The guideline targets patients aged 18 years or older with a potential diagnosis of BPPV, evaluated in any setting in which an adult with BPPV would be identified, monitored, or managed. This guideline is intended for all clinicians who are likely to diagnose and manage adults with BPPV. The primary purposes of this guideline are to improve quality of care and outcomes for BPPV by improving the accurate and efficient diagnosis of BPPV, reducing the inappropriate use of vestibular suppressant medications, decreasing the inappropriate use of ancillary tests such as radiographic imaging and vestibular testing, and to promote the use of effective repositioning maneuvers for treatment. In creating this guideline, the American Academy of Otolaryngology-Head and Neck Surgery Foundation selected a panel representing the fields of audiology, chiropractic medicine, emergency medicine, family medicine, geriatric medicine, internal medicine, neurology, nursing, otolaryngology-head and neck surgery, physical therapy, and physical medicine and rehabilitation. The panel made strong recommendations that 1) clinicians should diagnose posterior semicircular canal BPPV when vertigo associated with nystagmus is provoked by the Dix-Hallpike maneuver. The panel made recommendations against 1) radiographic imaging, vestibular testing, or both in patients diagnosed with BPPV, unless the diagnosis is uncertain or there are additional symptoms or signs unrelated to BPPV that warrant testing; and 2) routinely treating BPPV with vestibular suppressant medications such as antihistamines or benzodiazepines. The panel made recommendations that 1) if the patient has a history compatible with BPPV and the Dix-Hallpike test is negative, clinicians should perform a supine roll test to assess for lateral semicircular canal BPPV; 2) clinicians should differentiate BPPV from other causes of imbalance, dizziness, and vertigo; 3) clinicians should question patients with BPPV for factors that modify management including impaired mobility or balance, CNS disorders, lack of home support, and increased risk for falling; 4) clinicians should treat patients with posterior canal BPPV with a particle repositioning maneuver (PRM); 5) clinicians should reassess patients within 1 month after an initial period of observation or treatment to confirm symptom resolution; 6) clinicians should evaluate patients with BPPV who are initial treatment failures for persistent BPPV or underlying peripheral vestibular or CNS disorders; and 7) clinicians should counsel patients regarding the impact of BPPV on their safety, the potential for disease recurrence, and the importance of follow-up. The panel offered as options that 1) clinicians may offer vestibular rehabilitation, either self-administered or with a clinician, for the initial treatment of BPPV and 2) clinicians may offer observation as initial management for patients with BPPV and with assurance of follow-up. The panel made no recommendation concerning audiometric testing in patients diagnosed with BPPV. This clinical practice guideline is not intended as a sole source of guidance in managing benign paroxysmal positional vertigo. Rather, it is designed to assist clinicians by providing an evidence-based framework for decision-making strategies. The guideline is not intended to replace clinical judgement or establish a protocol for all individuals with this condition, and may not provide the only appropriate approach to diagnosing and managing this problem.
BibTeX: @article{Bhattacharyya2008, author = {Bhattacharyya, Neil and Baugh, Reginald F and Orvidas, Laura and Barrs, David and Bronston, Leo J and Cass, Stephen and Chalian, Ara A and Desmond, Alan L and Earll, Jerry M and Fife, Terry D and Fuller, Drew C and Judge, James O and Mann, Nancy R and Rosenfeld, Richard M and Schuring, Linda T and Steiner, Robert W P and Whitney, Susan L and Haidari, Jenissa and American Academy of Otolaryngology-Head and Neck Surgery Foundation}, title = {Clinical practice guideline: benign paroxysmal positional vertigo.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2008}, volume = {139}, issue = {5 Suppl 4}, pages = {S47--S81}, doi = {https://doi.org/10.1016/j.otohns.2008.08.022}, keywords = {Adolescent; Audiometry; Diagnosis, Differential; Humans; Physical Examination; Practice Patterns, Physicians', standards; Severity of Illness Index; Vertigo, diagnosis, physiopathology; Vestibule, Labyrinth, physiopathology}, pmid = {18973840} }
Kim, J.-S. and Zee, D.S.	Clinical practice. Benign paroxysmal positional vertigo. [BibTeX]	2014	The New England journal of medicine Vol. 370(12), pp. 1138-1147	article	DOI
BibTeX: @article{Kim2014b, author = {Kim, Ji-Soo and Zee, David S}, title = {Clinical practice. Benign paroxysmal positional vertigo.}, journal = {The New England journal of medicine}, year = {2014}, volume = {370}, issue = {12}, pages = {1138--1147}, doi = {https://doi.org/10.1056/NEJMcp1309481}, keywords = {Benign Paroxysmal Positional Vertigo; Female; Humans; Middle Aged; Patient Positioning; Practice Guidelines as Topic; Remission, Spontaneous; Semicircular Canals; Vertigo, diagnosis, therapy}, pmid = {24645946} }
Taguchi, K., Hirabayashi, C. and Kikukawa, M.	Clinical significance of head movement while stepping. [Abstract] [BibTeX]	1984	Acta oto-laryngologica. Supplementum Vol. 406, pp. 125-128	article
Abstract: Head movement of normal subjects and patients with peripheral vestibular disorders while stepping was recorded using three accelerometers, a multi-channel telemeter and a microcomputer. The head movement registered from normal subjects was stable at a stepping speed of 1.2 or 1.4 steps/sec. Patients with peripheral vestibular disorders (except for BPPV) showed significantly greater head movement values in all three directions and smaller ratios of anteroposterior component to lateral component in the head movement, as compared with those of normal subjects.
BibTeX: @article{Taguchi1984, author = {Taguchi, K and Hirabayashi, C and Kikukawa, M}, title = {Clinical significance of head movement while stepping.}, journal = {Acta oto-laryngologica. Supplementum}, year = {1984}, volume = {406}, pages = {125--128}, keywords = {Adolescent; Adult; Gait; Head, physiology; Hearing Loss, Sudden, physiopathology; Humans; Meniere Disease, physiopathology; Movement; Vertigo, physiopathology; Vestibular Nerve; Vestibulocochlear Nerve Diseases, physiopathology}, pmid = {6591688} }
Jeon, E.-J., Park, Y.-S., Park, S.-N., Park, K.-H., Kim, D.-H., Nam, I.-C. and Chang, K.-H.	Clinical significance of orthostatic dizziness in the diagnosis of benign paroxysmal positional vertigo and orthostatic intolerance. [Abstract] [BibTeX]	2013	American journal of otolaryngology Vol. 34(5), pp. 471-476	article	DOI
Abstract: Orthostatic dizziness (OD) and positional dizziness (PD) are considerably common conditions in dizziness clinic, whereas those two conditions are not clearly separated. We aimed to evaluate the clinical significance of simple OD and OD combined with PD for the diagnosis of benign paroxysmal positional vertigo (BPPV) and orthostatic intolerance (OI). Patients presenting with OD (n=102) were divided into two groups according to their symptoms: group PO, presenting with PD as well as OD; group O, presenting with OD. A thorough medical history, physical examination, and vestibular function tests were performed to identify the etiology of the dizziness. Orthostatic vital sign measurement (OVSM) was used to diagnose OI. The majority of patients were in group PO (87.3%). BPPV was the most common cause of OD for entire patients (36.3%) and group PO (37.1%), while OI was most common etiology for group O (38.5%). Total of 17 (16.7%) OI patients were identified by OVSM test. Orthostatic hypotension (n=10) was most frequently found, followed by orthostatic hypertension (n=5), and orthostatic tachycardia (n=2). Group O showed significantly higher percentage (38.5%) of OI than group PO (13.5%) (P=0.039). It is suggested that orthostatic testing such as OVSM or head-up tilt table test should be performed as an initial work up for the patients with simple OD. Positional tests for BPPV should be considered as an essential diagnostic test for patients with OD, even though their dizziness is not associated with PD.
BibTeX: @article{Jeon2013, author = {Jeon, Eun-Ju and Park, Yong-Soo and Park, Shi-Nae and Park, Kyoung-Ho and Kim, Dong-Hyun and Nam, In-Chul and Chang, Ki-Hong}, title = {Clinical significance of orthostatic dizziness in the diagnosis of benign paroxysmal positional vertigo and orthostatic intolerance.}, journal = {American journal of otolaryngology}, year = {2013}, volume = {34}, issue = {5}, pages = {471--476}, doi = {https://doi.org/10.1016/j.amjoto.2013.04.005}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Diagnosis, Differential; Dizziness, diagnosis, etiology, physiopathology; Female; Humans; Male; Middle Aged; Orthostatic Intolerance, complications, diagnosis, physiopathology; Posture, physiology; Tilt-Table Test; Vertigo, complications, diagnosis, physiopathology; Young Adult}, pmid = {23790615} }
Yang, W.S., Kim, S.H., Lee, J.D. and Lee, W.-S.	Clinical significance of vestibular evoked myogenic potentials in benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2008	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 29(8), pp. 1162-1166	article	DOI
Abstract: To investigate the vestibular evoked myogenic potentials (VEMPs) resulting in benign paroxysmal positional vertigo (BPPV) patients and to verify its clinical applications in BPPV. A prospective study. Tertiary referral dizziness center. Forty-one patients with diagnosis of BPPV and 92 healthy volunteers who underwent VEMP testing. Patients were treated by canalith repositioning maneuvers according to the affected canal, and testing of VEMP was performed at diagnosis and after treatment. Testing of VEMP was performed in BPPV patients and in the control group. The number of times the canalith repositioning maneuver was repeated until the patient's report of relief from vertigo and findings of negative positioning test were recorded to find out the relationship between VEMP results and the progress of disease. Vestibular evoked myogenic potential results of BPPV patients showed prolonged p13 and n23 latencies compared with those of the control group, and we could not find any significant difference in VEMP latencies between patients with posterior and horizontal canal type of BPPV. The number of times that the maneuver was repeated did not correlate with the degree of latency prolongation, but in the "no response" group, the number of times was considerably greater than that in the "response" group. We found that VEMP latencies are increased in BPPV patients, which may signify neuronal degenerative changes in the macula of the saccule. When an extensive neuronal damage was suspected by VEMP results such as "no response" in VEMP, the disease progress showed a chronic and resistive course. Therefore, we propose that VEMP could be a useful method to determine a clinical prognosis of patients with BPPV.
BibTeX: @article{Yang2008, author = {Yang, Won Sun and Kim, Sung Huhn and Lee, Jong Dae and Lee, Won-Sang}, title = {Clinical significance of vestibular evoked myogenic potentials in benign paroxysmal positional vertigo.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2008}, volume = {29}, issue = {8}, pages = {1162--1166}, doi = {https://doi.org/10.1097/MAO.0b013e31818a0881}, keywords = {Dizziness, physiopathology; Evoked Potentials, physiology; Female; Humans; Male; Middle Aged; Muscle, Skeletal, physiopathology; Posture; Prospective Studies; Reaction Time; Reference Values; Reproducibility of Results; Saccule and Utricle, physiopathology; Vertigo, etiology, physiopathology}, pmid = {18833020} }
Zainun, Z., Zakaria, M.N., Sidek, D. and Ismail, Z.	Clinical use of Malay Version of Vertigo Symptom Scale (MWSS) in patients with peripheral vestibular disorder (PVD). [Abstract] [BibTeX]	2012	The Medical journal of Malaysia Vol. 67(4), pp. 386-389	article
Abstract: The Vertigo symptom scale (VSS) is a well established tool for the evaluation of vestibular disorders and the associated symptoms of autonomic arousal and somatosensation. By using a validated Malay version of vertigo symptom scale (MVVSS) questionnaire, the severity of the vertigo from patients' perspective can be determined and rated. Before MVVSS can be applied clinically among Malaysians, it was of interest to determine its clinical value in identifying vestibular disorders. Forty normal and 65 PVD subjects participated in this cross-sectional study. Normal subjects were recruited amongst Universiti Sains Malaysia (USM) staff and students who had no history of ear and vestibular disorders. Mean total score of MVVSS in normal and PVD subjects were 13.9 +/- 11.1 and 30.1 +/- 20.9, respectively. When the total scores of normal and PVD group were compared, the Mann-Whitney U test showed that there was a significant difference between the two groups (p < 0.05). This is consistent with previous studies. It was also of interest to see if subtypes of PVD [benign paroxymal positional vertigo (BPPV), Meniere's disease, labyrinthitis and unknown] have different MVVSS results. However, analysis of variance (ANOVA) found no significant difference in term of outcomes of MVVSS among the different PVD pathologies. Using receiver operating characteristic curve (ROC) method, the sensitivity and specificity of MVVSS were 71% and 60%, respectively. MVVSS is able to discriminate clinically among the normal and PVD subjects. However, it is not a good indicator for differential diagnosis of PVD subtypes, at least in this study. Its sensitivity and specificity in clinical diagnosis are reasonably high. Perhaps a bigger sample size would be useful to further study the clinical usefulness of MVVSS.
BibTeX: @article{Zainun2012, author = {Zainun, Zuraida and Zakaria, Mohd Normani and Sidek, Dinsuhaimi and Ismail, Zalina}, title = {Clinical use of Malay Version of Vertigo Symptom Scale (MWSS) in patients with peripheral vestibular disorder (PVD).}, journal = {The Medical journal of Malaysia}, year = {2012}, volume = {67}, issue = {4}, pages = {386--389}, keywords = {Adolescent; Adult; Aged; Child; Female; Humans; Male; Middle Aged; Severity of Illness Index; Surveys and Questionnaires; Vertigo, physiopathology; Vestibular Diseases, diagnosis, physiopathology; Young Adult}, pmid = {23082446} }
Oh, K.H., Suh, K.D., Lee, Y.H., Lee, S.Y., Chang, M.Y. and Mun, S.-K.	Clinical utility of cervical vestibular-evoked myogenic potentials in predicting residual dizziness after benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2019	Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology Vol. 130(1), pp. 95-100	article	DOI
Abstract: In the present study, the value of cervical vestibular-evoked myogenic potential (cVEMP) as a predictive factor for residual dizziness after recovery of benign paroxysmal positional vertigo (BPPV) was evaluated. The present study included 65 patients who had BPPV and underwent cVEMP testing. Patients were divided into two groups depending on the presence or absence of residual dizziness after recovery of BPPV. Univariate and multivariate analyses were performed to determine the factors associated with residual dizziness using age, gender, affected semicircular canal, affected side, BPPV duration, and cVEMP parameters. In univariate analysis, cVEMP-modified interaural amplitude difference (IAD) ratio and p13 latency showed a relatively significant association (p < 0.20) with residual dizziness. Based on multivariate analysis, increased cVEMP-modified interaural amplitude difference (IAD) ratio at the affected side (≥25%; p = 0.018, OR 6.623) remained as an associated factor. Increased cVEMP-modified IAD ratio at the affected side is associated with residual dizziness. BPPV patients with increased cVEMP-modified IAD ratio at the affected side are more likely to have residual dizziness after recovery of BPPV. cVEMP testing could be used for the prediction of residual dizziness. An increased cVEMP-modified IAD ratio at the affected side may be used as a predictor of residual dizziness.
BibTeX: @article{Oh2019, author = {Oh, Kyung Hyun and Suh, Kang Duk and Lee, Yang Ho and Lee, Sei Young and Chang, Mun Young and Mun, Seog-Kyun}, title = {Clinical utility of cervical vestibular-evoked myogenic potentials in predicting residual dizziness after benign paroxysmal positional vertigo.}, journal = {Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology}, year = {2019}, volume = {130}, issue = {1}, pages = {95--100}, doi = {https://doi.org/10.1016/j.clinph.2018.11.005}, keywords = {Benign paroxysmal positional vertigo; Interaural amplitude difference; Residual dizziness; cVEMP}, pmid = {30497047} }
Knox, G.W.	CO2 laser-assisted posterior semicircular canal ablation for benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2010	The Laryngoscope Vol. 120 Suppl 4, pp. S209	article	DOI
Abstract: The objective of this study was to analyze a new technique, CO2 laser-assisted posterior semicircular canal ablation (LAPSCCA), in the treatment of refractory benign paroxysmal positional vertigo. Prospective study of patients with disabling BPPV who failed conservative therapy. Patients noted to have been treated with at least three Epley maneuvers without success and continuing to have disabling symptoms were enrolled in this study. Patients underwent pre- and post-operative electronystagmography. The surgical technique is modified from Parnes1 and involves plugging each end of the fenestrated posterior semicircular canal with bone grafts and fibrin glue. The CO2 fiberoptic (Omniguide) laser is then used at a setting of 2 watts to incise between the cut ends of the canal to completely section the membranous labyrinth. All six patients had excellent relief of positional vertigo symptoms. LAPSCCA is an excellent treatment option for patients with intractable BPPV.
BibTeX: @article{Knox2010, author = {Knox, Glenn W}, title = {CO2 laser-assisted posterior semicircular canal ablation for benign paroxysmal positional vertigo.}, journal = {The Laryngoscope}, year = {2010}, volume = {120 Suppl 4}, pages = {S209}, doi = {https://doi.org/10.1002/lary.21676}, keywords = {Adolescent; Adult; Aged; Female; Humans; Laser Therapy, methods; Male; Middle Aged; Semicircular Canals, surgery; Treatment Outcome; Vertigo, surgery}, pmid = {21225807} }
Yetişer, S.	Co-existence of Benign Paroxysmal Positional Vertigo and Meniere's Syndrome. [Abstract] [BibTeX]	2017	The journal of international advanced otology Vol. 13(1), pp. 65-68	article	DOI
Abstract: Recent studies indicate interrelation of benign paroxysmal positional vertigo (BPPV) and Meniere's disease (MD). These two entities may have different clinical characteristics. Five hundred thirty patients with BPPV evaluated between 2009-2015 were enrolled in the study. 351 patients who had no clear problem associated with BPPV (idiopathic) and 17 patients with MD were analyzed in detail. The age, sex, site of involvement, type of BPPV, symptom duration, and treatment outcome were compared. Meniere's disease + BPPV was more common in the female population (2/15; 7.5 v 127/224; 1.8, p<0.05). Comparative analysis of average age was not statistically significant (42.82±9.94 v. 40.29±1.65, p=0.601). There was no difference in right and left ear involvement between groups. Lateral canal involvement was more common in the BPPV + MD group (9/17; 53% v. 100/351; 28%, p<0.05). BPPV was ipsilateral to the ear with MD in 75% of patients and it was present before the diagnosis of BPPV in 82.3% of patients. Comparative analysis of cure rate between idiopathic BPPV and BPPV + MD after one session was significant (64.7% v 78%, p<0.05). Benign paroxysmal positional vertigo associated with MD presented a divergent picture. It was more frequent in females. Lateral canal involvement was higher. Patients had MD before the development of BPPV and they had prolonged symptoms, which raised a question of diagnostic delay since these two problems were in the same ear in majority of patients. Finally, relief of symptoms required more attempts of repositioning maneuvers.
BibTeX: @article{Yetiser2017a, author = {Yetişer, Sertaç}, title = {Co-existence of Benign Paroxysmal Positional Vertigo and Meniere's Syndrome.}, journal = {The journal of international advanced otology}, year = {2017}, volume = {13}, issue = {1}, pages = {65--68}, doi = {https://doi.org/10.5152/iao.2016.2906}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, complications, diagnosis, epidemiology, therapy; Child; Female; Humans; Incidence; Male; Meniere Disease, complications, diagnosis, epidemiology, therapy; Middle Aged; Retrospective Studies; Risk Factors; Sex Distribution; Turkey, epidemiology; Vertigo, diagnosis; Young Adult}, pmid = {28085000} }
Bertholon, P., Chelikh, L., Tringali, S., Timoshenko, A. and Martin, C.	Combined horizontal and posterior canal benign paroxysmal positional vertigo in three patients with head trauma. [Abstract] [BibTeX]	2005	The Annals of otology, rhinology, and laryngology Vol. 114(2), pp. 105-110	article	DOI
Abstract: We report 3 patients who complained of positional vertigo shortly after head trauma. Positional maneuvers performed in the plane of the posterior canal (PC; Dix-Hallpike maneuver) and the horizontal canal (HC; patients were rolled to either side in a supine position with the head raised 30 degrees) revealed a complex positional nystagmus that could only be interpreted as the result of combined PC and HC benign paroxysmal positional vertigo (BPPV). Two patients had a right PC BPPV and an ageotropic HC BPPV, and 1 patient had a bilateral PC BPPV and a left geotropic HC BPPV. All 3 patients were rapidly free of vertigo after the PC BPPV was cured by the Epley maneuver and the geotropic HC BPPV was cured by the Vannucchi method. The ageotropic HC BPPV resolved spontaneously. Neuroimaging (brain computed tomography and/or magnetic resonance imaging scans) findings were normal in all 3 patients. From a physiopathological viewpoint, it is easy to conceive that head trauma could throw otoconial debris into different canals of each labyrinth and be responsible for these combined forms of BPPV. Consequently, in trauma patients with vertigo, it is mandatory to perform the Dix-Hallpike maneuver, as well as supine lateral head turns, in order to diagnose PC BPPV, HC BPPV, or the association of both. Early diagnosis and treatment of BPPV may help to reduce the postconcussion syndrome.
BibTeX: @article{Bertholon2005, author = {Bertholon, Pierre and Chelikh, Larbi and Tringali, Stéphane and Timoshenko, Andrei and Martin, Christian}, title = {Combined horizontal and posterior canal benign paroxysmal positional vertigo in three patients with head trauma.}, journal = {The Annals of otology, rhinology, and laryngology}, year = {2005}, volume = {114}, issue = {2}, pages = {105--110}, doi = {https://doi.org/10.1177/000348940511400204}, keywords = {Adult; Female; Head Injuries, Closed, complications; Humans; Male; Middle Aged; Vertigo, diagnosis, etiology, physiopathology}, pmid = {15757188} }
Song, J.-J., Yoo, Y.-T., An, Y.-H., Yoo, J.C., Kim, J.S. and Koo, J.-W.	Comorbid benign paroxysmal positional vertigo in idiopathic sudden sensorineural hearing loss: an ominous sign for hearing recovery. [Abstract] [BibTeX]	2012	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 33(2), pp. 137-141	article	DOI
Abstract: To determine characteristics and their prognostic value in idiopathic sudden sensorineural hearing loss (ISSNHL) with comorbid ipsilateral benign paroxysmal positional vertigo (BPPV). Retrospective chart review. Tertiary referral center. Of the 374 patients with a diagnosis of ISSNHL at Seoul National University Bundang Hospital from January 2004 to December 2009, 32 patients (8.6%) with comorbid BPPV were recruited and compared with matched ISSNHL patients without BPPV. Otologic and neurotologic examinations, pure-tone audiometry (PTA), vestibular function tests, and brain magnetic resonance imagings. Comparison of the findings of serial audiograms for 6 months and vestibular function tests in patients with ISSNHL and concurrent BPPV with those in age-matched ISSNHL patients without BPPV. Patients with BPPV showed higher PTA averages than those without BPPV on initial and follow-up audiograms. Moreover, the improvement in PTA was less in the BPPV group than in the control. BPPV most commonly involved the posterior canal (17/32, 53.1%), followed by the horizontal canal (8/32, 25%), both the posterior and horizontal canals (6/32, 18.8%), and the anterior canal (1/32, 3.1%). Thirteen (40.6%) of 32 patients had recurrences of BPPV, 9 within a week and another 2 within 3 months. Comorbid BPPV is a negative prognostic indicator of auditory function in ISSNHL. Concurrent BPPV in ISSNHL suggests combined damage to the utricle and may indicate severe and widespread labyrinthine damage, leading to the poor prognosis.
BibTeX: @article{Song2012a, author = {Song, Jae-Jin and Yoo, Young-Tae and An, Yong-Hwi and Yoo, Jae Chul and Kim, Ji Soo and Koo, Ja-Won}, title = {Comorbid benign paroxysmal positional vertigo in idiopathic sudden sensorineural hearing loss: an ominous sign for hearing recovery.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2012}, volume = {33}, issue = {2}, pages = {137--141}, doi = {https://doi.org/10.1097/MAO.0b013e318241c27a}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Audiometry, Pure-Tone; Auditory Threshold; Benign Paroxysmal Positional Vertigo; Caloric Tests; Child, Preschool; Female; Follow-Up Studies; Hearing Loss, Sensorineural, complications; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Prognosis; Recovery of Function; Retrospective Studies; Vertigo, etiology; Vestibular Evoked Myogenic Potentials, physiology; Vestibular Function Tests; Young Adult}, pmid = {22215458} }
Hagr, A.	Comorbid psychiatric conditions of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2009	International journal of health sciences Vol. 3(1), pp. 23-28	article
Abstract: No studies have assessed psychopathology among benign paroxysmal positional vertigo (BPPV) patients. The General Health Questionnaire allows for distinguishing patients suffering from psychiatric problems from those in good mental health. To assess the psychiatric illness in Saudi patients with BPPV. The study was cross-sectional in nature. Institutional ethics committee approval and individual informed consent from study participants were obtained. Fifty patients with BPPV with unknown psychiatric illness were given the General Health Questionnaire-28 (GHQ-28) questionnaire to complete. Complete data were available for 50 patients. Thirty patients (60%) with BPPV scored above the conventional threshold. Their subgroups were: somatic complaints 28%, anxiety and insomnia 28%, social dysfunction 34%, and severe depression 10%. Greater attention needs to be paid to BPPV patients. Vulnerable female patients may have high levels of psychiatric symptomatology that may benefit from assessment and intervention.
BibTeX: @article{Hagr2009, author = {Hagr, Abdulrahman}, title = {Comorbid psychiatric conditions of benign paroxysmal positional vertigo.}, journal = {International journal of health sciences}, year = {2009}, volume = {3}, issue = {1}, pages = {23--28}, pmid = {21475507} }
Picciotti, P.M., Lucidi, D., De Corso, E., Meucci, D., Sergi, B. and Paludetti, G.	Comorbidities and recurrence of benign paroxysmal positional vertigo: personal experience. [Abstract] [BibTeX]	2016	International journal of audiology Vol. 55(5), pp. 279-284	article	DOI
Abstract: The aim of this study is to evaluate the correlation between clinical features of benign paroxysmal positional vertigo (BPPV) and age, sex, trauma, presence of one or more comorbidities such as cardiovascular, neurological, endocrinological, metabolic, psychiatric diseases. Retrospective review of medical records (chart review). A total of 475 patients aged from 14 to 87 years, affected by BPPV. Recurrence of BPPV occurred in 139/475 patients (29.2%). The recurrence rate was significantly higher in female and older patients. Comorbidities were present in 72.6% of subjects with recurrent BPPV vs. 48.9% of patients with no recurrence (p < 0.01). Forty-two patients (8.8%) reported a cranial trauma as a triggering event. Post-traumatic patients showed a significantly higher persistence rate (45.2%) compared to patients affected by non-traumatic BPPV (20.5%). Recurrence rates are overlapping between the two groups. Our results confirm the association between recurrence of BPPV and age, female sex, and presence of comorbidities. The correlation is stronger in patients affected by multiple associated diseases; the most frequently involved pathologies are psychiatric disorders, followed by neurological and vascular diseases. Collecting a complete medical history is important for prognostic stratification and detection of potential underlying pathological conditions.
BibTeX: @article{Picciotti2016, author = {Picciotti, P M and Lucidi, D and De Corso, E and Meucci, D and Sergi, B and Paludetti, G}, title = {Comorbidities and recurrence of benign paroxysmal positional vertigo: personal experience.}, journal = {International journal of audiology}, year = {2016}, volume = {55}, issue = {5}, pages = {279--284}, doi = {https://doi.org/10.3109/14992027.2016.1143981}, keywords = {Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, epidemiology, pathology; Cardiovascular Diseases, epidemiology; Comorbidity; Endocrine System Diseases, epidemiology; Female; Humans; Male; Mental Disorders, epidemiology; Middle Aged; Nervous System Diseases, epidemiology; Recurrence; Retrospective Studies; Sex Factors; Trauma, Nervous System, epidemiology; Young Adult; Benign paroxysmal positional vertigo; comorbidities; cranio-maxillo-facial trauma; recurrence}, pmid = {26963274} }
Eggers, S.D.Z., Neff, B.A., Shepard, N.T. and Staab, J.P.	Comorbidities in vestibular migraine. [Abstract] [BibTeX]	2014	Journal of vestibular research : equilibrium & orientation Vol. 24(5-6), pp. 387-395	article	DOI
Abstract: A growing body of clinical and epidemiological evidence supports a specific relationship between vestibular symptoms and migraine. Without a biomarker or complete understanding of pathophysiology, diagnosis of vestibular migraine (VM) currently depends upon symptoms in two dimensions: episodic vestibular symptoms temporally related to migraine symptoms. The Bárány Society and the International Headache Society have recently developed consensus diagnostic criteria. However, many issues remain unsettled, including the type, duration, and timing of vestibular symptoms related to headache that should be required for diagnosing VM. This paper focuses on the challenging third dimension of comorbidity, a frequent cause of diagnostic uncertainty that may confound clinical application and research validation of VM criteria. Several other neurotologic conditions occur more frequently in migraineurs than controls, including benign paroxysmal positional vertigo, Ménière's disease, and motion sickness. Patients with VM also have high rates of chronic subjective dizziness, which may be associated with anxious, introverted temperaments that can affect clinical presentation and treatment response. Broadly inclusive studies of well-characterized patients with other neurotologic and psychiatric comorbidities are needed to fully understand how vestibular symptoms and migraine interact in order to truly validate vestibular migraine, distill its essential features, define its boundaries, and characterize overlapping comorbidities.
BibTeX: @article{Eggers2014, author = {Eggers, Scott D Z and Neff, Brian A and Shepard, Neil T and Staab, Jeffrey P}, title = {Comorbidities in vestibular migraine.}, journal = {Journal of vestibular research : equilibrium & orientation}, year = {2014}, volume = {24}, issue = {5-6}, pages = {387--395}, doi = {https://doi.org/10.3233/VES-140525}, keywords = {Comorbidity; Dizziness, complications, epidemiology; Humans; Meniere Disease, complications, epidemiology; Migraine Disorders, epidemiology, etiology; Motion Sickness, epidemiology, etiology; Vertigo, complications, epidemiology; Vestibular Diseases, complications, epidemiology; Vestibular migraine; comorbidity; diagnostic criteria; epidemiology; validation}, pmid = {25564081} }
Warninghoff, J.C., Bayer, O., Ferrari, U. and Straube, A.	Co-morbidities of vertiginous diseases. [Abstract] [BibTeX]	2009	BMC neurology Vol. 9, pp. 29	article	DOI
Abstract: Co-morbidities of vertiginous diseases have so far not been investigated systematically. Thus, it is still unclear whether the different vertigo syndromes (e.g. benign paroxysmal positional vertigo (BPPV), Meniere's disease (MD), vestibular migraine and phobic vertigo (PPV)) have also different spectrums of co-morbidities. All patients from a cohort of 131 participants were surveyed using a standardised questionnaire about the co-morbidities hypertension, diabetes mellitus, BMI (body mass index), migraine, other headache, and psychiatric diseases in general and the likelihood of a depression in particular. We noted hypertension in 29.0% of the cohort, diabetes mellitus in 6.1%, migraine in 8.4%, other headache in 32.1%, psychiatric diseases in 16.0%, overweight and obesity in 33.6% and 13.7% respectively, as well as a clinical indication for depression in 15.9%. In general, we did not detect an increased prevalence of the co-morbidities diabetes mellitus, arterial hypertension, migraine, other headache and obesity compared to the general population. There was an increased prevalence of psychiatric co-morbidity in patients with PPV, and the prevalence of hypertension was elevated in patients with MD.
BibTeX: @article{Warninghoff2009, author = {Warninghoff, Jan C and Bayer, Otmar and Ferrari, Uta and Straube, Andreas}, title = {Co-morbidities of vertiginous diseases.}, journal = {BMC neurology}, year = {2009}, volume = {9}, pages = {29}, doi = {https://doi.org/10.1186/1471-2377-9-29}, keywords = {Body Mass Index; Comorbidity; Depression, epidemiology; Diabetes Mellitus, epidemiology; Female; Humans; Hypertension, epidemiology; Male; Meniere Disease, epidemiology; Middle Aged; Phobic Disorders, epidemiology; Surveys and Questionnaires; Vertigo, classification, epidemiology}, pmid = {19583869} }
Prigent, H., Samuel, C., Louis, B., Abinun, M.-F., Zerah-Lancner, F., Lejaille, M., Raphael, J.-C. and Lofaso, F.	Comparative effects of two ventilatory modes on speech in tracheostomized patients with neuromuscular disease. [Abstract] [BibTeX]	2003	American journal of respiratory and critical care medicine Vol. 167(2), pp. 114-119	article	DOI
Abstract: Many patients with respiratory failure related to neuromuscular disease receive chronic invasive ventilation through a tracheostomy. Improving quality of life, of which speech is an important component, is a major goal in these patients. We compared the effects on breathing and speech production of assist-control ventilation (ACV) and bilevel positive-pressure ventilation (BPPV) in nine patients with neuromuscular disease. Ventilator-delivered flow was measured using a pneumotachograph, and respiratory rate, inspiratory time, and ventilator-delivered volume were measured on this flow signal. Gas exchange was assessed using oxygen saturation and end-tidal carbon dioxide measurement. Microphone speech recordings were subjected to quantitative analysis. At rest, ventilatory parameters were similar with both modes. Speech induced an increase in inspiratory time during BPPV, with a greater increase in the volume released by the ventilator during speech as compared with ACV (172 +/- 194 versus 26 +/- 31 ml). Consequently, speech duration was longer during inspiration with BPPV. Moreover, BPPV allowed speech production to extend into expiration, and three patients could speak continuously during several respiratory cycles while receiving BPPV. Blood gas exchange was not modified by speech with BPPV or ACV. This study shows that BPPV provides better speech duration than ACV with no detectable short-term deleterious effects.
BibTeX: @article{Prigent2003, author = {Prigent, Hélène and Samuel, Christiane and Louis, Bruno and Abinun, Marie-France and Zerah-Lancner, Françoise and Lejaille, Michèle and Raphael, Jean-Claude and Lofaso, Frédéric}, title = {Comparative effects of two ventilatory modes on speech in tracheostomized patients with neuromuscular disease.}, journal = {American journal of respiratory and critical care medicine}, year = {2003}, volume = {167}, issue = {2}, pages = {114--119}, doi = {https://doi.org/10.1164/rccm.200201-026OC}, keywords = {Adult; Analysis of Variance; Female; Humans; Intubation, Intratracheal; Male; Middle Aged; Neuromuscular Diseases, complications, diagnosis; Positive-Pressure Respiration, adverse effects, methods; Probability; Prognosis; Prospective Studies; Pulmonary Gas Exchange; Respiration, Artificial, adverse effects, methods; Respiratory Insufficiency, etiology, therapy; Respiratory Mechanics; Risk Assessment; Sampling Studies; Severity of Illness Index; Speech, physiology; Speech Intelligibility; Speech Production Measurement; Tracheotomy, adverse effects, methods}, pmid = {12406841} }
Karawani, K., Bielinska, M., Nowosielska-Grygiel, J., Pietkiewicz, P., Kusmierczyk, K., Kolary, K. and Olszewski, J.	Comparative evaluation of the diagnostic value of the VHIT and Dix-Hallpike test in patients with balance system disorders in out-patient healthcare practice and expertise preparation. [Abstract] [BibTeX]	2018	Otolaryngologia polska = The Polish otolaryngology Vol. 72(6), pp. 37-43	article	DOI
Abstract: The aim of the paper was the comparative analysis of the diagnostic value of the Video Head Impulse Testing (VHIT) Ulmer I and Dix-Hallpike Test in patients with balance system disorders in out-patient practice and expertise preparation. The examination was performed in 63 patients aged 20-79, including 28 women aged 20-72 and 35 men aged 23-79, divided into two groups: Group I (study group) - 33 patients with mixed cause vertigo (on the basis of the Fitzgerald-Hallpike caloric test during the VNG examination), and Group II (reference group) - 30 healthy patients. After the ENT interview and physical examination, exclusion of pathological lesions in the external acoustic meatus and middle ear, each patient was subjected to a Fitzgerald-Hallpike caloric test during VNG examination, as well as a VHIT test and Dix-Hallpike test, with the evaluation of eyeball reaction during head rotation. In the group of patients with mixed-cause vertigo (Group I), the Fitzgerald-Hallpike caloric test showed unilateral labyrinth deficiencies in 90.9% of the patients (with the average value of 41.8%) and relative directional preponderance with the average value of 19.0%, while in 9.1% of the patients, the detected values of labyrinth excitability were normal. In the examination of patients with vertigo, benign paroxysmal positional vertigo was diagnosed in 9.1% of cases. This diagnosis was based on the positive response to the Dix-Hallpike manoeuvre and indicative of damage to the posterior semicircular canal in the VHIT test (without signs of deficiency in the VNG examination). The VHIT test and Dix-Hallpike test enable quick and precise detection of benign paroxysmal positional vertigo in out-patient practice and expertise preparation.
BibTeX: @article{Karawani2018, author = {Karawani, Kefah and Bielinska, Marzena and Nowosielska-Grygiel, Joanna and Pietkiewicz, Piotr and Kusmierczyk, Krzysztof and Kolary, Katarzyna and Olszewski, Jurek}, title = {Comparative evaluation of the diagnostic value of the VHIT and Dix-Hallpike test in patients with balance system disorders in out-patient healthcare practice and expertise preparation.}, journal = {Otolaryngologia polska = The Polish otolaryngology}, year = {2018}, volume = {72}, issue = {6}, pages = {37--43}, doi = {https://doi.org/10.5604/01.3001.0012.5421}, keywords = {Dix-Hallpike test; VHIT Ulmer I; vertigo}, pmid = {30647198} }
Tan, J., Yu, D., Feng, Y., Song, Q., You, J., Shi, H. and Yin, S.	Comparative study of the efficacy of the canalith repositioning procedure versus the vertigo treatment and rehabilitation chair. [Abstract] [BibTeX]	2014	Acta oto-laryngologica Vol. 134(7), pp. 704-708	article	DOI
Abstract: Vertigo treatment and rehabilitation chair (TRV) may be suggested as the first choice for patients with posterior canal benign paroxysmal positional vertigo (p-BPPV). To investigate the short- and long-term treatment efficacy of the canalith repositioning procedure (CRP) versus TRV for patients with p-BPPV. A total of 165 patients with unilateral p-BPPV were assigned to either the CRP group or the TRV group. Patients were assessed at 1 week, 4 weeks, 3 months, and 6 months after their first treatment. The numbers of treatment sessions required for successful repositioning in both groups at 4 weeks, 3 months, and 6 months were recorded. Treatment efficacy of patients in the TRV group was significantly better than that of patients in the CRP group 1 week after the first treatment. The number of treatment sessions needed for successful repositioning was significantly lower in the TRV group than in the CRP group at 4 weeks and 3 months after the first treatment.
BibTeX: @article{Tan2014, author = {Tan, Jun and Yu, Dongzhen and Feng, Yanmei and Song, Qiang and You, Jin and Shi, Haibo and Yin, Shankai}, title = {Comparative study of the efficacy of the canalith repositioning procedure versus the vertigo treatment and rehabilitation chair.}, journal = {Acta oto-laryngologica}, year = {2014}, volume = {134}, issue = {7}, pages = {704--708}, doi = {https://doi.org/10.3109/00016489.2014.899711}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo, therapy; Female; Follow-Up Studies; Humans; Male; Middle Aged; Musculoskeletal Manipulations; Nystagmus, Physiologic; Otolithic Membrane; Patient Positioning, instrumentation; Prospective Studies; Rehabilitation, instrumentation; Semicircular Canals; Treatment Outcome; Vertigo; recurrence; short-term efficacy}, pmid = {24807849} }
Tian, L., Sheng, H.-B., Wang, J., Luo, X., Yu, J., Jia, X.-H., Cheng, X., Han, Z. and Chi, F.-L.	Comparative Study on the Roles of the Number of Accelerations and Rotation Angle in the Treatment Maneuvers for Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo. [Abstract] [BibTeX]	2016	ORL; journal for oto-rhino-laryngology and its related specialties Vol. 78(1), pp. 36-45	article	DOI
Abstract: This study aims to investigate the roles of the number of accelerations and rotation angle in the treatment of posterior semicircular canal benign paroxysmal positional vertigo (PC-BPPV). We enrolled 344 patients with unilateral PC-BPPV. Of these, 167 patients in the simple-step maneuver (SSM) group were accelerated twice and rotated 120° per step, whereas 177 patients in the multi-step maneuver (MSM) group were accelerated 4 times and rotated 60° per step. Dix-Hallpike (DH) tests were performed to categorize the treatment outcome as follows: 'symptom free' if the result was negative, 'symptom persistent' if the result remained positive after performing the maneuver 3 times or 'canal conversion' if horizontal nystagmus was evoked. Of the patients in the SSM and MSM groups, 78.4 and 91.5% became symptom free, respectively, while canal conversion occurred in 13.8 and 5.1%, respectively (p = 0.003, χ(2) test). The success rate after performing the maneuver once was 57.1% in the MSM and 32.3% in the SSM symptom-free patients (p = 0.001, χ(2) test). One month after the treatment, 22.0 and 9.6% of the SSM and MSM patients had symptom relapse, respectively (p = 0.007, χ(2) test). More accelerations and a smaller rotation angle improved the effectiveness and efficiency of the repositioning maneuvers and reduced canal conversion.
BibTeX: @article{Tian2016, author = {Tian, Liang and Sheng, Hai-Bin and Wang, Jing and Luo, Xu and Yu, Jing and Jia, Xian-Hao and Cheng, Xiang and Han, Zhao and Chi, Fang-Lu}, title = {Comparative Study on the Roles of the Number of Accelerations and Rotation Angle in the Treatment Maneuvers for Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo.}, journal = {ORL; journal for oto-rhino-laryngology and its related specialties}, year = {2016}, volume = {78}, issue = {1}, pages = {36--45}, doi = {https://doi.org/10.1159/000442091}, keywords = {Acceleration; Benign Paroxysmal Positional Vertigo, diagnosis, physiopathology, therapy; Equipment and Supplies; Female; Humans; Male; Middle Aged; Patient Positioning; Physical Therapy Modalities; Prospective Studies; Rotation; Semicircular Canals, physiopathology; Single-Blind Method; Treatment Outcome}, pmid = {26682914} }
Jung, J.Y. and Kim, S.-H.	Comparison between objective and subjective benign paroxysmal positional vertigo: clinical features and outcomes. [Abstract] [BibTeX]	2016	Acta oto-laryngologica Vol. 136(12), pp. 1267-1272	article	DOI
Abstract: Objective benign paroxysmal positional vertigo (O-BPPV) and subjective BPPV (S-BPPV) have similar demographic and clinical features. Canalith repositioning manoeuvres (CRMs) can be an effective treatment for patients with S-BPPV, and a diagnosis of positional nystagmus is not essential for considering CRMs. This study supports the use of CRMs as the primary treatment for S-BPPV. To examine differences in demographic and clinical features, as well as treatment outcomes, between O-BPPV and S-BPPV. The medical records of 134 patients with BPPV were reviewed for demographic characteristics, past medical history, associated symptoms, response to CRMs, interval between symptom onset and the first medical visit, and recurrence rate. The O-BPPV group (n = 101) comprised patients who experienced vertigo and accompanying autonomic symptoms, and showed typical nystagmus. The S-BPPV group (n = 33) comprised patients who, when subjected to a provoking manoeuvre, showed all of the classic BPPV symptoms but did not show nystagmus. All patients had at least 3 years of follow-up. The demographics (age and sex ratio), past medical history, and associated symptoms were not significantly different between the two groups. Posterior semi-circular canal BPPV appeared more than twice as often as horizontal semi-circular canal BPPV in patients with S-BPPV. However, both canals were affected to a similar proportion in patients with O-BPPV, and the difference was marginally significant (p = 0.073). Overall improvement was better in O-BPPV than in S-BPPV; however, there was no significant difference. The total numbers of manoeuvres for recovery and the interval between symptom onset and the first medical visit also did not show any significant inter-group differences. During a 3-year follow-up, the recurrence rate was 13.8% for O-BPPV and 21.2% for S-BPPV.
BibTeX: @article{Jung2016, author = {Jung, Jae Yun and Kim, Se-Hyung}, title = {Comparison between objective and subjective benign paroxysmal positional vertigo: clinical features and outcomes.}, journal = {Acta oto-laryngologica}, year = {2016}, volume = {136}, issue = {12}, pages = {1267--1272}, doi = {https://doi.org/10.1080/00016489.2016.1203990}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo, diagnosis, epidemiology, therapy; Female; Humans; Male; Middle Aged; Republic of Korea, epidemiology; Retrospective Studies; Benign paroxysmal positional vertigo; canalolithiasis; nystagmus; repositioning manoeuvre}, pmid = {27388229} }
Wang, N., Zhou, H. and Huang, H.L.	Comparison of automatic and manual reposition treatment for horizontal semicircular canal benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2018	Journal of biological regulators and homeostatic agents Vol. 32(3), pp. 719-723	article
Abstract: The purpose of this investigation was to compare the efficacy of automatic to manual reposition treatment for patients with horizontal semicircular canal paroxysmal positional vertigo (BPPV). Sixty patients diagnosed with BPPV were equally and randomly divided into either a manual reposition treatment group or an automatic reposition treatment group. The groups were compared regarding difference in pain [visual analog scale (VAS)], extent of vertigo disorder [dizziness handicap inventory (DHI)], quality of life (SF-36), and therapeutic effect. Improved VAS, DHI and SF-36 were observed in both groups, however the efficacious rate of the automatic reposition group (96.7%) was 13.4% higher than that of the manual reposition group, reaching a statistical significance (p less than 0.05). In conclusion, in the treatment of BPPV patients, automatic reposition is more effective than manual reposition and can improve the patients quality of life.
BibTeX: @article{Wang2018d, author = {Wang, N and Zhou, H and Huang, H L}, title = {Comparison of automatic and manual reposition treatment for horizontal semicircular canal benign paroxysmal positional vertigo.}, journal = {Journal of biological regulators and homeostatic agents}, year = {2018}, volume = {32}, issue = {3}, pages = {719--723}, keywords = {Benign Paroxysmal Positional Vertigo, physiopathology, therapy; Female; Humans; Male; Pain, physiopathology; Pain Management; Pain Measurement; Physical Therapy Modalities; Quality of Life}, pmid = {29921405} }
Itaya, T., Yamamoto, E., Kitano, H., Yazawa, Y. and Kitajima, K.	Comparison of effectiveness of maneuvers and medication in the treatment of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	1997	ORL; journal for oto-rhino-laryngology and its related specialties Vol. 59(3), pp. 155-158	article	DOI
Abstract: In this paper, the treatment by medication together with two maneuvers-the particle repositioning maneuver (PRM) reported by Parnes and Price-Jones and the liberatory maneuver (LM) reported by Semont et al.-were compared with treatment by medication alone. Fourteen of 15 cases (93.3%) treated with the PRM and 11 of 14 cases (78.6%) treated with the LM showed improvement after 2 weeks. These results were better than that obtained by medication alone, in which 8 of 26 cases (30.8%) showed improvement after 2 weeks. The most important benefit of these maneuvers seemed to be the speedier recovery than with medication alone, as there was no significant difference in the late success rate after 3 months between the maneuvers and medication alone.
BibTeX: @article{Itaya1997, author = {Itaya, T and Yamamoto, E and Kitano, H and Yazawa, Y and Kitajima, K}, title = {Comparison of effectiveness of maneuvers and medication in the treatment of benign paroxysmal positional vertigo.}, journal = {ORL; journal for oto-rhino-laryngology and its related specialties}, year = {1997}, volume = {59}, issue = {3}, pages = {155--158}, doi = {https://doi.org/10.1159/000276929}, keywords = {Adult; Aged; Anti-Anxiety Agents, administration & dosage, therapeutic use; Betahistine, administration & dosage, therapeutic use; Combined Modality Therapy; Diazepam, administration & dosage, therapeutic use; Female; Histamine Agonists, administration & dosage, therapeutic use; Histamine H1 Antagonists, administration & dosage, therapeutic use; Humans; Male; Middle Aged; Piperidines, administration & dosage, therapeutic use; Vertigo, drug therapy, therapy; Vitamin B 12, administration & dosage, therapeutic use}, pmid = {9186970} }
Dispenza, F., Kulamarva, G. and De Stefano, A.	Comparison of repositioning maneuvers for benign paroxysmal positional vertigo of posterior semicircular canal: advantages of hybrid maneuver. [Abstract] [BibTeX]	2012	American journal of otolaryngology Vol. 33(5), pp. 528-532	article	DOI
Abstract: The prevalence of benign paroxysmal positional vertigo (BPPV) is becoming more frequent in elderly population. The presence of comorbid factors has to be considered before assessment as well as before commencing any repositioning treatment. Our aims were evaluation of the maneuvers efficacy and evaluation of the applicability of hybrid maneuver (HM) in patients with physical limitation. This is a randomized study in 2 tertiary referral centers. This is a therapeutic intervention. All consecutive patients with diagnosis of BPPV of posterior canal matching the inclusion criteria were enrolled. Patients underwent treatment soon after the initial diagnosis in all cases with a repositioning maneuver. The maneuver was casually selected among Semont, Epley, and hybrid. Patients were divided into 3 groups according to the maneuver adopted. Eighty-eight patients with posterior canal BPPV were enrolled for treatment. Fisher exact test showed that no statistical differences exist between HM and other maneuvers in terms of efficacy. Latency of repositioning nystagmus appeared longer in HM in comparison with other maneuvers (P < .05). Efficacy of maneuvers used for BPPV decreases in case of cupulolithiasis (P < .0001). We found no relationship between age, sex, and length of disturbance on response to maneuvers. All maneuvers evaluated demonstrated similar efficacy. The HM, as our data showed, allows us to obtain a good percentage of success similar to most maneuvers used. It is also more comfortable for the patients with hip or neck functional limitation allowing an effective treatment of the posterior canal BPPV.
BibTeX: @article{Dispenza2012a, author = {Dispenza, Francesco and Kulamarva, Gautham and De Stefano, Alessandro}, title = {Comparison of repositioning maneuvers for benign paroxysmal positional vertigo of posterior semicircular canal: advantages of hybrid maneuver.}, journal = {American journal of otolaryngology}, year = {2012}, volume = {33}, issue = {5}, pages = {528--532}, doi = {https://doi.org/10.1016/j.amjoto.2011.12.002}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Female; Follow-Up Studies; Humans; Male; Middle Aged; Patient Positioning, methods; Posture; Retrospective Studies; Semicircular Canals, physiopathology; Treatment Outcome; Vertigo, physiopathology, therapy}, pmid = {22317838} }
Steenerson, R.L. and Cronin, G.W.	Comparison of the canalith repositioning procedure and vestibular habituation training in forty patients with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	1996	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 114(1), pp. 61-64	article
Abstract: Forty patients with benign paroxysmal positional vertigo were treated with either the canalith repositioning procedure or vestibular habituation exercises to determine which treatment approach would be most effective. Twenty additional patients with benign paroxysmal positional vertigo were not treated and served as a control group. The intensity and duration of symptoms were monitored during a 3-month period. All patients had symptomatic relief in the treated groups. The canalith repositioning procedure seemed to give resolution of symptoms with fewer treatments, but long-term results show either treatment approach is effective in relieving positional vertigo. A significant number of patients in the control group (75%) continued to have vertigo. Advantages and disadvantages of the canalith repositioning procedure and vestibular habituation exercises are discussed.
BibTeX: @article{Steenerson1996, author = {Steenerson, R L and Cronin, G W}, title = {Comparison of the canalith repositioning procedure and vestibular habituation training in forty patients with benign paroxysmal positional vertigo.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {1996}, volume = {114}, issue = {1}, pages = {61--64}, keywords = {Adaptation, Physiological; Exercise Therapy; Female; Head, anatomy & histology; Humans; Male; Middle Aged; Otolithic Membrane, physiopathology; Patient Acceptance of Health Care; Physical Therapy Modalities; Posture; Prospective Studies; Time Factors; Treatment Outcome; Vertigo, physiopathology, therapy}, pmid = {8570252} }
Cetin, Y.S., Ozmen, O.A., Demir, U.L., Kasapoglu, F., Basut, O. and Coskun, H.	Comparison of the effectiveness of Brandt-Daroff Vestibular training and Epley Canalith repositioning maneuver in benign Paroxysmal positional vertigo long term result: A randomized prospective clinical trial. [Abstract] [BibTeX]	2018	Pakistan journal of medical sciences Vol. 34(3), pp. 558-563	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral cause of vertigo. It can be defined as transient vertigo induced by rapid change in head position, associated with a characteristic paroxysmal positional nystagmus. Posterior canal benign paroxysmal positional vertigo is the most frequent form of BPPV. The aim of our study was to investigate and compare the effectiveness of Epley maneuver and Brand-Daroff home exercises for the treatment of posterior canal BPPV. A total of 50 patients between 27 and 76 years of age who were diagnosed with unilateral posterior canal into BPPV were randomized prospectively into two groups. In Group-1, modified particle repositioning maneuver and in Group-2 Brandt-Daroff exercises were utilized as treatment. Patients were followed weekly. Cure weeks were recorded. The patients were followed for 12 to 24 months for recurrence. The recovery rates at the first, second and third week controls were 76%, 96% and 100% for Group-1 (modified Epley maneuver) and 64%, 88% and 100% for Group-2 (Brandt-Daroff exercises) respectively. The recovery rates were similar for both groups. The average follow-up duration was 18 months. In Group 1, 7 patients (28%) and in Group 2, 5 patients (20%) had recurrence, which was also similar with no statistical difference. It was concluded that both Brandt-Daroff Exercises and Modified Epley maneuvers were almost equally effective in the treatment of BPPV.
BibTeX: @article{Cetin2018, author = {Cetin, Yaser Said and Ozmen, Omer Afsin and Demir, Uygar Levent and Kasapoglu, Fikret and Basut, Oguz and Coskun, Hakan}, title = {Comparison of the effectiveness of Brandt-Daroff Vestibular training and Epley Canalith repositioning maneuver in benign Paroxysmal positional vertigo long term result: A randomized prospective clinical trial.}, journal = {Pakistan journal of medical sciences}, year = {2018}, volume = {34}, issue = {3}, pages = {558--563}, doi = {https://doi.org/10.12669/pjms.343.14786}, keywords = {Benign positional paroxysmal vertigo; Brandt-Daroff exercises; Canalith repositioning maneuvers; Video electronystagmography}, pmid = {30034415} }
Canale, A., Caranzano, F., Lanotte, M., Ducati, A., Calamo, F., Albera, A., Lacilla, M., Boldreghini, M., Lucisano, S. and Albera, R.	Comparison of VEMPs, VHIT and caloric test outcomes after vestibular neurectomy in Menière's disease. [Abstract] [BibTeX]	2018	Auris, nasus, larynx Vol. 45(6), pp. 1159-1165	article	DOI
Abstract: Selective unilateral vestibular neurectomy (VN) is considered a reliable surgical treatment in case of recurrent vertigo in Menière's disease (MD) because of hearing preservation and a minimally invasive posterior fossa retrosigmoid approach. The present study aimed to assess the quality of life and the long-term vestibular function in patients submitted to yearly follow-up after VN because of intractable MD. Retrospective series of 15 MD patients undergoing retrosigmoid VN for recurrent vertigo. Outcome measures included cVEMPs and oVEMPs (cervical and ocular vestibular evoked myogenic potentials), VHIT (Video Head Impulse Test) and caloric test, besides to DHI (Dizziness Handicap Inventory) and PTA (Pure Tone Audiometry). Mean DHI score resulted within normal values in 74% of patients, significantly correlated to the duration of the follow-up. In the operated side, cVEMPs and oVEMPs have not been elicited respectively in 11 patients (73%) and 13 patients (87%), whereas it was not possible to evoke any response at bithermal caloric test in 4 cases. The gain of VOR from VHIT resulted always below normal values after VN except in one patient, who has also undergone an episode of posterior BBPV. The difference between average PTA threshold before and after VN resulted not significant. The vestibular outcomes prove VN to be an effective and safe surgery in MD; furthermore, the unexpected occurrence of BPPV after VN can justify the presence of neural anastomosis between the inferior vestibular nerve and the cochlear nerve, allowing to still perceive vestibular symptomatology despite of a proper neurectomy.
BibTeX: @article{Canale2018, author = {Canale, Andrea and Caranzano, Federico and Lanotte, Michele and Ducati, Alessandro and Calamo, Francesco and Albera, Andrea and Lacilla, Michelangelo and Boldreghini, Marco and Lucisano, Sergio and Albera, Roberto}, title = {Comparison of VEMPs, VHIT and caloric test outcomes after vestibular neurectomy in Menière's disease.}, journal = {Auris, nasus, larynx}, year = {2018}, volume = {45}, issue = {6}, pages = {1159--1165}, doi = {https://doi.org/10.1016/j.anl.2018.04.006}, keywords = {Adult; Aged; Audiometry, Pure-Tone; Caloric Tests; Denervation; Female; Head Impulse Test; Humans; Male; Meniere Disease, complications, physiopathology, surgery; Middle Aged; Recurrence; Retrospective Studies; Treatment Outcome; Vertigo, etiology, physiopathology, surgery; Vestibular Evoked Myogenic Potentials; Vestibular Nerve, physiopathology, surgery; Young Adult; Menière’s disease; Neural anastomosis; Recurrent vertigo; Vestibular neurectomy; Vestibular neurectomy outcomes}, pmid = {29747962} }
Black, F.O. and Wall, C.	Comparison of vestibulo-ocular and vestibulospinal screening tests. [Abstract] [BibTeX]	1981	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 89(5), pp. 811-817	article	DOI
Abstract: A comparison of a newly developed vestibulospinal screening test and two vestibulo-ocular screening tests (caloric and rotation) was performed on two groups of patients, one with Meniere's disease (MD) the other with benign paroxysmal positional nystagmus (BPPN) and vertigo. Vestibulospinal screening tests were slightly more sensitive (not statistically significant) than caloric tests for detection of a peripheral vestibular disorder. Caloric, rotation, and vestibulospinal screening tests were specific neither for MD nor BPPN groups. The caloric test false-positive rate for the involved ear was unacceptably high for the BPPN group. The rotation test false-positive rate was the highest of the three tests for both groups. The vestibulospinal test combined with either the caloric or the rotational tests increased the sensitivity for detection of a peripheral vestibular disturbance, particularly for the MD patients.
BibTeX: @article{Black1981, author = {Black, F O and Wall, C}, title = {Comparison of vestibulo-ocular and vestibulospinal screening tests.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {1981}, volume = {89}, issue = {5}, pages = {811--817}, doi = {https://doi.org/10.1177/019459988108900523}, keywords = {False Positive Reactions; Humans; Meniere Disease, diagnosis; Nystagmus, Pathologic, diagnosis; Vertigo, diagnosis; Vestibular Function Tests, methods; Vestibule, Labyrinth, physiopathology}, pmid = {6799914} }
Galli, M., Petracca, T., Minozzi, F. and Gallottini, L.	Complications in implant surgery by Summer's technique: benign paroxysmal positional vertigo (BPPV). [Abstract] [BibTeX]	2004	Minerva stomatologica Vol. 53(9), pp. 535-541	article
Abstract: The aim of this study is to show the correlation between implant surgery using an osteotomic technique and benign paroxysmal positional vertigo (BPPV). The case of a 55-year-old patient submitted to oral implant surgery in the 2.3 area is described. The ridge was thin in this particular location and therefore the maxillary expansion technique according to Summer was preferred. After removing the sutures, the patient suffered from vertigo and was in a confusional state. The patient was therefore placed in the Tredelenburg's position and a few minutes later he felt better. However, the symptomatology that seemed disappeared was present again the following day. A careful check-up showed the presence of BPPV, treated as described in this paper.
BibTeX: @article{Galli2004, author = {Galli, M and Petracca, T and Minozzi, F and Gallottini, L}, title = {Complications in implant surgery by Summer's technique: benign paroxysmal positional vertigo (BPPV).}, journal = {Minerva stomatologica}, year = {2004}, volume = {53}, issue = {9}, pages = {535--541}, keywords = {Dental Implantation, adverse effects, methods; Humans; Male; Middle Aged; Vertigo, etiology}, pmid = {15499305} }
Herdman, S.J. and Tusa, R.J.	Complications of the canalith repositioning procedure. [Abstract] [BibTeX]	1996	Archives of otolaryngology--head & neck surgery Vol. 122(3), pp. 281-286	article
Abstract: To describe the conversion of benign paroxysmal positional vertigo involving the posterior canal into benign paroxysmal positional vertigo involving the anterior or horizontal canals after treatment using the canalith repositioning maneuver. Retrospective study of outcome. Outpatient clinic. Consecutive sample of 85 patients diagnosed as having benign paroxysmal positional vertigo affecting the posterior canal. Identification of posterior canal involvement was based on the observation of the direction of the vertical component of nystagmus after the Hallpike-Dix maneuver. Canalith repositioning maneuver. Eye movements were observed about 1 week after the treatment. The direction of nystagmus elicited after movement of the patient into the Hallpike-Dix position indicated which canal was involved in the patients who had not responded to treatment. Of the 85 patients studied who originally had posterior canal benign paroxysmal positional vertigo, five (6%) had anterior canal (n=2) or horizontal canal (n=3) positional vertigo after undergoing this maneuver. Careful observation of the direction of the nystagmus is necessary for correct identification of which canal is involved in patients who do not respond to the initial treatment using the canalith repositioning maneuver.
BibTeX: @article{Herdman1996, author = {Herdman, S J and Tusa, R J}, title = {Complications of the canalith repositioning procedure.}, journal = {Archives of otolaryngology--head & neck surgery}, year = {1996}, volume = {122}, issue = {3}, pages = {281--286}, keywords = {Adult; Aged; Diagnosis, Differential; Eye Movements; Female; Humans; Nystagmus, Pathologic, diagnosis, physiopathology; Outcome Assessment (Health Care); Physical Therapy Modalities, adverse effects; Posture; Retrospective Studies; Rotation; Semicircular Canals, physiology; Vertigo, diagnosis, etiology, therapy}, pmid = {8607956} }
Kim, C.-H., Shin, J.E., Park, H.J., Koo, J.-W. and Lee, J.H.	Concurrent posterior semicircular canal benign paroxysmal positional vertigo in patients with ipsilateral sudden sensorineural hearing loss: is it caused by otolith particles? [Abstract] [BibTeX]	2014	Medical hypotheses Vol. 82(4), pp. 424-427	article	DOI
Abstract: The etiology of benign paroxysmal positional vertigo (BPPV) is still elusive even though detached otolith particles from the utricular macula are generally thought to be responsible for the pathogenesis of BPPV. Sudden sensorineural hearing loss (SSNHL), of which the etiology is also idiopathic in most cases, may accompany concurrent BPPV. This uncommon condition of concurrent BPPV with SSNHL has been assumptively explained as selective damage of the cochlea and the utricle due to viral neurolabyrinthitis. Recently, radiological evidences that inner ear hemorrhage is observed in patients with SSNHL accompanied by severe vertigo have been reported. The basic hypothesis for this study is that blood debris in the endolymphatic fluid due to inner ear hemorrhage is one of the causes of concurrent posterior semicircular canal (PSCC) BPPV in patient with ipsilateral SSNHL. In this report, we will outline the clinical findings of 4 patients with PSCC BPPV with SSNHL, and present an experimental results using whole blood in artificial endolymph to evaluate the hypothesis.
BibTeX: @article{Kim2014c, author = {Kim, Chang-Hee and Shin, Jung Eun and Park, Hong Ju and Koo, Ja-Won and Lee, Jun Ho}, title = {Concurrent posterior semicircular canal benign paroxysmal positional vertigo in patients with ipsilateral sudden sensorineural hearing loss: is it caused by otolith particles?}, journal = {Medical hypotheses}, year = {2014}, volume = {82}, issue = {4}, pages = {424--427}, doi = {https://doi.org/10.1016/j.mehy.2014.01.015}, keywords = {Aged; Benign Paroxysmal Positional Vertigo; Ear, Inner, physiopathology; Endolymph; Female; Hearing Loss, Sensorineural, complications, diagnosis; Humans; Male; Middle Aged; Models, Theoretical; Otolithic Membrane, physiopathology; Semicircular Canals, physiopathology; Vertigo, complications, diagnosis}, pmid = {24529913} }
André, A.P.d.R., Moriguti, J.C. and Moreno, N.S.	Conduct after Epley's maneuver in elderly with posterior canal BPPV in the posterior canal. [Abstract] [BibTeX]	2010	Brazilian journal of otorhinolaryngology Vol. 76(3), pp. 300-305	article
Abstract: Benign Paroxysmal Positional Vertigo is the most common peripheral vestibular disorder, especially in the elderly and presents as the predominant etiology in this population of the degeneration of the utricular macula. To compare the effectiveness of the approaches after Epley maneuver. longitudinal cohort. The study included 53 volunteers with Benign Paroxysmal Positional Vertigo of the posterior semicircular canal, divided into Group 1, who underwent Epley maneuver associated with the use of neck collar and post-maneuver instructions, Group 2 underwent the Epley maneuver without the use cervical collar and/or post-maneuver restrictions, and Group 3 underwent the Epley maneuver associated with the use of a mini vibrator, without the use of neck collar and/or post-maneuver restrictions. In the three groups, the number of Epley maneuvers ranged from one to three. We employed the Brazilian Dizziness Handicap Inventory - pre-and post-treatment and observed a statistically significant difference on most scores pre-and post-treatment for both groups. Regardless of the post Epley maneuver treatment selected for the treatment of Benign Paroxysmal Positional Vertigo, it was effective when comparing the Brazilian Dizziness Handicap Inventory pre-and post-treatment.
BibTeX: @article{Andre2010, author = {André, Ana Paula do Rego and Moriguti, Julio Cesar and Moreno, Nathali Singaretti}, title = {Conduct after Epley's maneuver in elderly with posterior canal BPPV in the posterior canal.}, journal = {Brazilian journal of otorhinolaryngology}, year = {2010}, volume = {76}, issue = {3}, pages = {300--305}, keywords = {Aged; Aged, 80 and over; Cohort Studies; Dizziness, therapy; Female; Head Movements; Humans; Longitudinal Studies; Male; Middle Aged; Physical Therapy Modalities; Treatment Outcome; Vertigo, therapy}, pmid = {20658007} }
De Valck, C.F.J., Wuyts, F.L., Vanspauwen, R., Walravens, S. and Van de Heyning, P.H.	Conscientiousness in patients with Ménière's disease. [Abstract] [BibTeX]	2007	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 28(3), pp. 365-368	article	DOI
Abstract: To assess whether a conscientious personality profile is more prevalent in patients with Ménière's disease (MD) in comparison with other vertigo patients. Second, to investigate a sex effect and compare the obtained conscientiousness scores with published normative values. A total of 108 patients were included and subdivided into one of five pathology groups: MD, benign paroxysmal positional vertigo, vestibular neuritis, vestibular schwannoma, and posttraumatic nonbenign paroxysmal positional vertigo. The conscientiousness domain of the self-reporting NEO Five-Factor Inventory questionnaire. Conscientiousness score. There was no significant difference between the diagnostic groups or a sex effect. MD patients had a higher score than published normal values. As assessed with the NEO Five-Factor Inventory questionnaire, MD patients do not demonstrate a higher conscientious personality profile in comparison with other vertigo patients. Therefore, this limits the clinical use of the personality profile to discriminate between patient groups.
BibTeX: @article{DeValck2007, author = {De Valck, Claudia F J and Wuyts, Floris L and Vanspauwen, Robby and Walravens, Sylvia and Van de Heyning, Paul H}, title = {Conscientiousness in patients with Ménière's disease.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2007}, volume = {28}, issue = {3}, pages = {365--368}, doi = {https://doi.org/10.1097/mao.0b013e31802e3c67}, keywords = {Adaptation, Psychological; Cross-Sectional Studies; Female; Humans; Male; Meniere Disease, epidemiology, psychology; Middle Aged; Neuroma, Acoustic, epidemiology; Personality; Personality Inventory; Surveys and Questionnaires; Vertigo, epidemiology; Vestibular Neuronitis, epidemiology; Wounds and Injuries, epidemiology}, pmid = {17414043} }
Kerber, K.A., Skolarus, L.E., Callaghan, B.C., Zheng, K., Zhang, Y., An, L.C. and Burke, J.F.	Consumer Demand for Online Dizziness Information: If You Build it, They may Come. [Abstract] [BibTeX]	2014	Frontiers in neurology Vol. 5, pp. 50	article	DOI
Abstract: Dizziness is a common reason patients present to doctors, but effective diagnostic tests and treatments for dizziness are underused. The internet is a way to disseminate medical information and is emerging as an intervention platform. The objective of this study was to describe internet searches for dizziness terms to assess the possible consumer demand for internet-based dizziness diagnostic and treatment tools. Google AdWords and Google Insights for Search were used for keyword search data on the following generic terms: vertigo, dizzy, dizziness, lightheaded, and lightheadedness. Data collected included keyword ideas (i.e., additional keywords identified by Google as being related search terms), global and US only monthly search frequencies, as well as trends in top searches related to dizziness terms from 2004 to 2012. Keywords suggestive of benign paroxysmal positional vertigo (BPPV) or BPPV processes were identified. Of the five generic dizziness terms, vertigo had the most global searches per month (1.83 million) and lightheadedness had the least (90,500). Four BPPV-specific terms had more than 100,000 global searches per month. Three BPPV terms ("positional vertigo," "benign vertigo," and "benign positional vertigo") have been in the list of top searches related to vertigo every quarter since 2004. Substantial demand exists for dizziness information via the internet. Future studies should seek to better characterize the population seeking this information. The magnitude of this potential demand suggests that validated and tested diagnostic and treatment tools could contribute to healthcare efficiencies and patient outcomes.
BibTeX: @article{Kerber2014, author = {Kerber, Kevin A and Skolarus, Lesli E and Callaghan, Brian C and Zheng, Kai and Zhang, Yuhao and An, Lawrence C and Burke, James F}, title = {Consumer Demand for Online Dizziness Information: If You Build it, They may Come.}, journal = {Frontiers in neurology}, year = {2014}, volume = {5}, pages = {50}, doi = {https://doi.org/10.3389/fneur.2014.00050}, keywords = {consumer demand; dizziness; internet searches; vertigo}, pmid = {24795690} }
Bashir, K., Abid, A.R., Felaya, A., Masood, M., Ahmad, H.A. and Cameron, P.	Continuing lack of the diagnosis of benign paroxysmal positional vertigo in a tertiary care emergency department. [BibTeX]	2015	Emergency medicine Australasia : EMA Vol. 27(4), pp. 378-379	article	DOI
BibTeX: @article{Bashir2015, author = {Bashir, Khalid and Abid, Abdul R and Felaya, Ahmed and Masood, Maarij and Ahmad, Hossam A and Cameron, Peter}, title = {Continuing lack of the diagnosis of benign paroxysmal positional vertigo in a tertiary care emergency department.}, journal = {Emergency medicine Australasia : EMA}, year = {2015}, volume = {27}, issue = {4}, pages = {378--379}, doi = {https://doi.org/10.1111/1742-6723.12418}, keywords = {Adult; Benign Paroxysmal Positional Vertigo, diagnosis; Dizziness, diagnosis; Emergency Service, Hospital; Female; Humans; Male; Middle Aged; Retrospective Studies; Tomography, X-Ray Computed}, pmid = {26077511} }
von Brevern, M., Clarke, A.H. and Lempert, T.	Continuous vertigo and spontaneous nystagmus due to canalolithiasis of the horizontal canal. [Abstract] [BibTeX]	2001	Neurology Vol. 56(5), pp. 684-686	article
Abstract: The authors present a patient with benign paroxysmal positional vertigo of the right horizontal semicircular canal who developed persistent vertigo with spontaneous horizontal nystagmus to the left and caloric hypoexcitability on the right after a head shaking maneuver. Both spontaneous nystagmus and canal paresis resolved after repeated shaking of the head. The most probable mechanism of this type of vertigo is plugging of the horizontal canal by otoconial particles with a negative endolymph pressure between plug and cupula.
BibTeX: @article{Brevern2001a, author = {von Brevern, M and Clarke, A H and Lempert, T}, title = {Continuous vertigo and spontaneous nystagmus due to canalolithiasis of the horizontal canal.}, journal = {Neurology}, year = {2001}, volume = {56}, issue = {5}, pages = {684--686}, keywords = {Adult; Female; Humans; Lithiasis, physiopathology; Nystagmus, Pathologic, physiopathology; Posture, physiology; Semicircular Canals, physiopathology; Vertigo, physiopathology}, pmid = {11245729} }
Leong, A.C. and Golding-Wood, D.	Contralateral incipient posterior canal benign positional paroxysmal vertigo: complication after Epley maneuver. [Abstract] [BibTeX]	2008	The Laryngoscope Vol. 118(11), pp. 2087-2090	article	DOI
Abstract: Particle repositioning procedures give consistent results for the treatment of benign positional paroxysmal vertigo (BPPV). However, little consideration has been given to the possibilities of bilateral disease. To report contralateral symptoms and signs suggestive of revealed or incipient BPPV as a complication of Epley maneuver. A prospective cohort of 198 cases over a period of 11 years. Ten (5.0%) developed contralateral symptoms and signs suggestive of revealed or incipient posterior canal BPPV within 2 weeks of treatment. This novel observation has not been previously described and may influence the strategy for future management of patients with BPPV. Particle repositioning maneuvers for the previously asymptomatic contralateral ear may need to be considered in a subset of patients with posterior canal BPPV who suffer contralateral symptoms after undergoing treatment for the original ear.
BibTeX: @article{Leong2008, author = {Leong, Annabelle C and Golding-Wood, David}, title = {Contralateral incipient posterior canal benign positional paroxysmal vertigo: complication after Epley maneuver.}, journal = {The Laryngoscope}, year = {2008}, volume = {118}, issue = {11}, pages = {2087--2090}, doi = {https://doi.org/10.1097/MLG.0b013e3181820916}, keywords = {Adult; Aged; Aged, 80 and over; Female; Follow-Up Studies; Humans; Male; Middle Aged; Physical Therapy Modalities, adverse effects; Posture, physiology; Prognosis; Prospective Studies; Time Factors; Treatment Failure; Vertigo, diagnosis, etiology, physiopathology; Vestibular Function Tests}, pmid = {18849858} }
Norré, M.E.	Contribution of a posturographic six-test set to the evaluation of patients with peripheral vestibular disorders. [Abstract] [BibTeX]	1992	Journal of vestibular research : equilibrium & orientation Vol. 2(2), pp. 159-166	article
Abstract: A posturographic six-test set was developed in order to investigate the contribution of each sensory input in the balance performance of patients with peripheral vestibular disturbances. In test 1 (t1) the three sensory inputs are contributing to balance. In (t2), the contribution of vision is excluded by closing the eyes; in (t3) the neck proprioceptor is influenced by extreme retroflexion of the head, and in (t4) the input of the foot-ankle proprioceptor is altered by standing on foam rubber. The first two conditions are combined with the third one in (t5-t6). This test procedure compares the results obtained when the input of one (or two) sensors is impeded or altered with the results when the same sensors are uninfluenced. This comparison allows us to evaluate the individual contribution of the sensory inputs involved in the process of balance, especially in the compensation process in patients with benign paroxysmal positioning vertigo (BPPV) and with Ménière's disease. This comparative evaluation shows several "formulae." So can formulae with positive tests for head in retroflexion condition be more frequently met in the BPPV-group, whereas influence of visual exclusion is more frequently seen in the Ménière group.
BibTeX: @article{Norre1992, author = {Norré, M E}, title = {Contribution of a posturographic six-test set to the evaluation of patients with peripheral vestibular disorders.}, journal = {Journal of vestibular research : equilibrium & orientation}, year = {1992}, volume = {2}, issue = {2}, pages = {159--166}, keywords = {Adult; Aged; Aged, 80 and over; Evaluation Studies as Topic; Female; Humans; Male; Meniere Disease, physiopathology; Middle Aged; Postural Balance; Posture, physiology; Psychomotor Performance; Vertigo, physiopathology}, pmid = {1342390} }
Psillas, G., Vital, I., Rachovitsas, D., Vital, V. and Tsalighopoulos, M.	Conversion of canalolithiasis to cupulolithiasis in the course of a horizontal benign paroxysmal positional vertigo case. [Abstract] [BibTeX]	2011	American journal of otolaryngology Vol. 32(2), pp. 174-176	article	DOI
Abstract: The benign paroxysmal positional vertigo of the horizontal semicircular canal is manifested with either geotropic or apogeotropic horizontal nystagmus. A 61-year-old male patient who experienced repeated episodes of positional vertigo is presented in this study. The vertigo was reported to be more severe while rotating his head to the left and then to the right. The initial examination revealed a geotropic purely horizontal nystagmus at the lateral positions of the head compatible with canalolithiasis of the left horizontal semicircular canal. In this case, the otoconia debris migrates from the vestibule into the horizontal semicircular canal through its nonampullary end, where they float freely (canalolithiasis). Five days later, the geotropic nystagmus transformed to apogeotropic. Thus, it may be assumed that the otoconia debris adhered to the cupula and converted the canalolithiasis to cupulolithiasis of the horizontal semicircular canal on the same side. With rotation of the head to the left while the patient was in the supine position, gravity causes the weighted cupula to deflect ampullofugally, resulting in apogeotropic nystagmus; the opposite was noticed when the head was rotated to the right. The so-called barbecue maneuver was initially effective curing the geotropic form of the condition and consequently the modified Semont maneuver for the apogeotropic form.
BibTeX: @article{Psillas2011a, author = {Psillas, George and Vital, Iosif and Rachovitsas, Dimitrios and Vital, Victor and Tsalighopoulos, Miltiadis}, title = {Conversion of canalolithiasis to cupulolithiasis in the course of a horizontal benign paroxysmal positional vertigo case.}, journal = {American journal of otolaryngology}, year = {2011}, volume = {32}, issue = {2}, pages = {174--176}, doi = {https://doi.org/10.1016/j.amjoto.2010.01.002}, keywords = {Benign Paroxysmal Positional Vertigo; Calculi, complications; Ear Diseases, complications, physiopathology; Head Movements; Humans; Male; Middle Aged; Nystagmus, Pathologic, physiopathology, therapy; Posture; Semicircular Canals, physiopathology; Treatment Outcome; Vertigo, physiopathology, therapy}, pmid = {20447729} }
Califano, L.	Converting apogeotropic into geotropic lateral canalolithiasis by headpitching manoeuvre in the sitting position. [BibTeX]	2010	Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale Vol. 30(4), pp. 224	article
BibTeX: @article{Califano2010, author = {Califano, Luigi}, title = {Converting apogeotropic into geotropic lateral canalolithiasis by headpitching manoeuvre in the sitting position.}, journal = {Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale}, year = {2010}, volume = {30}, issue = {4}, pages = {224}, keywords = {Benign Paroxysmal Positional Vertigo; Humans; Nystagmus, Pathologic; Patient Positioning; Vertigo, physiopathology}, pmid = {21253291} }
Wada, M., Naganuma, H., Tokumasu, K. and Okamoto, M.	Correlation between arteriosclerotic changes and prognosis in patients with peripheral vestibular disorders. [Abstract] [BibTeX]	2009	The international tinnitus journal Vol. 15(2), pp. 193-195	article
Abstract: Symptoms such as vertigo and unsteady gait occur in various diseases and are among the relatively common chief complaints. Even at present, the mechanisms underlying these disorders are unclear. We report a significant correlation between a prolonged period of resolution of benign paroxysmal positional vertigo (BPPV) and histories of lifestyle-related illnesses. We consider the possibility of correlating between BPPV prognosis and arteriosclerotic changes. Using carotid ultrasonography, we examined maximum intima-media thickness (IMT), maximum common carotid artery IMT, and biochemical examinations in 105 patients with peripheral vertigo. We divided patients with BPPV into groups with and without abnormal thickness of the IMT. The maximum IMT was 1.35 mm in patients with peripheral vestibular disorders. The proportion of peripheral vestibular disorder patients with a maximum IMT of > or = 1.1 mm (i.e., thickening) was 58%. The rate at which the feeling of positional vertigo remained at the halfway point in the observation period was significantly higher in the group of patients with an IMT of > or =1.1 mm (p = .0007). Our results indicate that cervical ultrasonography is useful for noninvasive examination of arteriosclerotic changes in patients with peripheral vestibular disorders. We saw indications that such patients show progression of arteriosclerotic changes. This study suggested that the arteriosclerotic change was related to prognosis.
BibTeX: @article{Wada2009a, author = {Wada, Masaoki and Naganuma, Hideaki and Tokumasu, Koji and Okamoto, Makito}, title = {Correlation between arteriosclerotic changes and prognosis in patients with peripheral vestibular disorders.}, journal = {The international tinnitus journal}, year = {2009}, volume = {15}, issue = {2}, pages = {193--195}, keywords = {Aged; Arteriosclerosis, diagnosis; Carotid Artery, Common, pathology; Carotid Stenosis, diagnosis; Cholesterol, HDL, blood; Cholesterol, LDL, blood; Female; Glycated Hemoglobin A, metabolism; Humans; Life Style; Magnetic Resonance Imaging; Male; Middle Aged; Risk Factors; Triglycerides, blood; Ultrasonography; Vertigo, diagnosis; Vestibular Diseases, diagnosis; Vestibule, Labyrinth, pathology}, pmid = {20420346} }
Shim, D.B., Kim, J.H., Park, K.C., Song, M.H. and Park, H.J.	Correlation between the head-lying side during sleep and the affected side by benign paroxysmal positional vertigo involving the posterior or horizontal semicircular canal. [Abstract] [BibTeX]	2012	The Laryngoscope Vol. 122(4), pp. 873-876	article	DOI
Abstract: The aim of this study was to evaluate the relationship between the head position during sleep and the affected semicircular canal (SCC) in patients with benign paroxysmal positional vertigo (BPPV). Prospective study at a tertiary hospital. We conducted a prospective study in patients with BPPV involving posterior or horizontal SCCs. Of a total of 425 patients diagnosed with BPPV, 83 patients showing signs of simultaneous multiple canal involvement, and those having combined otologic diseases in the same ear were excluded from the study. All patients included in the study were asked to define their preferred head-lying side at the beginning of sleep among the following choices: supine, lateral (right or left), or no predominant side. Our study included 174 patients with posterior SCC BPPV (p-BPPV) and 168 patients with horizontal SCC BPPV (h-BPPV). Patients habitually adopted a lateral head position during sleep in 105 cases of p-BPPV and 109 cases of h-BPPV. Statistically significant correlation was demonstrated between the head-lying side during sleep and the affected side by BPPV (P < .01) in patients with p-BPPV as well as h-BPPV. There is significant correlation between the head-lying side during sleep and the side affected by BPPV in h-BPPV and p-BPPV, which may provide additional clues about the pathophysiology of BPPV. Clinically, this information may be used to provide helpful guidelines for patients with BPPV concerning their sleeping positions to prevent recurrence of BPPV.
BibTeX: @article{Shim2012, author = {Shim, Dae Bo and Kim, Ji Hong and Park, Kye Chun and Song, Mee Hyun and Park, Hong Ju}, title = {Correlation between the head-lying side during sleep and the affected side by benign paroxysmal positional vertigo involving the posterior or horizontal semicircular canal.}, journal = {The Laryngoscope}, year = {2012}, volume = {122}, issue = {4}, pages = {873--876}, doi = {https://doi.org/10.1002/lary.23180}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Child; Diagnosis, Differential; Female; Follow-Up Studies; Head Movements; Humans; Male; Middle Aged; Posture, physiology; Prospective Studies; Semicircular Canals, physiopathology; Sleep, physiology; Vertigo, diagnosis, physiopathology; Young Adult}, pmid = {22344794} }
	Corrigendum. [Abstract] [BibTeX]	2013	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 149(5), pp. 798	article	DOI
Abstract: Choi SJ, Lee JB, Lim HJ, et al. Clinical features of recurrent or persistent benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 2012;147:919-924. doi: 10.1177/0194599812454642 .
BibTeX: @article{2013a,, title = {Corrigendum.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2013}, volume = {149}, issue = {5}, pages = {798}, doi = {https://doi.org/10.1177/0194599813505840}, pmid = {29130828} }
Fishman, J.M., Burgess, C. and Waddell, A.	Corticosteroids for the treatment of idiopathic acute vestibular dysfunction (vestibular neuritis). [Abstract] [BibTeX]	2011	The Cochrane database of systematic reviews(5), pp. CD008607	article	DOI
Abstract: Idiopathic acute vestibular dysfunction (vestibular neuritis) is the second most common cause of peripheral vertigo after benign paroxysmal positional vertigo (BPPV) and accounts for 7% of the patients who present at outpatient clinics specialising in the treatment of dizziness. The exact aetiology of the condition is unknown and the effects of corticosteroids on the condition and its recovery are uncertain. To assess the effectiveness of corticosteroids in the management of patients with idiopathic acute vestibular dysfunction (vestibular neuritis). We searched the Cochrane ENT Group Trials Register; CENTRAL; PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 28 December 2010. Randomised controlled trials comparing corticosteroids with placebo, no treatment or other active treatments, for adults diagnosed with idiopathic acute vestibular dysfunction. Two authors independently selected studies from the search results and extracted data. Three authors independently assessed risk of bias. Four trials, involving a total of 149 participants, compared the effectiveness of oral corticosteroids against placebo. All the trials were small and of low methodological quality. Although there was an overall significant effect of corticosteroids compared with placebo medication on complete caloric recovery at one month (risk ratio (RR) of 2.81; 95% confidence interval (CI) 1.32 to 6.00, P = 0.007), no significant effect was seen on complete caloric recovery at 12 months (RR 1.58; 95% CI 0.45 to 5.62, P = 0.48), or on the extent of caloric recovery at either one month (mean difference (MD) 9.60%; 95% CI -20.66 to 39.86, P = 0.53) or at 12 months (MD 6.83%; 95% CI -27.69 to 41.36, P = 0.70). In addition, there was no significant difference between corticosteroids and placebo medication in the symptomatic recovery of vestibular function following idiopathic acute vestibular dysfunction with respect to vertigo at 24 hours (RR 0.39; 95% CI 0.04 to 3.57, P = 0.40) and use of the Dizziness Handicap Inventory score at one, three, six and 12 months. Overall, there is currently insufficient evidence from these trials to support the administration of corticosteroids to patients with idiopathic acute vestibular dysfunction. We found no trials with a low risk of methodological bias that used the highest level of diagnostic criteria and outcome measures. We recommend that future studies should include health-related quality of life and symptom-based outcome measures, in addition to objective measures of vestibular improvement, such as caloric testing and electronystagmography.
BibTeX: @article{Fishman2011, author = {Fishman, Jonathan M and Burgess, Chris and Waddell, Angus}, title = {Corticosteroids for the treatment of idiopathic acute vestibular dysfunction (vestibular neuritis).}, journal = {The Cochrane database of systematic reviews}, year = {2011}, issue = {5}, pages = {CD008607}, doi = {https://doi.org/10.1002/14651858.CD008607.pub2}, keywords = {Acute Disease; Adrenal Cortex Hormones, therapeutic use; Caloric Tests; Dexamethasone, therapeutic use; Humans; Methylprednisolone, therapeutic use; Prednisolone, therapeutic use; Randomized Controlled Trials as Topic; Vertigo, etiology; Vestibular Neuronitis, complications, drug therapy}, pmid = {21563170} }
Baugh, A.D., Baugh, R.F., Atallah, J.N., Gaudin, D. and Williams, M.	Craniofacial trauma and double epidural hematomas from horse training. [Abstract] [BibTeX]	2013	International journal of surgery case reports Vol. 4(12), pp. 1149-1152	article	DOI
Abstract: A case of complex poly-trauma requiring multi-service management of rare, diagnoses is reviewed. A healthy 20 year old female suffered double epidural hematoma, base of, skull fracture, traumatic cranial nerve X palsy, benign positional paroxysmal vertigo and supraorbital, neuralgia following equestrian injury. Epidemiology, differential diagnosis, and principles of management for each condition, are reviewed. Coordinated trauma care is well suited to address the complex poly trauma following, equestrian injury.
BibTeX: @article{Baugh2013, author = {Baugh, Aaron D and Baugh, Reginald F and Atallah, Joseph N and Gaudin, Daniel and Williams, Mallory}, title = {Craniofacial trauma and double epidural hematomas from horse training.}, journal = {International journal of surgery case reports}, year = {2013}, volume = {4}, issue = {12}, pages = {1149--1152}, doi = {https://doi.org/10.1016/j.ijscr.2013.10.011}, keywords = {Arytenoid subluxation; Double epidural hematoma; Equestrian; Supraorbital neuralgia; Temporal bone fracture; Traumatic cranial nerve, Palsy}, pmid = {24291680} }
Kusunoki, T., Cureoglu, S., Schachern, P.A., Oktay, M.F., Fukushima, H. and Paparella, M.M.	Cupular deposits and aminoglycoside administration in human temporal bones. [Abstract] [BibTeX]	2005	The Journal of laryngology and otology Vol. 119(2), pp. 87-91	article	DOI
Abstract: In this study, the deposits of basophilic material on the cupula of the semicircular canals in temporal bones from patients who had aminoglycoside administration within six months prior to death were compared with normal temporal bones. Subjects were divided into two groups. Group I included 24 normal control temporal bones age-matched to group II patients. Group II consisted of 23 temporal bones that had received aminoglycosides within six months prior to death. All temporal bones were examined under light microscopy. One (4.2 per cent) of 24 temporal bones in group I (normal) showed basophilic deposits. In group II, deposits were observed in 8 (34.8 per cent) of 23 temporal bones. The prevalence of basophilic deposits in group II was significantly higher than group I. This study demonstrates that within six months after aminoglycoside administration there is an increased prevalence of basophilic deposits on the surface of the cupula. Such changes may be related to the benign paroxysmal positional vertigo (BPPV) seen in some patients who have had aminoglycoside administration.
BibTeX: @article{Kusunoki2005, author = {Kusunoki, Takeshi and Cureoglu, Sebahattin and Schachern, Patricia A and Oktay, Mehmet F and Fukushima, Hisaki and Paparella, Michael M}, title = {Cupular deposits and aminoglycoside administration in human temporal bones.}, journal = {The Journal of laryngology and otology}, year = {2005}, volume = {119}, issue = {2}, pages = {87--91}, doi = {https://doi.org/10.1258/0022215053420040}, keywords = {Adolescent; Adult; Aged; Aminoglycosides, adverse effects, pharmacology; Anti-Bacterial Agents, adverse effects, pharmacology; Basophils, pathology; Female; Humans; Male; Middle Aged; Semicircular Canals, drug effects, metabolism, pathology; Temporal Bone, drug effects, metabolism, pathology; Vertigo, chemically induced, pathology}, pmid = {15829058} }
Bockisch, C.J., Straumann, D. and Weber, K.P.	Curing a 96-year-old patient afflicted with benign paroxysmal positional vertigo on a motorized turntable. [Abstract] [BibTeX]	2014	Clinical interventions in aging Vol. 9, pp. 589-591	article	DOI
Abstract: Dizziness in the elderly is a serious health concern due to the increased morbidity caused by falling. The most common cause of dizziness in the elderly, benign paroxysmal positional vertigo (BPPV), is frequently undiagnosed, and bedside treatment of these patients can be difficult due to neck and back stiffness, which makes repeated and accurate repositioning maneuvers difficult. After a fall, a 96-year-old woman was referred by a resident neurologist for intractable BPPV. The patient was placed on a motorized turntable and repositioned to remove the calcite particles from the affected posterior semicircular canal. Video monitoring of the eyes allowed confirmation of the diagnosis, as well as an immediate evaluation of the effectiveness of the maneuver. Every patient with dizziness or imbalance, even in the absence of typical complaints of BPPV, should be tested with provocation maneuvers, because the clinical picture of BPPV is not always typical. Even if elderly patients with dizziness are very frail, the completion of provocation maneuvers is imperative, since the therapeutic maneuvers are extremely effective. A motorized turntable is very helpful to perform the repositioning accurately and safely.
BibTeX: @article{Bockisch2014, author = {Bockisch, Christopher J and Straumann, Dominik and Weber, Konrad P}, title = {Curing a 96-year-old patient afflicted with benign paroxysmal positional vertigo on a motorized turntable.}, journal = {Clinical interventions in aging}, year = {2014}, volume = {9}, pages = {589--591}, doi = {https://doi.org/10.2147/CIA.S58785}, keywords = {Accidental Falls; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, therapy; Eye Movement Measurements; Eye Movements, physiology; Female; Humans; Remission Induction, methods; Rotation; nystagmus; vertigo; vestibulo ocular reflex}, pmid = {24748776} }
Semont, A., Freyss, G. and Vitte, E.	Curing the BPPV with a liberatory maneuver. [BibTeX]	1988	Advances in oto-rhino-laryngology Vol. 42, pp. 290-293	article
BibTeX: @article{Semont1988, author = {Semont, A and Freyss, G and Vitte, E}, title = {Curing the BPPV with a liberatory maneuver.}, journal = {Advances in oto-rhino-laryngology}, year = {1988}, volume = {42}, pages = {290--293}, keywords = {Aged; Female; Humans; Male; Manipulation, Orthopedic; Middle Aged; Posture; Vertigo, therapy}, pmid = {3213745} }
Brandt, T. and Steddin, S.	Current view of the mechanism of benign paroxysmal positioning vertigo: cupulolithiasis or canalolithiasis? [Abstract] [BibTeX]	1993	Journal of vestibular research : equilibrium & orientation Vol. 3(4), pp. 373-382	article
Abstract: Theoretical evidence is presented that all the typical features of BPPV (benign paroxysmal positioning vertigo) cannot be explained by cupulolithiasis in that otoconial debris become settled on the cupula of the posterior semicircular canal. A free floating clot of inorganic particles (heavier than endolymph) in the ampullofugal branch of the posterior semicircular canal is more likely to cause the syndrome. The clot always gravitates to the most dependent part of the canal as soon as the patient's head is moved in a way that alters the angle between the canal's plane and the gravity vector. As compared to a plunger (depending on the direction it moves) the clot produces push or pull forces on the cupula, thereby eliciting the BPPV attack. This clot-induced endolymph flow mechanism is compatible with all features of BPPV such as latency, limited duration, fatigability, change in direction of the induced nystagmus, and the efficacy of physical therapy in both posterior and horizontal semicircular canal BPPV. The floating clot is only activated by changes in position of the head relative to the gravitational vector (positioning vertigo) but not by prolonged static positions of the head (positional vertigo), which fits clinical experience. Therefore, canalolithiasis rather than cupulolithiasis provides a better definition of the underlying mechanism in BPPV.
BibTeX: @article{Brandt1993, author = {Brandt, T and Steddin, S}, title = {Current view of the mechanism of benign paroxysmal positioning vertigo: cupulolithiasis or canalolithiasis?}, journal = {Journal of vestibular research : equilibrium & orientation}, year = {1993}, volume = {3}, issue = {4}, pages = {373--382}, keywords = {Endolymph, physiology; Humans; Posture; Saccule and Utricle, physiopathology; Semicircular Canals, physiopathology; Vertigo, etiology, physiopathology; Vestibular Diseases, physiopathology}, pmid = {8275271} }
Helminski, J.O., Janssen, I. and Hain, T.C.	Daily exercise does not prevent recurrence of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2008	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 29(7), pp. 976-981	article	DOI
Abstract: The purpose of this study was to analyze if a daily routine of self-canalith repositioning procedure (CRP) will increase the time to recurrence and reduce the rate of recurrence of benign paroxysmal positional vertigo (BPPV). Prospective study, nonrandomized control group. Outpatient clinic. Thirty-nine patients diagnosed with posterior canal BPPV successfully treated with the CRP. Based on a convenience sample, 17 (44%) patients were assigned to the treatment group, whereas 22 (56%) were assigned to the no-treatment group. The number of subjects lost at the time of follow-up were 5 (29.4%) of the treatment group and 2 (9%) of the no-treatment group. Patients assigned to the treatment group performed the self-CRP daily, whereas those assigned to the no-treatment group performed no exercises. Patients were followed for up to 2 years. The main outcome measures were the rate of recurrence of BPPV and the time for BPPV to recur. Of the 39 subjects, symptoms recurred in 16 (41%) of the total population, 6 (35%) of 17 of the treatment group, and 10 (46%) of 22 of the no-treatment group. There was no difference in the frequency of recurrence (Pearson chi; p = 0.522) or the time to recurrence (survival analysis; log-rank test; p = 0.242). Our results suggest that a daily routine of the self-CRP does not affect the time to recurrence and the rate of recurrence of posterior canal-BPPV.
BibTeX: @article{Helminski2008, author = {Helminski, Janet Odry and Janssen, Imke and Hain, Timothy Carl}, title = {Daily exercise does not prevent recurrence of benign paroxysmal positional vertigo.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2008}, volume = {29}, issue = {7}, pages = {976--981}, doi = {https://doi.org/10.1097/MAO.0b013e318184586d}, keywords = {Aged; Exercise; Female; Head Movements, physiology; Humans; Male; Middle Aged; Motor Activity, physiology; Movement, physiology; Posture; Recurrence; Treatment Failure; Treatment Outcome; Vertigo, diagnosis, physiopathology, prevention & control}, pmid = {18698271} }
Nakahara, H., Yoshimura, E., Tsuda, Y. and Murofushi, T.	Damaged utricular function clarified by oVEMP in patients with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2013	Acta oto-laryngologica Vol. 133(2), pp. 144-149	article	DOI
Abstract: Utricular dysfunction in patients with posterior canal benign paroxysmal positional vertigo (pBPPV) was supported by findings for ocular vestibular evoked myogenic potential (oVEMP). To evaluate the utricular and saccular function in patients with pBPPV. This study focused on 12 patients definitively diagnosed with pBPPV showing typical nystagmus by Dix-Hallpike maneuver and 12 controls. In these subjects, oVEMPs and cVEMPs to air-conducted 500 Hz tone burst (125 dB SPL) were measured. The patients also underwent caloric tests. More of the patients with pBPPV showed abnormal responses in oVEMPs by stimulation on their affected side than the controls, while the results of cVEMPs showed no significant differences between pBPPV patients and controls. The abnormal results for oVEMPs on the affected side showed a higher percentage than those for cVEMPs and caloric tests in pBPPV patients. There was no significant association between any of the tests. These findings support the possibility that oVEMP reflects the specific abnormal condition in pBPPV, i.e. that the urticular function in pBPPV patients was highly damaged.
BibTeX: @article{Nakahara2013, author = {Nakahara, Haruka and Yoshimura, Eriko and Tsuda, Yukiko and Murofushi, Toshihisa}, title = {Damaged utricular function clarified by oVEMP in patients with benign paroxysmal positional vertigo.}, journal = {Acta oto-laryngologica}, year = {2013}, volume = {133}, issue = {2}, pages = {144--149}, doi = {https://doi.org/10.3109/00016489.2012.720030}, keywords = {Acoustic Stimulation, methods; Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Saccule and Utricle, physiopathology; Vertigo, diagnosis, physiopathology; Vestibular Evoked Myogenic Potentials, physiology; Vestibular Function Tests}, pmid = {22992120} }
Deng, W., Yang, C., Xiong, M., Fu, X., Lai, H. and Huang, W.	Danhong enhances recovery from residual dizziness after successful repositioning treatment in patients with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2014	American journal of otolaryngology Vol. 35(6), pp. 753-757	article	DOI
Abstract: Although the repositioning maneuvers are usually very effective in patients with BPPV, some patients still complain residual dizziness. Danhong injection (DHI), a traditional Chinese medicine, can effectively dilate blood vessels and improve microcirculation, and has been proven to be effective in improving cervical vertigo and posterior circulation ischemic vertigo. The aim of this study was to evaluate the effects of DHI on residual dizziness after successful repositioning treatment in patients with BPPV. Eighty-six patients with BPPV were randomized into two treatment groups, DHI group and non DHI group. The DHI group received the same repositioning treatment as the non-DHI group, with the addition of DHI therapy. The durations of residual dizziness of DHI group and non-DHI group were compared. In addition, the scores of the dizziness handicap inventory of these two groups were calculated. The durations of residual dizziness of DHI group were shorter than that of non-DHI group. There were no significant differences in the scores of dizziness handicap inventory in the first week between these two groups, and there were much significant differences in the second, the fourth, the sixth and eighth weeks. The results demonstrate that DHI can significantly improve the residual dizziness after successful repositioning treatment in patients with BPPV.
BibTeX: @article{Deng2014, author = {Deng, Wenting and Yang, Chuanhong and Xiong, Min and Fu, Xiaoyan and Lai, Huangwen and Huang, Weiyi}, title = {Danhong enhances recovery from residual dizziness after successful repositioning treatment in patients with benign paroxysmal positional vertigo.}, journal = {American journal of otolaryngology}, year = {2014}, volume = {35}, issue = {6}, pages = {753--757}, doi = {https://doi.org/10.1016/j.amjoto.2014.07.001}, keywords = {Adult; Benign Paroxysmal Positional Vertigo, physiopathology, therapy; Dizziness, drug therapy; Double-Blind Method; Drugs, Chinese Herbal, therapeutic use; Female; Humans; Male; Middle Aged; Movement, physiology; Otolithic Membrane, physiopathology; Patient Positioning; Prospective Studies}, pmid = {25146349} }
Jeong, S.-H., Kim, J.-S., Shin, J.W., Kim, S., Lee, H., Lee, A.Y., Kim, J.-M., Jo, H., Song, J. and Ghim, Y.	Decreased serum vitamin D in idiopathic benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2013	Journal of neurology Vol. 260(3), pp. 832-838	article	DOI
Abstract: Previous studies have demonstrated an association of osteopenia/osteoporosis with idiopathic benign paroxysmal positional vertigo (BPPV). Since vitamin D takes part in the regulation of calcium and phosphorus found in the body and plays an important role in maintaining proper bone structure, decreased bone mineral density in patients with BPPV may be related to decreased serum vitamin D. We measured the serum levels of 25-hydroxyvitamin D in 100 patients (63 women and 37 men, mean age ± SD = 61.8 ± 11.6) with idiopathic BPPV and compared the data with those of 192 controls (101 women and 91 men, mean age ± SD = 60.3 ± 11.3) who had lived in the same community without dizziness or imbalance during the preceding year. The selection of the controls and acquisition of clinical information were done using the data from the Fourth Korean National Health and Nutrition Examination Survey, 2008. The serum level of 25-hydroxyvitamin D was lower in the patients with BPPV than in the controls (mean ± SD = 14.4 ± 8.4 versus 19.1 ± 6.8 ng/ml, p = 0.001). Furthermore, patients with BPPV showed a higher prevalence of decreased serum vitamin D (<20 ng/ml, 80.0 vs. 60.1 %, p < 0.001) than the controls. Multiple logistic regression analyses adjusted for age, sex, body mass index, hypertension, diabetes, proteinuria, regular exercise and the existence of decreased bone mineral density demonstrated that vitamin D insufficiency (10-20 ng/ml) and deficiency (<10 ng/ml) were associated with BPPV with the odds ratios of 3.8 (95 % confidence interval = 1.51-9.38, p = 0.004) and 23.0 (95 % confidence interval = 6.88-77.05, p < 0.001). Our study demonstrated an association between idiopathic BPPV and decreased serum vitamin D. Decreased serum vitamin D may be a risk factor of BPPV.
BibTeX: @article{Jeong2013, author = {Jeong, Seong-Hae and Kim, Ji-Soo and Shin, Jong Wook and Kim, Sungbo and Lee, Hajeong and Lee, Ae Young and Kim, Jae-Moon and Jo, Hyunjin and Song, Junghan and Ghim, Yuna}, title = {Decreased serum vitamin D in idiopathic benign paroxysmal positional vertigo.}, journal = {Journal of neurology}, year = {2013}, volume = {260}, issue = {3}, pages = {832--838}, doi = {https://doi.org/10.1007/s00415-012-6712-2}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Biomarkers, blood; Female; Humans; Male; Middle Aged; Vertigo, blood, diagnosis, epidemiology; Vitamin D, blood; Vitamin D Deficiency, blood, diagnosis, epidemiology}, pmid = {23096068} }
Arshad, M., Abbas, S. and Qureshi, I.A.	Delay in diagnosis and treatment of benign paroxysmal positional vertigo in current practice. [Abstract] [BibTeX]	2013	Journal of Ayub Medical College, Abbottabad : JAMC Vol. 25(1-2), pp. 93-95	article
Abstract: More than 50% of the patients with peripheral vestibular disorders are suffering from Benign Paroxysmal Positional Vertigo (BPPV). Diagnosis is established by positive Dix-Halpike test and/or roll test. Objective of this study was to analyse the delay in diagnosis and treatment of BPPV in current practice and to suggest measures to avoid this delay. One hundred and fifty two consecutive patients who were diagnosed and treated for BPPV in ENT department CMH Rawalpindi from Jan 2009 to Sep 2011 were selected for this study. All these patients were interviewed in detail regarding duration of vertigo, associated symptoms, visits to hospitals, investigations, treatment taken, cost of treatment and last or referral diagnosis before coming to our department. Out of 458 patients who presented with vertigo, 152 (33.2%) fulfilled the diagnostic criteria of BPPV. Male to female ratio was 1:1.17. Age range was 13-80 years and mean age 58.2 +/- 12.6. Posterior canal was affected in 96.7% and lateral canal in only 3.3%. Average duration between onset of first symptoms and diagnostic positional test was 19 months. One hundred and thirty eight patients have been visiting to general practitioners, various specialists, Homeopaths and Hakeems. Only 21% patients had visited to ENT specialists. 15.2% patients were already labelled correct diagnosis mostly by ENT specialists but Halpike test was done only in 8 patients and Epley's manoeuvre was tried in only four patients. 16.4% patients had undergone costly investigations like CT scan and MRI. Average cost on treatment before final diagnosis was Rs. 13,500 per patient. Particle repositioning procedure was successful in 84% patients in first attempt and 96% in two attempts. Though BPPV is a common and easily treatable condition, its diagnosis and treatment is delayed because of lack of awareness of this condition among doctors and patients. Clear understanding of the patho-physiology, diagnostic positional tests and canalith repositioning manoeuvre should be achieved through lectures and demonstrations.
BibTeX: @article{Arshad2013, author = {Arshad, Muhammad and Abbas, Shujaat and Qureshi, Ishaq Ahmad}, title = {Delay in diagnosis and treatment of benign paroxysmal positional vertigo in current practice.}, journal = {Journal of Ayub Medical College, Abbottabad : JAMC}, year = {2013}, volume = {25}, issue = {1-2}, pages = {93--95}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Delayed Diagnosis; Female; Humans; Male; Middle Aged; Physical Therapy Modalities; Unnecessary Procedures, statistics & numerical data; Vertigo, diagnosis, therapy; Young Adult}, pmid = {25098065} }
Wang, H., Yu, D., Song, N., Su, K. and Yin, S.	Delayed diagnosis and treatment of benign paroxysmal positional vertigo associated with current practice. [Abstract] [BibTeX]	2014	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 271(2), pp. 261-264	article	DOI
Abstract: The purposes of this study were to demonstrate the current status of benign paroxysmal positional vertigo (BPPV) management and the advantages of repositioning maneuvers as well as to facilitate the accurate and efficient diagnosis and management of BPPV. Of 131 participants with severe dizziness/vertigo who were examined and treated, 31 (23.7%) fulfilled the diagnostic criteria for BPPV. All patients in the study had a diagnosis of BPPV confirmed by their history, typical subjective symptom reports, and characteristic positional nystagmus during the Dix-Hallpike test and/or roll test. All participants were comprehensively interviewed regarding their medical history, characteristics of the first attack of vertigo, associated symptoms, previous financial costs, and number of hospital visits. The average duration from the appearance of the first symptoms until a final diagnostic positional maneuver was >70 months. On average, patients visited hospitals more than eight times before the final diagnosis due to initial visits to inappropriate departments, including neurology, emergency, orthopaedic surgery, and Traditional Chinese Medicine, with a corresponding average financial cost of more than 5,000 RMB. The canalith repositioning procedure (CRP) was effective in 80.65% of patients after the first repositioning maneuver. Our data demonstrated that despite the significant prevalence of BPPV, delays in diagnosis and treatment frequently occur, which have both cost and quality-of-life impacts on both patients and their caregivers. The CRP is very effective for patients with BPPV. It is important for patients to pay more attention to the impact of BPPV on their lives and recognize its nature to ensure compliant follow-up in otolaryngology.
BibTeX: @article{Wang2014b, author = {Wang, Hui and Yu, Dongzhen and Song, Ningying and Su, Kaiming and Yin, Shankai}, title = {Delayed diagnosis and treatment of benign paroxysmal positional vertigo associated with current practice.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2014}, volume = {271}, issue = {2}, pages = {261--264}, doi = {https://doi.org/10.1007/s00405-012-2333-8}, keywords = {Benign Paroxysmal Positional Vertigo; Delayed Diagnosis, economics, statistics & numerical data; Female; Health Services, economics, statistics & numerical data; Humans; Male; Middle Aged; Patient Positioning, methods; Time-to-Treatment, statistics & numerical data; Vertigo, diagnosis, economics, therapy}, pmid = {23455578} }
Yetiser, S. and Ince, D.	Demographic analysis of benign paroxysmal positional vertigo as a common public health problem. [Abstract] [BibTeX]	2015	Annals of medical and health sciences research Vol. 5(1), pp. 50-53	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular problem. However, demographic analysis is few. The aim of this study was to document the demographic data of patients with BPPV regarding distribution of gender, age, associated problems, most common form, symptom duration, severity of nystagmus and cure rate. A total of 263 patients with video-nystagmography confirmed BPPV were enrolled in this retrospective study (2009-2013). The data were collected in Anadolu Medical Center. Distribution of gender, age and affected side were reviewed. Associated problems were noted. Patients were analyzed according to the canal involvement, age, duration of symptoms, duration of nystagmus and recurrence. Mean values and standard deviations were calculated. One-way ANOVA test was used for the analysis of the data (Statistical Package for the Social Sciences 17.0 version, IBM, Chicago, III, USA). Statistical significance was set at P < 0.05. Women were affected more frequently than men (1:1.5). Comparative analysis of average age between the two gender groups was not statistically significant (P = 0.84). BPPV was common at middle age group. The incidence of affected side was not significant (P = 0.74). Posterior canal-BPPV (PC-BPPV) was the most leading one (129/263; 49%) followed by lateral canal (LC)-canalolithiasis (60/263; 22.8%), LC-cupulolithiasis (38/263; 14.5%) and superior canal-BPPV (9/263; 3.4%). 55.1% of patients were defined as idiopathic (145/263). Associated problems were migraine (31/263; 11.8%), trauma (19/263; 7.2%), inner ear disorders (18/263; 6.8%) and other systemic problems (50/263; 19.1%). 72.6% of patients had symptoms <2 months (191/263). 23,6% of patients had intensive nystagmus lasting more than a minute regardless of canal involvement (62/263). 33% of patients required two or more maneuvers for the relief of symptoms (87/263). Symptoms are prone to recur in those of traumatic origin, associated inner ear problems and systemic disorders. As the prognostic factors are illuminated, preventive measures will be more effective and more patients will be cured properly.
BibTeX: @article{Yetiser2015c, author = {Yetiser, S and Ince, D}, title = {Demographic analysis of benign paroxysmal positional vertigo as a common public health problem.}, journal = {Annals of medical and health sciences research}, year = {2015}, volume = {5}, issue = {1}, pages = {50--53}, doi = {https://doi.org/10.4103/2141-9248.149788}, keywords = {Benign paroxysmal positional vertigo; Nystagmus; Semicircular canal}, pmid = {25745577} }
Walther, L.E., Wenzel, A., Buder, J., Bloching, M.B., Kniep, R. and Blödow, A.	Detection of human utricular otoconia degeneration in vital specimen and implications for benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2014	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 271(12), pp. 3133-3138	article	DOI
Abstract: Otoconia are assumed to be involved in inner ear disorders such as benign paroxysmal positional vertigo (BPPV). Up to now, the distinct structure and morphology of intact and degenerate human utricular otoconia has been only poorly investigated on vital specimen. In this study, human otoconia were obtained from the utricle in five patients undergoing translabyrinthine vestibular schwannoma surgery. Specimens were examined by environmental scanning electron microscopy. Intact and degenerate otoconia as well as fracture particles of otoconia and bone were analyzed by energy dispersive X-ray microanalysis (EDX) and powder X-ray diffraction (XRD). Intact otoconia reveal a uniform size showing characteristic symmetry properties. Degenerative changes can be observed at several stages with gradual minor and major changes in their morphology including fragment formation. EDX analyses reveal the characteristic chemical composition also for otoconia remnants. XRD shows that intact and degenerate otoconia as well as remnants consist of the calcite modification. In conclusion, electron microscopy serves as a standard method for morphological investigations of otoconia. Human utricular otoconia show a uniform outer morphology corresponding to a calcite-based nanocomposite. Morphological changes provide further evidence for degeneration of utricular otoconia in humans, which might be a preconditioning factor causing BPPV. In case of uncertain origin, particles can be clearly assigned to otoconial origin using EDX and XRD analyses.
BibTeX: @article{Walther2014b, author = {Walther, Leif Erik and Wenzel, Angela and Buder, Jana and Bloching, Marc Boris and Kniep, Rüdiger and Blödow, Alexander}, title = {Detection of human utricular otoconia degeneration in vital specimen and implications for benign paroxysmal positional vertigo.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2014}, volume = {271}, issue = {12}, pages = {3133--3138}, doi = {https://doi.org/10.1007/s00405-013-2784-6}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis, etiology; Crystallography, X-Ray, methods; Female; Humans; Male; Microscopy, Electron, Scanning; Middle Aged; Neuroma, Acoustic, complications, pathology; Otolithic Membrane, diagnostic imaging, ultrastructure; Radiography; Reproducibility of Results; Saccule and Utricle, pathology, ultrastructure}, pmid = {24170182} }
Seo, T., Saka, N., Ohta, S. and Sakagami, M.	Detection of utricular dysfunction using ocular vestibular evoked myogenic potential in patients with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2013	Neuroscience letters Vol. 550, pp. 12-16	article	DOI
Abstract: The ocular vestibular evoked myogenic potential (oVEMP) is thought to originate from the contralateral utricular organ. However, the clinical use of oVEMP has not yet been established. This study aimed to clarify whether oVEMP could be used to detect utricular dysfunction in patients with benign paroxysmal positional vertigo (BPPV). Sixteen patients with BPPV underwent oVEMP measurements. Recordings were made on 2 separate occasions: when typical nystagmus was confirmed (pretreatment oVEMP) and 1 week after performing Epley's maneuver (posttreatment oVEMP). Results were evaluated using the asymmetry ratio (AR) of n1-p1 wave peak-to-peak amplitude and defined as reduced oVEMP when AR was >31.6%, or augmented oVEMP when AR was <-31.6%. Bilateral responses were recorded in 13 patients on the pretreatment oVEMP. Abnormal results were found in 11 patients (84.5%). These included 5 patients with reduced response and 6 with augmented response. On the posttreatment oVEMP, abnormal results were found in 5 patients (38.5%). All indicated reduced oVEMP. Abnormal results on the pretreatment oVEMP were not related to any persistent positional vertigo (p>0.05, Fisher's exact test). Three out of 4 patients (75.0%) with continuing unsteadiness had abnormal results (reduced response) on the posttreatment oVEMP. The oVEMP measurements indicated abnormal function of the utricle in patients with BPPV. Reduced oVEMP is thought to originate from the partial degeneration of utricular hair cells. Conversely, augmented oVEMP in the affected ear is thought to originate from a hypermobility of the stereocilia due to the detachment of otoconia within the utricle. The above-mentioned utricular dysfunction should be independent of the existence of otoconia in the semicircular canal; thus, the results of oVEMP were not related to the recovery of symptoms. oVEMP can be reliably used to detect utricular lesions in patients with BPPV.
BibTeX: @article{Seo2013, author = {Seo, Toru and Saka, Naoki and Ohta, Shigeto and Sakagami, Masafumi}, title = {Detection of utricular dysfunction using ocular vestibular evoked myogenic potential in patients with benign paroxysmal positional vertigo.}, journal = {Neuroscience letters}, year = {2013}, volume = {550}, pages = {12--16}, doi = {https://doi.org/10.1016/j.neulet.2013.06.041}, keywords = {Adult; Benign Paroxysmal Positional Vertigo; Female; Humans; Male; Middle Aged; Posture, physiology; Saccule and Utricle, physiopathology; Vertigo, physiopathology; Vestibular Evoked Myogenic Potentials, physiology; Vestibular Function Tests; Benign paroxysmal positional vertigo; Ocular vestibular evoked myogenic potential; Utricle}, pmid = {23827225} }
Obrist, D., Nienhaus, A., Zamaro, E., Kalla, R., Mantokoudis, G. and Strupp, M.	Determinants for a Successful Sémont Maneuver: An , javax.xml.bind.JAXBElement@560244a1, Study with a Semicircular Canal Model. [Abstract] [BibTeX]	2016	Frontiers in neurology Vol. 7, pp. 150	article	DOI
Abstract: To evaluate the effect of time between the movements/steps, angle of body movements as well as the angular velocity of the maneuvers in an model of a semicircular canal (SCC) to improve the efficacy of the Sémont maneuver (SM) in benign paroxysmal positional vertigo. Sémont maneuvers were performed on an SCC model. Otoconia trajectories were captured by a video camera. The effects of time between the movements, angles of motion (0°, 10°, 20°, and 30° below the horizontal line), different angular velocities (90, 135, 180°/s), and otoconia size (36 and 50 μm) on the final position of the otoconia in the SCC were tested. Without extension of the movements beyond the horizontal, the experiments (with particles corresponding to 50 μm diameter) did not yield successful canalith repositioning. If the movements were extended by 20° beyond the horizontal position, SM were successful with resting times of at least 16 s. For larger extension angles, the required time decreased. However, for smaller particles (36 μm), the required time doubled. The angular maneuver velocity (tested between 90 and 180°/s) did not have a major impact on the final position of the otoconia. The two primary determinants for success of the SM are the time between the movements and the extension of the movements beyond the horizontal. The time between the movements should be at least 45 s. Angles of 20° or more below horizontal line (so-called Sémont+) should increase the success rate of SM.
BibTeX: @article{Obrist2016, author = {Obrist, Dominik and Nienhaus, Andrea and Zamaro, Ewa and Kalla, Roger and Mantokoudis, Georgios and Strupp, Michael}, title = {Determinants for a Successful Sémont Maneuver: An , javax.xml.bind.JAXBElement@560244a1, Study with a Semicircular Canal Model.}, journal = {Frontiers in neurology}, year = {2016}, volume = {7}, pages = {150}, doi = {https://doi.org/10.3389/fneur.2016.00150}, keywords = {BPPV; Sémont liberatory maneuver; canalolithiasis; semicircular canal; vertigo}, pmid = {27695437} }
Tabanfar, R., Chan, H.H.L., Lin, V., Le, T. and Irish, J.C.	Development and face validation of a Virtual Reality Epley Maneuver System (VREMS) for home Epley treatment of benign paroxysmal positional vertigo: A randomized, controlled trial. [Abstract] [BibTeX]	2018	American journal of otolaryngology Vol. 39(2), pp. 184-191	article	DOI
Abstract: To develop and validate a smartphone based Virtual Reality Epley Maneuver System (VREMS) for home use. A smartphone application was designed to produce stereoscopic views of a Virtual Reality (VR) environment, which when viewed after placing a smartphone in a virtual reality headset, allowed the user to be guided step-by-step through the Epley maneuver in a VR environment. Twenty healthy participants were recruited and randomized to undergo either assisted Epleys or self-administered Epleys following reading instructions from an Instructional Handout (IH). All participants were filmed and two expert Otologists reviewed the videos, assigning each participant a score (out of 10) for performance on each step. Participants rated their perceived workload by completing a validated task-load questionnaire (NASA Task Load Index) and averages for both groups were calculated. Twenty participants were evaluated with average age 26.4±7.12years old in the VREMS group and 26.1±7.72 in the IH group. The VR assisted group achieved an average score of 7.78±0.99 compared to 6.65±1.72 in the IH group. This result was statistically significant with p=0.0001 and side dominance did not appear to play a factor. Analyzing each step of the Epley maneuver demonstrated that assisted Epleys were done more accurately with statically significant results in steps 2-4. Results of the NASA-TLX scores were variable with no significant findings. We have developed and demonstrated face validity for VREMS through our randomized controlled trial. The VREMS platform is promising technology, which may improve the accuracy and effectiveness of home Epley treatments. N/A.
BibTeX: @article{Tabanfar2018, author = {Tabanfar, Reza and Chan, Harley H L and Lin, Vincent and Le, Trung and Irish, Jonathan C}, title = {Development and face validation of a Virtual Reality Epley Maneuver System (VREMS) for home Epley treatment of benign paroxysmal positional vertigo: A randomized, controlled trial.}, journal = {American journal of otolaryngology}, year = {2018}, volume = {39}, issue = {2}, pages = {184--191}, doi = {https://doi.org/10.1016/j.amjoto.2017.11.006}, keywords = {Adult; Benign Paroxysmal Positional Vertigo, physiopathology, therapy; Equipment Design; Facial Recognition, physiology; Female; Humans; Male; Patient Positioning, methods; Physical Therapy Modalities, instrumentation; Posture, physiology; Smartphone; Treatment Outcome; Virtual Reality; BPPV; Epley maneuver; Virtual reality}, pmid = {29169952} }
Jacobson, G.P., Piker, E.G., Hatton, K., Watford, K.E., Trone, T., McCaslin, D.L., Bennett, M.L., Rivas, A., Haynes, D.S. and Roberts, R.A.	Development and Preliminary Findings of the Dizziness Symptom Profile. [Abstract] [BibTeX]	2018	Ear and hearing	article	DOI
Abstract: Dizziness, vertigo, and unsteadiness are common complaints of patients who present to primary care providers. These patients often are referred to otology for assessment and management. Unfortunately, there are a small number of specialists to manage these patients. However, there are several dizziness disorders that can be successfully managed by primary care providers if the disorder is properly identified. To assist in the identification of several of the most common dizziness disorders, we developed the dizziness symptom profile (DSP). The DSP is a self-report questionnaire designed to generate one or more differential diagnoses that can be combined with the patient's case history and physical examination. This report describes three investigations. Investigations 1 and 2 (i.e., exploratory and confirmatory investigations, N = 514) describe the development of the DSP. Investigation 3 (N = 195) is a validation study that describes the level of agreement between the DSP completed by the patient, and, the differential diagnosis of the otologist. The final version of the DSP consists of 31 items. Preliminary findings suggest that the DSP is in agreement with the differential diagnoses of ear specialists for Meniere's disease (100% agreement), vestibular migraine (95% agreement), and benign paroxysmal positional vertigo (82% agreement). Early results suggest that DSP may be useful in the creation of differential diagnoses for dizzy patients that can be evaluated and managed locally. This has the potential to reduce the burden on primary care providers and reduce delays in the diagnosis of common dizziness and vertigo disorders.
BibTeX: @article{Jacobson2018, author = {Jacobson, Gary P and Piker, Erin G and Hatton, Kelsey and Watford, Kenneth E and Trone, Timothy and McCaslin, Devin L and Bennett, Marc L and Rivas, Alejandro and Haynes, David S and Roberts, Richard A}, title = {Development and Preliminary Findings of the Dizziness Symptom Profile.}, journal = {Ear and hearing}, year = {2018}, doi = {https://doi.org/10.1097/AUD.0000000000000628}, pmid = {29979254} }
Yang, C.J., Lee, J.-W., Kim, S.-J., Lee, C.-W. and Park, H.J.	Development of a murine model of traumatic benign paroxysmal positional vertigo: a preliminary study. [Abstract] [BibTeX]	2017	Acta oto-laryngologica Vol. 137(1), pp. 29-34	article	DOI
Abstract: The results showed a gradual detachment of otoconia in the utricle after a single event of head vibration, possibly explaining the frequent recurrence of BPPV attacks and persistent dizziness after trauma. This study developed a murine model of traumatic BPPV and observed the changes in otoconia detachment over time. Six-week-old CBA mice were used in this study. Otoconia detachment was induced by vibrating the head for 2 min. Utricles of mice were harvested from different groups: before the head vibration and 1 day, 1 week, 1 month, and 3 months after vibration application. Using scanning electron microscopy and ImageJ software, the percentage of the intact area of otoconia in the utricle was calculated. Hearing thresholds were compared among the groups. The mean (± SD) percentages of the intact area of otoconia in the utricle were 98.1% ± 1.7% before the vibration and 93.6% ± 1.7%, 88.9% ± 5.3%, 78.2% ± 20.9%, and 38.9% ± 24.1% at 1 day, 1 week, 1 month, and 3 months after the vibration, respectively. The percentage decreased significantly over time after the vibration (p < .001). The hearing thresholds were not different among the groups.
BibTeX: @article{Yang2017a, author = {Yang, Chan Joo and Lee, Ji-Won and Kim, Sung-Jin and Lee, Chang-Whan and Park, Hong Ju}, title = {Development of a murine model of traumatic benign paroxysmal positional vertigo: a preliminary study.}, journal = {Acta oto-laryngologica}, year = {2017}, volume = {137}, issue = {1}, pages = {29--34}, doi = {https://doi.org/10.1080/00016489.2016.1217043}, keywords = {Animals; Auditory Threshold; Benign Paroxysmal Positional Vertigo; Disease Models, Animal; Male; Mice, Inbred CBA; Otolithic Membrane, pathology; Vibration; Benign paroxysmal positional vertigo; murine model; otoconia}, pmid = {27564837} }
Kasbekar, A.V., Mullin, N., Morrow, C., Youssef, A.M., Kay, T. and Lesser, T.H.	Development of a physiotherapy-led balance clinic: the Aintree model. [Abstract] [BibTeX]	2014	The Journal of laryngology and otology Vol. 128(11), pp. 966-971	article	DOI
Abstract: To create a 'one-stop' clinic in which assessment, diagnosis, treatment and therapies for most patients presenting with balance and dizziness disorders are delivered simultaneously. Patients triaged via referral letters were selected to attend the balance clinic, which is led by specialist balance physiotherapists. Patients were seen by an audiologist, and a 'balance' ENT consultant was available for joint consultations when required. Further details of the clinic set up are discussed. Over an 18-month period, 200 new 'dizzy' patients attended the clinic. Benign paroxysmal positional vertigo and labyrinthitis were the commonest diagnoses. Fifty per cent of all patients were discharged after a single clinic visit. Questionnaires showed that patient satisfaction was high. The physiotherapy-led balance clinic has reduced patient waiting times to be seen, has a high level of patient satisfaction and is economically beneficial.
BibTeX: @article{Kasbekar2014, author = {Kasbekar, A V and Mullin, N and Morrow, C and Youssef, A M and Kay, T and Lesser, T H}, title = {Development of a physiotherapy-led balance clinic: the Aintree model.}, journal = {The Journal of laryngology and otology}, year = {2014}, volume = {128}, issue = {11}, pages = {966--971}, doi = {https://doi.org/10.1017/S0022215114002060}, keywords = {Aged; Ambulatory Care Facilities, organization & administration; Diagnostic Techniques, Otological; Dizziness, diagnosis, rehabilitation; Female; Humans; Male; Middle Aged; Patient Satisfaction; Physical Therapy Modalities, organization & administration; Vertigo, diagnosis, rehabilitation}, pmid = {25311108} }
Friedland, D.R., Tarima, S., Erbe, C. and Miles, A.	Development of a Statistical Model for the Prediction of Common Vestibular Diagnoses. [Abstract] [BibTeX]	2016	JAMA otolaryngology-- head & neck surgery Vol. 142(4), pp. 351-356	article	DOI
Abstract: Treatment of patients with vestibular disorders can be complex, requires lengthy clinic visit time, and uses greater clinical resources for diagnosis. A pre-encounter intake questionnaire may predict the most common disorders, allowing for more efficient allocation of resources and use of clinicians. To develop a statistical model for predicting vestibular diagnoses, prior to clinical evaluation, from an intake questionnaire. Retrospective review of 414 consecutive new vestibular patient intake questionnaires (September 2012 through January 2014) and associated medical records with performance of logistic regression analyses and development of predictive models (July 2013 through May 2015). Use of a vestibular intake questionnaire for triaging of new patients with complaints of dizziness. Predictors for the diagnosis of benign paroxysmal positional vertigo (BPPV), Ménière's disease, and vestibular migraine. Of the 414 questionnaires analyzed, 381 (92%) had clinician information necessary to define a final diagnosis. Patients were 34% male and had a mean (range) age of 57 (19-91) years. Of the diagnoses, 183 (48%) were ear related (including 103 BPPV and 49 Meniere's disease), 141 (37%) neurological (including 109 vestibular migraine), 36 (9%) medical, 8 (2%) of psychological origin, 46 (12%) of unknown etiology, and 33 (9%) other causes. The diagnosis of BPPV could be predicted from 4 variables with a sensitivity of 79% and specificity of 65%. The diagnosis of Ménière's disease could be predicted from 5 variables with a sensitivity of 81% and specificity of 85%. The diagnosis of vestibular migraine could be predicted from 4 variables with a sensitivity of 76% and specificity of 59%. A pre-encounter history questionnaire can provide useful diagnostic information for common vestibular disorders. This can help direct appointment scheduling to improve clinical efficiency, time to intervention, and use of resources. Further refinement may enable the use of shorter questionnaires or screening algorithms.
BibTeX: @article{Friedland2016, author = {Friedland, David R and Tarima, Sergey and Erbe, Christy and Miles, Alexia}, title = {Development of a Statistical Model for the Prediction of Common Vestibular Diagnoses.}, journal = {JAMA otolaryngology-- head & neck surgery}, year = {2016}, volume = {142}, issue = {4}, pages = {351--356}, doi = {https://doi.org/10.1001/jamaoto.2015.3663}, keywords = {Adult; Aged; Aged, 80 and over; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Models, Statistical; Predictive Value of Tests; Surveys and Questionnaires; Vestibular Diseases, diagnosis; Vestibular Function Tests, statistics & numerical data; Young Adult}, pmid = {26913615} }
Cohen, H.S. and Kimball, K.T.	Development of the vestibular disorders activities of daily living scale. [Abstract] [BibTeX]	2000	Archives of otolaryngology--head & neck surgery Vol. 126(7), pp. 881-887	article
Abstract: Existing scales of self-perceived disablement in patients with vestibular impairment either are too broad to detect the subtle deficits in this population or omit some important daily life tasks. To develop a scale to assess self-perceived disablement in patients with vestibular impairment and to describe the development and initial testing of this new assessment tool. A list of items was developed, sent to a panel of expert therapists for review, and then revised to yield the preliminary 31-item, 10-point scale that was administered to subjects. The scale was revised again, yielding the final 28-item scale, which was administered to a new group of subjects. Data were collected from patients in an outpatient clinic of a tertiary care center. Patients diagnosed as having benign paroxysmal positional vertigo and patients diagnosed as having chronic vestibulopathy, excluding Ménière disease, postsurgical vertigo, and postconcussion vertigo. The final scale has 3 subscales: functional, ambulation, and instrumental. It has good face validity, high internal consistency (alpha> or =.90), and high test-retest reliability (r(c)> or =0.87). Scale ratings ranged from 1 (independent) to 10 (ceasing to participate in the activity), but median scores for most subjects were 4 or less. From 41% (39/94) to 44% (41/94) of subjects considered themselves to be independent on those tasks. This scale has good face validity, high internal consistency, and high test-retest reliability. It may be useful for evaluating functional limitation and perceived handicap or disability before and after intervention and for helping patients become more realistic in understanding their own capabilities.
BibTeX: @article{Cohen2000a, author = {Cohen, H S and Kimball, K T}, title = {Development of the vestibular disorders activities of daily living scale.}, journal = {Archives of otolaryngology--head & neck surgery}, year = {2000}, volume = {126}, issue = {7}, pages = {881--887}, keywords = {Activities of Daily Living; Adult; Aged; Aged, 80 and over; Humans; Middle Aged; Vestibular Diseases, physiopathology}, pmid = {10889001} }
O'Reilly, R., Grindle, C., Zwicky, E.F. and Morlet, T.	Development of the vestibular system and balance function: differential diagnosis in the pediatric population. [Abstract] [BibTeX]	2011	Otolaryngologic clinics of North America Vol. 44(2), pp. 251-71, vii	article	DOI
Abstract: Dizziness is a rare complaint among children. In this article, the authors present the embryology and development of the vestibular system, and offer a rational approach to taking a careful history and ordering and interpreting appropriate vestibular and balance testing in children. A differential diagnosis is presented, so that the likely cause of the balance disorder can be elucidated even in the most complex pediatric patients.
BibTeX: @article{OReilly2011, author = {O'Reilly, Robert and Grindle, Chris and Zwicky, Emily F and Morlet, Thierry}, title = {Development of the vestibular system and balance function: differential diagnosis in the pediatric population.}, journal = {Otolaryngologic clinics of North America}, year = {2011}, volume = {44}, issue = {2}, pages = {251--71, vii}, doi = {https://doi.org/10.1016/j.otc.2011.01.001}, keywords = {Benign Paroxysmal Positional Vertigo; Child; Diagnosis, Differential; Ear, Inner, embryology; Humans; Physical Examination; Postural Balance, physiology; Proprioception, physiology; Reflex, Vestibulo-Ocular, physiology; Vertigo, diagnosis, physiopathology; Vestibular Evoked Myogenic Potentials, physiology; Vestibule, Labyrinth, innervation, physiology, physiopathology}, pmid = {21474003} }
Kovar, M., Jepson, T. and Jones, S.	Diagnosing and treating benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2006	Journal of gerontological nursing Vol. 32(12), pp. 22-7; quiz 28-9	article
Abstract: Gerontological nurses play a critical role in the early recognition of benign paroxysmal positional vertigo (BPPV), a condition that accounts for approximately 50% of vertigo in older adults. BPPV results in vertigo when debris collects in one or more of the semicircular canals, most typically the posterior canal. It may be differentiated from other forms of vertigo because it results in dizziness when recumbent or with head position changes. BPPV may be successfully treated with repositioning therapy, such as the Epley maneuver. Nurses working in medical offices, longterm care facilities, and assisted living may be called on to perform this maneuver. Gerontological nurses play a key role in assessing and treating BPPV, therefore minimizing unnecessary testing and medication and reducing the suffering and expense for patients with this condition.
BibTeX: @article{Kovar2006, author = {Kovar, Mary and Jepson, Terry and Jones, Susan}, title = {Diagnosing and treating benign paroxysmal positional vertigo.}, journal = {Journal of gerontological nursing}, year = {2006}, volume = {32}, issue = {12}, pages = {22--7; quiz 28-9}, keywords = {Aged; Aged, 80 and over; Dizziness, diagnosis, etiology, nursing, rehabilitation; Female; Humans; Physical Examination; Physical Therapy Modalities; Vertigo, diagnosis, etiology, nursing, rehabilitation}, pmid = {17190403} }
Lee, A.T.H.	Diagnosing the cause of vertigo: a practical approach. [Abstract] [BibTeX]	2012	Hong Kong medical journal = Xianggang yi xue za zhi Vol. 18(4), pp. 327-332	article
Abstract: Dizziness is among the commonest of chief complaints. It often presents a significant challenge to the attending physician, because the symptoms and signs are often vague and non-specific. However, a robust systematic approach can usually arrive at the diagnosis. Maintaining balance requires sensory inputs from the vestibular, visual, and somatosensory systems and the cerebellum fine-tunes inaccurate motor outputs. Causes of vertigo are most commonly otological, followed by central, somatosensory, and visual. The first question in approaching patients with dizziness is to categorise dizziness into one of the four groups: lightheadedness, pre-syncope, disequilibrium, and vertigo. Secondly, central vertigo has to be differentiated with peripheral vertigo. For peripheral vertigo, the most common cause is benign paroxysmal positional vertigo and should be specifically looked for. The tempo of the vertiginous attacks and other associated symptoms can help differentiate the other causes of peripheral vertigo, including Meniere's disease, vestibular neuronitis, labyrinthitis, and a perilymph fistula.
BibTeX: @article{Lee2012b, author = {Lee, Alex T H}, title = {Diagnosing the cause of vertigo: a practical approach.}, journal = {Hong Kong medical journal = Xianggang yi xue za zhi}, year = {2012}, volume = {18}, issue = {4}, pages = {327--332}, keywords = {Humans; Labyrinthitis, complications; Meniere Disease, complications; Physical Examination; Vertigo, diagnosis, etiology; Vestibular Neuronitis, complications}, pmid = {22865178} }
El-Kashlan, H.K. and Telian, S.A.	Diagnosis and initiating treatment for peripheral system disorders: imbalance and dizziness with normal hearing. [Abstract] [BibTeX]	2000	Otolaryngologic clinics of North America Vol. 33(3), pp. 563-578	article
Abstract: Disorders affecting the peripheral vestibular system commonly involve the peripheral auditory system causing hearing loss. There are a number of disorders, however, that selectively involve the peripheral vestibular system causing dizziness without hearing loss. These disorders include benign paroxysmal positional vertigo, vestibular neuritis, recurrent vestibulopathy, familial vestibulopathy, and bilateral idiopathic vestibulopathy. This article reviews these disorders and their diagnosis and management.
BibTeX: @article{El-Kashlan2000, author = {El-Kashlan, H K and Telian, S A}, title = {Diagnosis and initiating treatment for peripheral system disorders: imbalance and dizziness with normal hearing.}, journal = {Otolaryngologic clinics of North America}, year = {2000}, volume = {33}, issue = {3}, pages = {563--578}, keywords = {Diagnosis, Differential; Habituation, Psychophysiologic; Hearing, physiology; Humans; Posture, physiology; Vertigo, diagnosis, etiology, therapy; Vestibular Neuronitis, complications}, pmid = {10815037} }
Parnes, L.S., Agrawal, S.K. and Atlas, J.	Diagnosis and management of benign paroxysmal positional vertigo (BPPV). [Abstract] [BibTeX]	2003	CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne Vol. 169(7), pp. 681-693	article
Abstract: There is compelling evidence that free-floating endolymph particles in the posterior semicircular canal underlie most cases of benign paroxysmal positional vertigo (BPPV). Recent pathological findings suggest that these particles are otoconia, probably displaced from the otolithic membrane in the utricle. They typically settle in the dependent posterior canal and render it sensitive to gravity. Well over 90% of patients can be successfully treated with a simple outpatient manoeuvre that moves the particles back into the utricle. We describe the various techniques for this manoeuvre, plus treatments for uncommon variants of BPPV such as that of the lateral canal. For the rare patient whose BPPV is not responsive to these manoeuvres and has severe symptoms, posterior canal occlusion surgery is a safe and highly effective procedure.
BibTeX: @article{Parnes2003, author = {Parnes, Lorne S and Agrawal, Sumit K and Atlas, Jason}, title = {Diagnosis and management of benign paroxysmal positional vertigo (BPPV).}, journal = {CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne}, year = {2003}, volume = {169}, issue = {7}, pages = {681--693}, keywords = {Aged; Ear, Inner, anatomy & histology, physiology; Female; Humans; Male; Middle Aged; Posture; Vertigo, diagnosis, physiopathology, therapy}, pmid = {14517129} }
White, J.A., Coale, K.D., Catalano, P.J. and Oas, J.G.	Diagnosis and management of lateral semicircular canal benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2005	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 133(2), pp. 278-284	article	DOI
Abstract: Describe the diagnosis, treatment, and outcome of a group of 20 patients with lateral semicircular canal benign paroxysmal positional vertigo (LSC-BPPV). Retrospective review of 20 patients with LSC-BPPV (10 with geotropic and 10 with apogeotropic nystagmus) presenting to a tertiary balance center. Diagnosis was confirmed with infrared nystagmography in Dix-Hallpike positioning tests and supine positional tests. Patients were treated with one or more particle repositioning maneuvers. Addition of supine positional nystagmus tests to Dix-Hallpike positioning testing improves sensitivity in the diagnosis of LSC-BPPV. Treatment outcomes in the apogeotropic LSC-BPPV group were poorer than the geotropic LSC-BPPV group. Adding supine positional testing to routine vestibular diagnostic testing will increase the identification of LSC-BPPV. Apogeotropic LSC-BPPV is more challenging to treat.
BibTeX: @article{White2005, author = {White, Judith A and Coale, Kathleen D and Catalano, Peter J and Oas, John G}, title = {Diagnosis and management of lateral semicircular canal benign paroxysmal positional vertigo.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2005}, volume = {133}, issue = {2}, pages = {278--284}, doi = {https://doi.org/10.1016/j.otohns.2005.03.080}, keywords = {Adult; Aged; Aged, 80 and over; Caloric Tests; Cohort Studies; Female; Follow-Up Studies; Humans; Male; Middle Aged; Otolaryngology, methods; Probability; Retrospective Studies; Risk Assessment; Semicircular Canals, physiopathology; Severity of Illness Index; Treatment Outcome; Vertigo, diagnosis, therapy}, pmid = {16087028} }
Halmagyi, G.M.	Diagnosis and management of vertigo. [Abstract] [BibTeX]	2005	Clinical medicine (London, England) Vol. 5(2), pp. 159-165	article
Abstract: Vertigo is an illusion of rotation due to a disorder of the vestibular system, almost always peripheral. In the history it must be distinguished from pre-syncope, seizures and panic attacks. A single attack of acute, isolated spontaneous vertigo lasting a day or more is due either to vestibular neuritis or cerebellar infarction; distinguishing between the two requires mastery of the head impulse test. Recurrent vertigo is mostly due to benign paroxysmal positioning vertigo (BPPV), Meniere's disease or migraine. With a good history, a positional test, an audiogram and a caloric test, it is usually possible to distinguish between these. BPPV is the single most common cause of recurrent vertigo and can usually be cured immediately with a particle repositioning manoeuvre. Posterior circulation ischaemia very rarely causes isolated vertigo attacks and when it does the attacks are brief and frequent and the history is short.
BibTeX: @article{Halmagyi2005, author = {Halmagyi, G M}, title = {Diagnosis and management of vertigo.}, journal = {Clinical medicine (London, England)}, year = {2005}, volume = {5}, issue = {2}, pages = {159--165}, keywords = {Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Palpation, methods; Tomography, X-Ray Computed; Vertigo, diagnosis, therapy}, pmid = {15847010} }
Ling, X., Li, K.-Z., Shen, B., Si, L.-H., Hong, Y. and Yang, X.	Diagnosis and treatment of anterior canal benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2018	International journal of audiology Vol. 57(9), pp. 673-680	article	DOI
Abstract: To investigate the diagnosis and treatment of anterior canal benign paroxysmal positional vertigo (AC-BPPV). Retrospective analysis of clinical data regarding the diagnosis and treatment of patients with AC-BPPV. Six patients with AC-BPPV. All patients underwent the Dix-Hallpike test and/or the straight head-hanging test to induce vertigo and down-beating nystagmus with or without torsional components. Down-beating nystagmus in patients 1, 3 and 6 lasted <1 min and was successfully treated with the Yacovino manoeuvre. Down-beating nystagmus in patients 2, 4 and 5 lasted >1 min. The Yacovino manoeuvre was not effective in patient 4, whereas it was effective in patient 2 but with frequently recurring symptoms. Patients 3, 4 and 6 also had other types of typical BPPV. Canal conversion appeared in patients 4 and 5 during the follow-up period. Typical BPPV, canal conversion, a therapeutic diagnosis after applying the Yacovino manoeuvre, and the follow-up outcome contribute to AC-BPPV diagnosis in patients with dizziness and vertigo presenting with down-beating positional nystagmus. Yacovino manoeuvre was more effective in AC-BPPV patients with down-beating positional nystagmus lasted <1 min than in those in whom it lasted >1 min.
BibTeX: @article{Ling2018, author = {Ling, Xia and Li, Kang-Zhi and Shen, Bo and Si, Li-Hong and Hong, Yuan and Yang, Xu}, title = {Diagnosis and treatment of anterior canal benign paroxysmal positional vertigo.}, journal = {International journal of audiology}, year = {2018}, volume = {57}, issue = {9}, pages = {673--680}, doi = {https://doi.org/10.1080/14992027.2018.1472397}, keywords = {Anterior canal; Yacovino manoeuvre; benign paroxysmal positional vertigo; follow-up diagnosis; nystagmus}, pmid = {30318958} }
Anagnostou, E., Kouzi, I. and Spengos, K.	Diagnosis and Treatment of Anterior-Canal Benign Paroxysmal Positional Vertigo: A Systematic Review. [Abstract] [BibTeX]	2015	Journal of clinical neurology (Seoul, Korea) Vol. 11(3), pp. 262-267	article	DOI
Abstract: In contrast to the posterior- and horizontal-canal variants, data on the frequency and therapeutic management of anterior-canal benign paroxysmal positional vertigo (AC-BPPV) are sparse. To synthesize the existing body of evidence into a systematic review regarding the incidence and treatment of AC-BPPV. Systematic search of medical databases employing predefined criteria, using the term "anterior canal benign paroxysmal positional vertigo." The electronic search retrieved 178 unique citations, 31 of which were considered eligible for further analysis. Analysis of the collected data revealed an estimated occurrence of AC-BPPV among benign paroxysmal positional vertigo patients of 3% (range 1-17.1%). No controlled therapeutic trials could be identified, and so the analysis was focused on uncontrolled case series. Treatment was categorized into three groups: Epley maneuver, Yacovino maneuver, and specific, nonstandard maneuvers described in individual articles. All three categories demonstrated success rates of over 75%, and the overall sample-size-weighted mean was 85.6%. The present analysis demonstrated that AC-BPPV comprises about 3% of all BPPV cases. It can be treated safely using the Epley, Yacovino, and other maneuvers with rates of symptom resolution lying in the range of that reported for the other, more frequent canal variants. Multicenter controlled trials are needed in order to develop evidence-based guidelines for the treatment of AC-BPPV.
BibTeX: @article{Anagnostou2015, author = {Anagnostou, Evangelos and Kouzi, Ioanna and Spengos, Konstantinos}, title = {Diagnosis and Treatment of Anterior-Canal Benign Paroxysmal Positional Vertigo: A Systematic Review.}, journal = {Journal of clinical neurology (Seoul, Korea)}, year = {2015}, volume = {11}, issue = {3}, pages = {262--267}, doi = {https://doi.org/10.3988/jcn.2015.11.3.262}, keywords = {Epley; anterior semicircular canal; benign paroxysmal positional vertigo; repositioning; yacovino}, pmid = {26022461} }
Thomas, D.B. and Newman-Toker, D.E.	Diagnosis is a team sport - partnering with allied health professionals to reduce diagnostic errors: A case study on the role of a vestibular therapist in diagnosing dizziness. [Abstract] [BibTeX]	2016	Diagnosis (Berlin, Germany) Vol. 3(2), pp. 49-59	article	DOI
Abstract: Diagnostic errors are the most common, most costly, and most catastrophic of medical errors. Interdisciplinary teamwork has been shown to reduce harm from therapeutic errors, but sociocultural barriers may impact the engagement of allied health professionals (AHPs) in the diagnostic process. A qualitative case study of the experience at a single institution around involvement of an AHP in the diagnostic process for acute dizziness and vertigo. We detail five diagnostic error cases in which the input of a physical therapist was central to correct diagnosis. We further describe evolution of the sociocultural milieu at the institution as relates to AHP engagement in diagnosis. Five patients with acute vestibular symptoms were initially misdiagnosed by physicians and then correctly diagnosed based on input from a vestibular physical therapist. These included missed labyrinthine concussion and post-traumatic benign paroxysmal positional vertigo (BPPV); BPPV called gastroenteritis; BPPV called stroke; stroke called BPPV; and multiple sclerosis called BPPV. As a consequence of surfacing these diagnostic errors, initial resistance to physical therapy input to aid medical diagnosis has gradually declined, creating a more collaborative environment for 'team diagnosis' of patients with dizziness and vertigo at the institution. Barriers to AHP engagement in 'team diagnosis' include sociocultural norms that establish medical diagnosis as something reserved only for physicians. Drawing attention to the valuable diagnostic contributions of AHPs may help facilitate cultural change. Future studies should seek to measure diagnostic safety culture and then implement proven strategies to breakdown sociocultural barriers that inhibit effective teamwork and transdisciplinary diagnosis.
BibTeX: @article{Thomas2016a, author = {Thomas, Dana B and Newman-Toker, David E}, title = {Diagnosis is a team sport - partnering with allied health professionals to reduce diagnostic errors: A case study on the role of a vestibular therapist in diagnosing dizziness.}, journal = {Diagnosis (Berlin, Germany)}, year = {2016}, volume = {3}, issue = {2}, pages = {49--59}, doi = {https://doi.org/10.1515/dx-2016-0009}, keywords = {Diagnosis; diagnostic errors; dizziness; misdiagnosis; physical therapy specialty; vertigo}, pmid = {28758055} }
Thomas, D.B. and Newman-Toker, D.E.	Diagnosis is a team sport - partnering with allied health professionals to reduce diagnostic errors. [Abstract] [BibTeX]	2016	Diagnosis (Berlin, Germany) Vol. 3(2), pp. 49-59	article	DOI
Abstract: Diagnostic errors are the most common, most costly, and most catastrophic of medical errors. Interdisciplinary teamwork has been shown to reduce harm from therapeutic errors, but sociocultural barriers may impact the engagement of allied health professionals (AHPs) in the diagnostic process. A qualitative case study of the experience at a single institution around involvement of an AHP in the diagnostic process for acute dizziness and vertigo. We detail five diagnostic error cases in which the input of a physical therapist was central to correct diagnosis. We further describe evolution of the sociocultural milieu at the institution as relates to AHP engagement in diagnosis. Five patients with acute vestibular symptoms were initially misdiagnosed by physicians and then correctly diagnosed based on input from a vestibular physical therapist. These included missed labyrinthine concussion and post-traumatic benign paroxysmal positional vertigo (BPPV); BPPV called gastroenteritis; BPPV called stroke; stroke called BPPV; and multiple sclerosis called BPPV. As a consequence of surfacing these diagnostic errors, initial resistance to physical therapy input to aid medical diagnosis has gradually declined, creating a more collaborative environment for 'team diagnosis' of patients with dizziness and vertigo at the institution. Barriers to AHP engagement in 'team diagnosis' include sociocultural norms that establish medical diagnosis as something reserved only for physicians. Drawing attention to the valuable diagnostic contributions of AHPs may help facilitate cultural change. Future studies should seek to measure diagnostic safety culture and then implement proven strategies to breakdown sociocultural barriers that inhibit effective teamwork and transdisciplinary diagnosis.
BibTeX: @article{Thomas2016, author = {Thomas, Dana B and Newman-Toker, David E}, title = {Diagnosis is a team sport - partnering with allied health professionals to reduce diagnostic errors.}, journal = {Diagnosis (Berlin, Germany)}, year = {2016}, volume = {3}, issue = {2}, pages = {49--59}, doi = {https://doi.org/10.1515/dx-2016-0009}, keywords = {Diagnosis; diagnostic errors; dizziness; misdiagnosis; physical therapy specialty; vertigo}, pmid = {29536891} }
Spector, M.	Diagnosis of benign paroxysmal positional vertigo. [BibTeX]	1984	The Laryngoscope Vol. 94(4), pp. 557	article
BibTeX: @article{Spector1984, author = {Spector, M}, title = {Diagnosis of benign paroxysmal positional vertigo.}, journal = {The Laryngoscope}, year = {1984}, volume = {94}, issue = {4}, pages = {557}, keywords = {Electronystagmography, methods; Humans; Posture; Vertigo, diagnosis}, pmid = {6708705} }
Balatsouras, D.G., Koukoutsis, G., Ganelis, P., Korres, G.S. and Kaberos, A.	Diagnosis of Single- or Multiple-Canal Benign Paroxysmal Positional Vertigo according to the Type of Nystagmus. [Abstract] [BibTeX]	2011	International journal of otolaryngology Vol. 2011, pp. 483965	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is a common peripheral vestibular disorder encountered in primary care and specialist otolaryngology and neurology clinics. It is associated with a characteristic paroxysmal positional nystagmus, which can be elicited with specific diagnostic positional maneuvers, such as the Dix-Hallpike test and the supine roll test. Current clinical research focused on diagnosing and treating various types of BPPV, according to the semicircular canal involved and according to the implicated pathogenetic mechanism. Cases of multiple-canal BPPV have been specifically investigated because until recently these were resistant to treatment with standard canalith repositioning procedures. Probably, the most significant factor in diagnosis of the type of BPPV is observation of the provoked nystagmus, during the diagnostic positional maneuvers. We describe in detail the various types of nystagmus, according to the canals involved, which are the keypoint to accurate diagnosis.
BibTeX: @article{Balatsouras2011, author = {Balatsouras, Dimitris G and Koukoutsis, George and Ganelis, Panayotis and Korres, George S and Kaberos, Antonis}, title = {Diagnosis of Single- or Multiple-Canal Benign Paroxysmal Positional Vertigo according to the Type of Nystagmus.}, journal = {International journal of otolaryngology}, year = {2011}, volume = {2011}, pages = {483965}, doi = {https://doi.org/10.1155/2011/483965}, pmid = {21792356} }
Higashi-Shingai, K., Imai, T., Kitahara, T., Uno, A., Ohta, Y., Horii, A., Nishiike, S., Kawashima, T., Hasegawa, T. and Inohara, H.	Diagnosis of the subtype and affected ear of benign paroxysmal positional vertigo using a questionnaire. [Abstract] [BibTeX]	2011	Acta oto-laryngologica Vol. 131(12), pp. 1264-1269	article	DOI
Abstract: The prediction of subtype and the affected ear of benign paroxysmal positional vertigo (BPPV) derived from the answers to our questionnaire can support the definitive diagnosis of BPPV. We examined to what extent the diagnosis of subtype and the affected ear of BPPV judged from answers to a questionnaire agreed with the diagnosis decided by the results of the positional nystagmus test. We asked the following questions: 'What kind of head movements induce vertigo?' and 'How long does the vertigo continue?'. As for the affected ear, we asked which ear was lower during stronger vertigo when induced in a supine position or during sleep. The percentages of correct diagnosis speculated by the combined answers were 69% in posterior canal-type BPPV, 48% in BPPV with geotropic nystagmus, and 39% in BPPV with apogeotropic nystagmus. The percentage of correct diagnoses of the affected ear was more than 80%.
BibTeX: @article{Higashi-Shingai2011, author = {Higashi-Shingai, Kayoko and Imai, Takao and Kitahara, Tadashi and Uno, Atsuhiko and Ohta, Yumi and Horii, Arata and Nishiike, Suetaka and Kawashima, Takayuki and Hasegawa, Taro and Inohara, Hidenori}, title = {Diagnosis of the subtype and affected ear of benign paroxysmal positional vertigo using a questionnaire.}, journal = {Acta oto-laryngologica}, year = {2011}, volume = {131}, issue = {12}, pages = {1264--1269}, doi = {https://doi.org/10.3109/00016489.2011.611535}, keywords = {Female; Head Movements, physiology; Humans; Male; Nystagmus, Pathologic, physiopathology; Posture, physiology; Surveys and Questionnaires; Vertigo, diagnosis, physiopathology}, pmid = {21905795} }
Pan, Q., Zhang, Y., Long, T., He, W., Zhang, S., Fan, Y. and Zhou, J.	Diagnosis of Vertigo and Dizziness Syndromes in a Neurological Outpatient Clinic. [Abstract] [BibTeX]	2018	European neurology Vol. 79(5-6), pp. 287-294	article	DOI
Abstract: Dizziness and vertigo are frequent complaints of outpatients in the neurological department. Our objective was to explore the epidemiological category and clinical features of patients with dizziness or vertigo in the neurological outpatient department of a tertiary hospital. We consecutively recruited all patients with dizziness and/or vertigo visiting the neurological outpatient clinic of the First Affiliated Hospital of Chongqing Medical University from January 2016 to June 2017. All patients were interviewed by 4 neurologists and they completed self-administered questionnaires. General physical and standardized neuro-otology bedside examinations were performed in all participants. Instrumental examinations and other related examinations were prescribed as needed. A total of 392 patients, 272 female and 120 male, were enrolled and the ratio of males to females was 1: 2.27. The mean age was 52.39 ± 13.87 years (range 11-90). Elderly patients (≥60 years) accounted for about one-third of the patients. Peripheral vestibular disorders accounted for 54.6% of patients, central vestibular disorders (including vestibular migraine [VM]) accounted for 22.4% of patients, psychogenic vertigo in 64 (16.3%), other reasons in 9 (2.3%) and unknown in 17 (4.3%). Benign paroxysmal positional vertigo (BPPV; 30.8%), psychiatric dizziness (20.5%), and VM (14.4%) were the 3 major vestibular diseases in patients under 60 years of age; however, BPPV (27.9%), central vertigo (21.7%), and Meniere's disease (11.7%) were more common in patients over 60 years of age. This study provided a classification and clinical features of vestibular disorders in a neurological outpatient department of a tertiary hospital in China. The spectrum of vertigo or dizziness is different between different age groups and clinicians should pay attention to this difference in clinical reasoning.
BibTeX: @article{Pan2018, author = {Pan, Qi and Zhang, Yixin and Long, Ting and He, Wei and Zhang, Shanshan and Fan, Yulan and Zhou, Jiying}, title = {Diagnosis of Vertigo and Dizziness Syndromes in a Neurological Outpatient Clinic.}, journal = {European neurology}, year = {2018}, volume = {79}, issue = {5-6}, pages = {287--294}, doi = {https://doi.org/10.1159/000489639}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Ambulatory Care Facilities; Child; China; Dizziness, diagnosis, epidemiology, etiology; Female; Humans; Male; Middle Aged; Outpatients; Syndrome; Vertigo, diagnosis, epidemiology, etiology; Young Adult; Classification; Clinical features; Outpatient; Vestibular disorders}, pmid = {29794430} }
Asprella Libonati, G.	Diagnostic and treatment strategy of lateral semicircular canal canalolithiasis. [Abstract] [BibTeX]	2005	Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale Vol. 25(5), pp. 277-283	article
Abstract: A new strategy for the diagnosis and treatment both of geotropic and apogeotropic Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo is proposed. To this end, a new strategy of approach to Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo is described in order to rapidly highlight both the side and the affected canal. Thus, in the first treatment session, using the so-called "strategy of the minimum stimulus", a large percentage of cases are successfully treated, with the lowest number of vertigos for the patient. Following a review of the literature, 269 case studies, personally observed over a 4-year period, are described. The diagnostic strategy is performed by a single manoeuvre to determine whether the posterior semicircular canal or the lateral canal is affected. In the latter case, it is possible to highlight the affected sides both of the geotropic and apogeotropic forms. The therapeutic strategy comprises several liberatory manoeuvres, barbecue rotation techniques (Vannucchi-Asprella, Lempert), and Gufoni manoeuvre by continuously monitoring the ampullofugal movement of the otoliths. Almost 98% of cases are successfully treated at the first treatment diagnostic-therapeutic session. This approach to Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo allows a two-fold goal to be achieved, i.e., to effect both diagnosis and treatment at the first examination. Furthermore, thanks to the philosophy of the approach to Benign Paroxysmal Positional Vertigo, called the "Strategy of the minimum stimulus", patient compliance is very good since a very small number of vertigos are produced, and few neuro-vegetative disorders.
BibTeX: @article{AsprellaLibonati2005, author = {Asprella Libonati, G}, title = {Diagnostic and treatment strategy of lateral semicircular canal canalolithiasis.}, journal = {Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale}, year = {2005}, volume = {25}, issue = {5}, pages = {277--283}, keywords = {Follow-Up Studies; Humans; Nystagmus, Pathologic; Nystagmus, Physiologic; Otolithic Membrane; Patient Compliance; Posture; Rotation; Semicircular Canals, physiopathology; Time Factors; Treatment Outcome; Vertigo, diagnosis, physiopathology, therapy}, pmid = {16602326} }
Büttner, U., Helmchen, C. and Brandt, T.	Diagnostic criteria for central versus peripheral positioning nystagmus and vertigo: a review. [Abstract] [BibTeX]	1999	Acta oto-laryngologica Vol. 119(1), pp. 1-5	article
Abstract: Head positioning can lead to pathological nystagmus and vertigo. In most instances the cause is a peripheral vestibular disorder, as in benign paroxysmal positioning vertigo (BPPV). Central lesions can lead to positional nystagmus (central PN) or to paroxysmal positioning nystagmus and vertigo (central PPV). Lesions in central PPV are often found dorsolateral to the fourth ventricle or in the dorsal vermis. This localization, together with other clinical features (associated cerebellar and oculomotor signs), generally allows one to easily distinguish central PPV from BPPV. However, in individual cases this may prove difficult, since the two syndromes share many features. Even if only BPPV as a peripheral lesion is considered, differentiation based on such features as latency, course, and duration of nystagmus during an attack, fatigability, vertigo, vomiting, and time period during which nystagmus bouts occur, may be impossible. Only the direction of nystagmus during an attack can allow differentiation.
BibTeX: @article{Buettner1999, author = {Büttner, U and Helmchen, C and Brandt, T}, title = {Diagnostic criteria for central versus peripheral positioning nystagmus and vertigo: a review.}, journal = {Acta oto-laryngologica}, year = {1999}, volume = {119}, issue = {1}, pages = {1--5}, keywords = {Diagnosis, Differential; Head Movements, physiology; Humans; Nystagmus, Pathologic, diagnosis, etiology, physiopathology; Posture, physiology; Vertigo, diagnosis, etiology, physiopathology; Vestibular Diseases, complications, diagnosis}, pmid = {10219377} }
Lee, J.B., Choi, S.J., Park, K., Park, H.Y., Hong, J.J., Hwang, E., Lee, H.J., Kim, C.H. and Choung, Y.-H.	Diagnostic efficiency of the cochlear hydrops analysis masking procedure in Ménière's disease. [Abstract] [BibTeX]	2011	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 32(9), pp. 1486-1491	article	DOI
Abstract: To determine whether cochlear hydrops analysis masking procedure (CHAMP) has diagnostic value in patients with definite Ménière's disease (MD) comparing the diagnostic validity index of CHAMP with those of electrocochleography (ECoG). A prospective study. Tertiary referral center. One hundred eight patients were classified into 3 groups: the "definite MD" group (MD group, n = 47); the "non-MD" group (n = 41) of other vestibular diseases including vestibular neuritis, and benign paroxysmal positional vertigo; and the control group (n = 20), which included patients without dizziness. CHAMP and extratympanic ECoG were performed in all patients. Sensitivity, specificity, and definitions of abnormal values were less than 0.3 ms in latency delay (0.5 kHz high pass noise [HPN]-click alone) and less than 0.95 in compound amplitude ratio (click alone-0.5 kHz HPN/click alone) in CHAMP and 0.4 for the summating potential/action potential ratio in ECoG. The mean latency delay and amplitude ratio of CHAMP in the MD group significantly differed from these values for other groups, whereas the mean summating potential/action potential ratio of ECoG did not. In ECoG, sensitivity was as low as 21%, specificity was 97%, and diagnostic accuracy was 62%. Sensitivity, specificity, and diagnostic accuracy of CHAMP were 64%, 98%, and 80%, respectively, in latency delay and 91%, 83%, and 88%, respectively, in amplitude ratio. The sensitivity and diagnostic accuracy of CHAMP were significantly higher than the corresponding values for ECoG. CHAMP is more valuable in detection of definite MD than extratympanic ECoG.
BibTeX: @article{Lee2011, author = {Lee, Jong Bin and Choi, Seong Jun and Park, Keehyun and Park, Hun Yi and Hong, Jung Joo and Hwang, Eun and Lee, Ho Jin and Kim, Chan Ho and Choung, Yun-Hoon}, title = {Diagnostic efficiency of the cochlear hydrops analysis masking procedure in Ménière's disease.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2011}, volume = {32}, issue = {9}, pages = {1486--1491}, doi = {https://doi.org/10.1097/MAO.0b013e318235586c}, keywords = {Adult; Aged; Audiometry, Evoked Response; Dizziness, diagnosis; Endolymphatic Hydrops, diagnosis; Female; Humans; Male; Meniere Disease, diagnosis; Middle Aged; Prospective Studies; Reproducibility of Results; Sensitivity and Specificity; Vertigo, diagnosis}, pmid = {21997588} }
Bayer, O., Warninghoff, J.-C. and Straube, A.	Diagnostic indices for vertiginous diseases. [Abstract] [BibTeX]	2010	BMC neurology Vol. 10, pp. 98	article	DOI
Abstract: Vertigo and dizziness are symptoms which are reported frequently in clinical practice. We aimed to develop diagnostic indices for four prevalent vertiginous diseases: benign paroxysmal positional vertigo (BPPV), Menière's disease (MD), vestibular migraine (VM), and phobic postural vertigo (PPV). Based on a detailed questionnaire handed out to consecutive patients presenting for the first time in our dizziness clinic we preselected a set of seven questions with desirable diagnostic properties when compared with the final diagnosis after medical workup. Using exact logistic regression analysis diagnostic scores, each comprising of four to six items that can simply be added up, were built for each of the four diagnoses. Of 193 patients 131 questionnaires were left after excluding those with missing consent or data. Applying the suggested cut-off points, sensitivity and specificity were 87.5 and 93.5% for BPPV, 100 and 87.4% for MD, 92.3 and 83.7% for VM, 73.7 and 84.1% for PPV, respectively. By changing the cut-off points sensitivity and specificity can be adjusted to meet diagnostic needs. The diagnostic indices showed promising diagnostic properties. Once further validated, they could provide an ease to use and yet flexible tool for screening vertigo in clinical practice and epidemiological research.
BibTeX: @article{Bayer2010, author = {Bayer, Otmar and Warninghoff, Jan-Christian and Straube, Andreas}, title = {Diagnostic indices for vertiginous diseases.}, journal = {BMC neurology}, year = {2010}, volume = {10}, pages = {98}, doi = {https://doi.org/10.1186/1471-2377-10-98}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Area Under Curve; Female; Humans; Male; Middle Aged; ROC Curve; Sensitivity and Specificity; Surveys and Questionnaires; Vertigo, diagnosis; Young Adult}, pmid = {20973968} }
Hoffmann, O., Klingebiel, R., Braun, J.S., Katchanov, J. and Valdueza, J.M.	Diagnostic pitfall: atypical cerebral venous drainage via the vertebral venous system. [Abstract] [BibTeX]	2002	AJNR. American journal of neuroradiology Vol. 23(3), pp. 408-411	article
Abstract: We report a case of atypical cerebral venous drainage in a 38-year-old woman with symptoms of benign paroxysmal positional vertigo. Thrombosis of the left internal jugular vein and sigmoid sinus was suspected on the basis of spin-echo and time-of-flight MR findings, but multisection CT angiograms showed a patent sigmoid sinus and predominant drainage via the emissary veins toward the vertebral plexus, with only a minor contribution of the jugular veins. This case illustrates the variability of the venous anatomy in the craniocervical region.
BibTeX: @article{Hoffmann2002, author = {Hoffmann, Olaf and Klingebiel, Randolf and Braun, Johann S and Katchanov, Juri and Valdueza, José M}, title = {Diagnostic pitfall: atypical cerebral venous drainage via the vertebral venous system.}, journal = {AJNR. American journal of neuroradiology}, year = {2002}, volume = {23}, issue = {3}, pages = {408--411}, keywords = {Adult; Cerebral Veins, abnormalities, diagnostic imaging; Cranial Sinuses, abnormalities, diagnostic imaging; Diagnosis, Differential; Female; Humans; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Sinus Thrombosis, Intracranial, diagnosis; Tomography, X-Ray Computed; Ultrasonography; Vertigo, diagnosis}, pmid = {11901009} }
Norré, M.E.	Diagnostic problems in patients with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	1994	The Laryngoscope Vol. 104(11 Pt 1), pp. 1385-1388	article	DOI
Abstract: The steps of the examination procedure applied for a correct diagnosis of benign paroxysmal positional vertigo (BPPV) are reviewed. A precise diagnosis is important in view of treatment of this type of vertigo by rehabilitation therapy. Clinical experience supports the concept that the diagnosis has to be based not only on a typical history, but also on the presence of a reproducible vertigo and paroxysmal positioning nystagmus. In the procedure applied in the department, this nystagmus can be reproduced by the Dix-Hallpike maneuver under Frenzel's glasses, during electronystagmography (ENG) recording in the position tests, or it can be present in the vestibular habituation training test battery (a battery of 19 maneuvers applied for defining the adequate exercises in the rehabilitation treatment for BPPV). Analysis of the reviewed data in 95 patients showed that one third of the patients described the vertigo in a rather atypical way, while the further testing revealed a typical BPPV. This experience denies any absolute reliability to only history. In fact, only the finding of such a paroxysmal positioning nystagmus is conclusive for confirming BPPV. However, also the presence of such a nystagmus appeared not to be a constant datum, so that in some patients more than one examination was necessary to come to a reliable diagnosis. It is obvious that, for detecting a paroxysmal positioning nystagmus, ENG is less reliable than the Dix-Hallpike maneuver under Frenzel's glasses.
BibTeX: @article{Norre1994, author = {Norré, M E}, title = {Diagnostic problems in patients with benign paroxysmal positional vertigo.}, journal = {The Laryngoscope}, year = {1994}, volume = {104}, issue = {11 Pt 1}, pages = {1385--1388}, doi = {https://doi.org/10.1288/00005537-199411000-00012}, keywords = {Adult; Aged; Aged, 80 and over; Audiometry; Caloric Tests; Electronystagmography; Evoked Potentials, Auditory, Brain Stem, physiology; Female; Habituation, Psychophysiologic; Humans; Male; Middle Aged; Nystagmus, Optokinetic; Patient Selection; Physical Therapy Modalities; Posture; Reflex, Abnormal, physiology; Reflex, Vestibulo-Ocular, physiology; Vertigo, diagnosis, physiopathology, rehabilitation; Vestibule, Labyrinth, physiology}, pmid = {7968169} }
Yetiser, S. and Ince, D.	Diagnostic Role of Head-Bending and Lying-Down Tests in Lateral Canal Benign Paroxysmal Positional Vertigo. [Abstract] [BibTeX]	2015	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 36(7), pp. 1231-1237	article	DOI
Abstract: To compare the diagnostic value of the head-bending test (HBT), lying-down positioning test (LDPT) and patient's report to identify the affected canal in video-nystagmographically (VNG) confirmed patients with lateral canal benign paroxysmal positional vertigo (LC-BPPV). Case series with chart review. Head-bending, lying-down positioning and the head-roll maneuver (HRM) under VNG guidance. The data were collected in a referral community hospital. Seventy-eight patients (32 apogeotropic and 46 geotropic nystagmus) with LC-BPPV who had been recruited between 2009 and 2013 were enrolled in the study. Patients were tested with the HRM and then were asked about subjectively worse side. Later, they were subjected to HBT when sitting and the LDPT. The results were compared and studied with the 1-way ANOVA and chi-square tests. Statistical significance was set at p < 0.05. Affected side was identified by HRM in 75% of patients with apogeotropic nystagmus and 95.6% of patients with geotropic nystagmus. Approximately 65.6% of patients with apogeotropic and 52% of patients with geotropic nystagmus had nystagmus during LDPT. However, its comparability with HRM was low. However, treatment plan based on LDPT results alone provided relief of symptoms in additional 12.5% of patients with apogeotropic and in 2.2% of patients with geotropic nystagmus. Approximately 63% of patients with apogeotropic and 56% of patients with geotropic nystagmus were able to tell the worse side. Nystagmus comparable with HRM during HBT was low and not diagnostic. HRM has the greatest diagnostic value of positioning tests in LC-BPPV in this study. LDPT provides some contribution in the diagnosis of LC-BPPV but much less than HRM. Patients' subjective feeling of vertigo was also a useful test. However, HBT was not as sensitive as other measures in uncertain cases.
BibTeX: @article{Yetiser2015b, author = {Yetiser, Sertac and Ince, Dilay}, title = {Diagnostic Role of Head-Bending and Lying-Down Tests in Lateral Canal Benign Paroxysmal Positional Vertigo.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2015}, volume = {36}, issue = {7}, pages = {1231--1237}, doi = {https://doi.org/10.1097/MAO.0000000000000774}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Ear Canal, physiopathology; Electronystagmography; Female; Functional Laterality; Head; Humans; Male; Middle Aged; Nystagmus, Physiologic; Patient Care Planning; Posture; Supine Position; Vertigo, diagnosis, physiopathology, therapy; Vestibular Function Tests, methods; Young Adult}, pmid = {25938792} }
Evren, C., Demirbilek, N., Elbistanlı, M.S., Köktürk, F. and Çelik, M.	Diagnostic value of repeated Dix-Hallpike and roll maneuvers in benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2017	Brazilian journal of otorhinolaryngology Vol. 83(3), pp. 243-248	article	DOI
Abstract: Benign Paroxysmal Positional Vertigo (BPPV) is the most common peripheral vestibular disorder. The Dix-Hallpike and Roll maneuvers are used to diagnose BPPV. This study aims to investigate the diagnostic value of repeated Dix-Hallpike and Roll maneuvers in BPPV. We performed Dix-Hallpike and roll maneuvers in patients who admitted with peripheral vertigo anamnesis and met our criteria. The present study consists of 207 patients ranging in age from 16 to 70 (52.67±10.67). We conducted the same maneuvers sequentially one more time in patients with negative results. We detected patients who had negative results in first maneuver and later developed symptom and nystagmus. We evaluated post-treatment success and patient satisfaction by performing Dizziness Handicap Inventory (DHI) at first admittance and two weeks after treatment in all patients with BPPV. Of a total of 207 patients, we diagnosed 139 in first maneuver. We diagnosed 28 more patients in sequentially performed maneuvers. The remaining 40 patients were referred to imaging. There was a significant difference between pre- and post-treatment DHI scores in patients with BPPV (p<0.001). Performing the diagnostic maneuvers only one more time in vertigo patients in the first clinical evaluation increases the diagnosis success in BPPV. Canalith repositioning maneuvers are effective and satisfactory treatment methods in BPPV.
BibTeX: @article{Evren2017, author = {Evren, Cenk and Demirbilek, Nevzat and Elbistanlı, Mustafa Suphi and Köktürk, Füruzan and Çelik, Mustafa}, title = {Diagnostic value of repeated Dix-Hallpike and roll maneuvers in benign paroxysmal positional vertigo.}, journal = {Brazilian journal of otorhinolaryngology}, year = {2017}, volume = {83}, issue = {3}, pages = {243--248}, doi = {https://doi.org/10.1016/j.bjorl.2016.03.007}, keywords = {Adolescent; Adult; Aged; Benign Paroxysmal Positional Vertigo, diagnosis, physiopathology; Female; Humans; Male; Middle Aged; Posture, physiology; Prospective Studies; Sensitivity and Specificity; Treatment Outcome; Young Adult; Dix-Hallpike maneuver; Manobra de Dix-Hallpike; Repeat; Repetição; Vertigem; Vertigo}, pmid = {27170347} }
Korres, S.G. and Balatsouras, D.G.	Diagnostic, pathophysiologic, and therapeutic aspects of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2004	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 131(4), pp. 438-444	article	DOI
Abstract: Benign paroxysmal positional vertigo is the most common peripheral vestibular disorder. It can be defined as transient vertigo induced by a rapid head position change, associated with a characteristic paroxysmal positional nystagmus. Canalolithiasis of the posterior semicircular canal is considered the most convincing theory of its pathogenesis and the development of appropriate therapeutic maneuvers resulted in its effective treatment. However, involvement of the horizontal or the anterior canal has been found in a significant rate and the recognition and treatment of these variants completed the clinical picture of the disease. This paper describes the advances in understanding how this disease is generated and discusses the current therapeutic modalities.
BibTeX: @article{Korres2004, author = {Korres, Stavros G and Balatsouras, Dimitrios G}, title = {Diagnostic, pathophysiologic, and therapeutic aspects of benign paroxysmal positional vertigo.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2004}, volume = {131}, issue = {4}, pages = {438--444}, doi = {https://doi.org/10.1016/j.otohns.2004.02.046}, keywords = {Humans; Vertigo, diagnosis, physiopathology, therapy}, pmid = {15467614} }
Shih, R.D., Walsh, B., Eskin, B., Allegra, J., Fiesseler, F.W., Salo, D. and Silverman, M.	Diazepam and Meclizine Are Equally Effective in the Treatment of Vertigo: An Emergency Department Randomized Double-Blind Placebo-Controlled Trial. [Abstract] [BibTeX]	2017	The Journal of emergency medicine Vol. 52(1), pp. 23-27	article	DOI
Abstract: Vertigo is a debilitating disease that is commonly encountered in the emergency department (ED). Diazepam and meclizine are oral medications that are commonly used to alleviate symptoms. We sought to determine whether meclizine or diazepam is superior in the treatment of patients with peripheral vertigo in the ED. We performed a double-blind clinical trial at a suburban, teaching ED. We randomized a convenience sample of adult patients with acute peripheral vertigo (APV) to diazepam 5 mg or meclizine 25 mg orally. Demographic and historical features were recorded on a standardized data form. Patients recorded their initial level (t0) of vertigo on a 100-mm visual analog scale (VAS) and after 30 min (t30) and 60 min (t60). The primary outcome parameter was the mean change in VAS score from t0 to t60. Differences between groups and 95% confidence intervals were calculated. Our a priori power calculation estimated that a sample size of 20 patients in each group was required to have an 80% power to detect a difference of 20 mm between treatment groups. There were 20 patients in the diazepam group and 20 in the meclizine group. The two groups were similar with respect to patient demographics and presenting signs and symptoms. At t60, the mean improvements in the diazepam and meclizine groups were 36 and 40, respectively (difference -4; 95% confidence interval -20 to 12; p = 0.60). We found no difference between oral diazepam and oral meclizine for the treatment of ED patients with acute peripheral vertigo.
BibTeX: @article{Shih2017, author = {Shih, Richard D and Walsh, Brian and Eskin, Barnet and Allegra, John and Fiesseler, Frederick W and Salo, Dave and Silverman, Michael}, title = {Diazepam and Meclizine Are Equally Effective in the Treatment of Vertigo: An Emergency Department Randomized Double-Blind Placebo-Controlled Trial.}, journal = {The Journal of emergency medicine}, year = {2017}, volume = {52}, issue = {1}, pages = {23--27}, doi = {https://doi.org/10.1016/j.jemermed.2016.09.016}, keywords = {Adult; Diazepam, pharmacology, therapeutic use; Double-Blind Method; Emergency Service, Hospital, organization & administration, statistics & numerical data; Female; Humans; Male; Meclizine, pharmacology, therapeutic use; Middle Aged; Prospective Studies; Treatment Outcome; Vertigo, drug therapy; benign paroxysmal positional vertigo; diazepam; meclizine; vertigo}, pmid = {27789115} }
Crevits, L.	Different canalith repositioning procedures for horizontal canal benign paroxysmal positional vertigo. [BibTeX]	2005	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 133(5), pp. 817	article	DOI
BibTeX: @article{Crevits2005, author = {Crevits, Luc}, title = {Different canalith repositioning procedures for horizontal canal benign paroxysmal positional vertigo.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2005}, volume = {133}, issue = {5}, pages = {817}, doi = {https://doi.org/10.1016/j.otohns.2005.06.020}, keywords = {Electronystagmography; Female; Follow-Up Studies; Humans; Male; Otolaryngology, methods; Patient Satisfaction; Posture, physiology; Risk Assessment; Severity of Illness Index; Treatment Outcome; Vertigo, diagnosis, therapy}, pmid = {16274821} }
Tomanovic, T. and Bergenius, J.	Different types of dizziness in patients with peripheral vestibular diseases--their prevalence and relation to migraine. [Abstract] [BibTeX]	2010	Acta oto-laryngologica Vol. 130(9), pp. 1024-1030	article	DOI
Abstract: Besides spontaneous attacks of vertigo or unsteadiness, other symptoms, i.e. drop attacks, lateropulsion, illusions that the room or body is tilted, 'walking on pillows' or 'stepping into a hole', occur without precipitating head movement in almost 50% of patients with peripheral vestibular dysfunctions. The sensation of static tilt was closely connected to migraine and Meniere's disease (MD). To record the prevalence of the different symptoms with respect to vestibular diagnosis and its relation to migraine. Data from 100 patients with MD, benign paroxysmal positional vertigo (BPPV), or unilateral peripheral vestibular impairment (UPVI) were analyzed with respect to vestibular diagnosis and migraine as a secondary diagnosis. Spontaneous attacks of vertigo or unsteadiness occurred in 74% and 48% of patients, respectively. Vertigo was significantly more often reported in patients with MD and BPPV. In patients with BPPV, the duration of spontaneous vertigo was shorter than in patients with MD. The relative incidence of other symptoms were: unsteadiness, 48%; 'stepping into a hole', 46%; lateropulsion, 35%; 'walking on pillows', 21%; and drop attacks, 19%. Only the sensation of static tilt, which occurred in 8% of patients, was significantly correlated to MD or to migraine.
BibTeX: @article{Tomanovic2010, author = {Tomanovic, Tatjana and Bergenius, Johan}, title = {Different types of dizziness in patients with peripheral vestibular diseases--their prevalence and relation to migraine.}, journal = {Acta oto-laryngologica}, year = {2010}, volume = {130}, issue = {9}, pages = {1024--1030}, doi = {https://doi.org/10.3109/00016481003671236}, keywords = {Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Migraine Disorders, complications, epidemiology; Prevalence; Sweden, epidemiology; Vertigo, epidemiology, etiology; Vestibular Diseases, complications, epidemiology; Young Adult}, pmid = {20380548} }
Roberts, R.A., Gans, R.E. and Kastner, A.H.	Differentiation of migrainous positional vertigo (MPV) from horizontal canal benign paroxysmal positional vertigo (HC-BPPV). [Abstract] [BibTeX]	2006	International journal of audiology Vol. 45(4), pp. 224-226	article	DOI
Abstract: This article presents an approach to differentiation of migrainous positional vertigo (MPV) from horizontal canal benign paroxysmal positional vertigo (HC-BPPV). Such an approach is essential because of the difference in intervention between the two disorders in question. Results from evaluation of the case study presented here revealed a persistent ageotropic positional nystagmus consistent with MPV or a cupulolithiasis variant of HC-BPPV. The patient was treated with liberatory maneuvers to remove possible otoconial debris from the horizontal canal in an attempt, in turn, to provide further diagnostic information. There was no change in symptoms following treatment for HC-BPPV. This case was diagnosed subsequently as MPV, and the patient was referred for medical intervention. Treatment has been successful for 22 months. Incorporation of HC-BPPV treatment, therefore, may provide useful information in the differential diagnosis of MPV and the cupulolithiasis variant of HC-BPPV.
BibTeX: @article{Roberts2006a, author = {Roberts, Richard A and Gans, Richard E and Kastner, Allison H}, title = {Differentiation of migrainous positional vertigo (MPV) from horizontal canal benign paroxysmal positional vertigo (HC-BPPV).}, journal = {International journal of audiology}, year = {2006}, volume = {45}, issue = {4}, pages = {224--226}, doi = {https://doi.org/10.1080/14992020500429658}, keywords = {Aged; Diagnosis, Differential; Female; Humans; Migraine Disorders, complications, drug therapy, physiopathology; Nystagmus, Pathologic; Nystagmus, Physiologic, physiology; Vertigo, diagnosis, etiology, therapy}, pmid = {16684703} }
Kim, C.-H., Shin, J.E., Yoo, M.H. and Park, H.J.	Direction-Changing and Direction-Fixed Positional Nystagmus in Patients With Vestibular Neuritis and Meniere Disease. [Abstract] [BibTeX]	2018	Clinical and experimental otorhinolaryngology	article	DOI
Abstract: Direction-changing positional nystagmus (PN) was considered to indicate the presence of benign paroxysmal positional vertigo involving lateral semicircular canal in most cases. We investigated the incidence of PN on the supine head-roll test and compared the characteristics of nystagmus in patients with vestibular neuritis (VN) and Meniere disease (MD). A retrospective review of patients, who were diagnosed with unilateral VN or unilateral definite MD between September 2005 and November 2011, was conducted. Sixty-five VN patients and 65 MD patients were enrolled. Eye movements were recorded for 30-60 seconds at the positions of sitting, head roll to the right, and head roll to the left, and maximum slow-phase eye velocity was calculated. PN was classified as direction-fixed (paretic or recovery) and direction-changing (geotropic or apogeotropic). Spontaneous nystagmus was observed in 57 patients (87%, the slow-phase eye velocity of 7°/sec±5°/sec) with acute VN, 39 (60%, 2°/sec±1°/sec) with follow-up VN, and 32 (49%, 2°/sec±2°/sec) with MD. Direction-fixed PN was the most common type. Direction-fixed paretic type was most common in acute VN (80%) and follow-up VN (42%), and direction-fixed recovery type was most common in MD (31%). Paretic type was significantly more common in acute VN (80%) than in follow-up VN (42%) and MD (26%), and the recovery type was significantly more common in MD (31%) than in acute VN (3%) and follow-up VN (14%). Direction-changing PN was more common in MD (22%), followed by follow-up VN (14%) and acute VN (9%). Though direction-fixed paretic PN was most common in VN and MD patients, direction-changing PN could be observed in a few patients (9%-20%) with peripheral vestibular disorders regardless of the duration from the onset of dizziness, suggesting the presence of otolith-related dizziness.
BibTeX: @article{Kim2018a, author = {Kim, Chang-Hee and Shin, Jung Eun and Yoo, Myung Hoon and Park, Hong Ju}, title = {Direction-Changing and Direction-Fixed Positional Nystagmus in Patients With Vestibular Neuritis and Meniere Disease.}, journal = {Clinical and experimental otorhinolaryngology}, year = {2018}, doi = {https://doi.org/10.21053/ceo.2018.00038}, keywords = {Benign Paroxysmal Positional Vertigo; Meniere Disease; Nystagmus; Positional; Vestibular Neuritis}, pmid = {30509014} }
Califano, L., Vassallo, A., Melillo, M.G., Mazzone, S. and Salafia, F.	Direction-fixed paroxysmal nystagmus lateral canal benign paroxysmal positioning vertigo (BPPV): another form of lateral canalolithiasis. [Abstract] [BibTeX]	2013	Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale Vol. 33(4), pp. 254-260	article
Abstract: Benign paroxysmal positioning vertigo (BPPV) is the most frequent vertiginous syndrome. It is caused either by free-floating otoliths in the semicircular canals (canalolithiasis) or by otoconial debris adhering to a canal cupula (cupulolithiasis). The posterior canal is the most frequently involved (80%), while the lateral canal is involved less frequently (15%), and the rarest conditions are anterior canalolithiasis and apogeotropic posterior canalolithiasis (5%). The main diagnostic sign of lateral canal BPPV is paroxysmal horizontal bidirectional positioning nystagmus evoked through Pagnini-McClure's test (head roll in the yaw plane in supine position). In the geotropic variant, which is more frequent, the fast phase of the nystagmus is directed towards the lowermost ear, when the patient lies on the affected side or on the healthy side; in the apogeotropic variant, which is less frequent, the fast phase is directed always toward the uppermost ear, regardless of which side the patient lies on. Paroxysmal nystagmus is more intense on the affected side in the geotropic form, and more intense on the healthy side in the apogeotropic form. The authors describe five cases of another primitive and rare form of lateral BPPV, defined as "direction-fixed paroxysmal nystagmus lateral canal BPPV", which has previously been described by other authors as a transitory step observed during the transformation from an apogeotropic into a geotropic form. It is characterized by typical BPPV symptoms and diagnosed by the presence of a paroxysmal horizontal unidirectional positioning nystagmus, evoked through Pagnini-McClure's test, which is apogeotropic on the affected side and geotropic on the healthy side. In the reported cases, direction-fixed horizontal paroxysmal nystagmus was always transformed into a typical geotropic form. The clinical features and pathophysiology of direction-fixed nystagmus lateral canal BPPV are discussed.
BibTeX: @article{Califano2013, author = {Califano, L and Vassallo, A and Melillo, M G and Mazzone, S and Salafia, F}, title = {Direction-fixed paroxysmal nystagmus lateral canal benign paroxysmal positioning vertigo (BPPV): another form of lateral canalolithiasis.}, journal = {Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale}, year = {2013}, volume = {33}, issue = {4}, pages = {254--260}, keywords = {Benign Paroxysmal Positional Vertigo; Ear Diseases, complications; Female; Humans; Lithiasis; Male; Middle Aged; Otolithic Membrane; Semicircular Canals; Vertigo, diagnosis, etiology; Direction-fixed nystagmus; Horizontal canalolithiasis; Lateral Apogeotropic canalolithiasis; Lateral canalolithiasis; Lateral geotropic canalolithiasis}, pmid = {24043913} }
Jannetta, P.J., Møller, M.B. and Møller, A.R.	Disabling positional vertigo. [Abstract] [BibTeX]	1984	The New England journal of medicine Vol. 310(26), pp. 1700-1705	article	DOI
Abstract: We have identified a group of patients with vestibular disorders whose symptoms are not consistent with the commonly recognized syndromes such as Meniere's disease, benign paroxysmal positional vertigo, and vestibular neuronitis. These patients have a constant positional vertigo and are often nauseated to an extent that makes them disabled. Their symptoms do not respond to conventional medical treatment or habituating therapy. We have found specific clinical-pathological signs in these patients that indicate that the vestibular nerve is compressed intracranially by blood vessels. Treatment of nine such patients by microvascular decompression of the eighth nerve brought total relief of symptoms in eight patients and improvement in one. We suggest that this syndrome be named disabling positional vertigo.
BibTeX: @article{Jannetta1984, author = {Jannetta, P J and Møller, M B and Møller, A R}, title = {Disabling positional vertigo.}, journal = {The New England journal of medicine}, year = {1984}, volume = {310}, issue = {26}, pages = {1700--1705}, doi = {https://doi.org/10.1056/NEJM198406283102604}, keywords = {Adult; Cerebellopontine Angle, surgery; Female; Head; Humans; Male; Microsurgery, methods; Middle Aged; Nerve Compression Syndromes, etiology; Neurologic Examination; Posture; Tinnitus, complications; Vertigo, diagnosis, etiology, surgery; Vestibular Nerve, surgery; Vestibulocochlear Nerve, surgery}, pmid = {6610127} }
Newman-Toker, D.E., Camargo, C.A., Hsieh, Y.-H., Pelletier, A.J. and Edlow, J.A.	Disconnect between charted vestibular diagnoses and emergency department management decisions: a cross-sectional analysis from a nationally representative sample. [Abstract] [BibTeX]	2009	Academic emergency medicine : official journal of the Society for Academic Emergency Medicine Vol. 16(10), pp. 970-977	article	DOI
Abstract: The most common vestibular disorders seen in the emergency department (ED) are benign paroxysmal positional vertigo (BPPV) and acute peripheral vestibulopathy (APV; i.e., vestibular neuritis or labyrinthitis). BPPV and APV are two very distinct disorders that have different clinical presentations that require different diagnostic and treatment strategies. BPPV can be diagnosed without imaging and is treated with canalith-repositioning maneuvers. APV sometimes requires neuroimaging by magnetic resonance imaging (MRI) to exclude posterior fossa stroke mimics and should be treated with vestibular sedatives and corticosteroids. We sought to determine if emergency physicians (EPs) apply best practices to diagnose and treat these common vestibular disorders. This was a cross-sectional study of ED visits from the National Hospital Ambulatory Medical Care Survey (NHAMCS). A weighted sample of U.S. ED visits (1993-2005) was used. Patients at least 16 years of age who were given a final ED diagnosis of BPPV (International Classification of Diseases, 9th Revision [ICD-9], 386.11) or APV (ICD-9 386.12 or 386.3x) comprised the study population. The frequency of imaging and drug therapy in those diagnosed as BPPV or APV versus controls was the main outcome measure. A total of 9,472 dizzy patient visits were sampled over 13 years (weighted estimate 33.6 million U.S. ED visits over that period). A weighted estimate of 2.5 million patients (7.4%) were given a vestibular diagnosis, mostly BPPV (weighted 0.2 million) or APV (weighted 1.9 million). Patients given BPPV (19%) and APV (19%) diagnoses were more likely to undergo imaging (all by computed tomography [CT]) than controls (7%; p < 0.001). Patients given BPPV (58%) and APV (70%) diagnoses were more likely to receive meclizine than controls (0.1%; p < 0.001). Corticosteroid administration was rarely documented (2% BPPV, 1% APV). Patients given a vestibular diagnosis in the ED may not be managed optimally. Patients given BPPV and APV diagnoses undergo imaging (predominantly CT) with equal frequency, suggesting overuse of CT (BPPV) and probably underuse of MRI (APV). Most patients diagnosed with BPPV are given meclizine, which is not indicated. Specific therapy for APV (corticosteroids) is probably underutilized. Educational initiatives and clinical guidelines merit consideration.
BibTeX: @article{Newman-Toker2009, author = {Newman-Toker, David E and Camargo, Carlos A and Hsieh, Yu-Hsiang and Pelletier, Andrea J and Edlow, Jonathan A}, title = {Disconnect between charted vestibular diagnoses and emergency department management decisions: a cross-sectional analysis from a nationally representative sample.}, journal = {Academic emergency medicine : official journal of the Society for Academic Emergency Medicine}, year = {2009}, volume = {16}, issue = {10}, pages = {970--977}, doi = {https://doi.org/10.1111/j.1553-2712.2009.00523.x}, keywords = {Adolescent; Adult; Aged; Cross-Sectional Studies; Decision Making; Diagnostic Imaging; Emergency Service, Hospital, statistics & numerical data; Female; Health Care Surveys; Humans; Male; Middle Aged; Outcome Assessment (Health Care); Practice Patterns, Physicians', statistics & numerical data; United States; Vertigo, diagnosis, drug therapy; Vestibular Neuronitis, diagnosis, drug therapy}, pmid = {19799573} }
Kentala, E., Laurikkala, J., Pyykkö, I. and Juhola, M.	Discovering diagnostic rules from a neurotologic database with genetic algorithms. [Abstract] [BibTeX]	1999	The Annals of otology, rhinology, and laryngology Vol. 108(10), pp. 948-954	article	DOI
Abstract: Data on patients with Meniere's disease, vestibular schwannoma, traumatic vertigo, sudden deafness, benign paroxysmal positional vertigo, or vestibular neuritis were retrieved from the database of otoneurologic expert system ONE for the development and testing of a genetic algorithm (GA). The accuracy of the diagnostic rules in solving the test cases was 81%, 91%, 92%, 95%, 96%, and 98% for the respective diseases. The best rules retrieved from the GA were described by a set of questions with the most likely answers. The most important questions concerned the duration of hearing loss and the occurrence of head injury. The validity and structure of the rules created with a GA can be analyzed in detail. For rare diseases, some other reasoning process can be used, for example, case-based reasoning.
BibTeX: @article{Kentala1999, author = {Kentala, E and Laurikkala, J and Pyykkö, I and Juhola, M}, title = {Discovering diagnostic rules from a neurotologic database with genetic algorithms.}, journal = {The Annals of otology, rhinology, and laryngology}, year = {1999}, volume = {108}, issue = {10}, pages = {948--954}, doi = {https://doi.org/10.1177/000348949910801005}, keywords = {Algorithms; Artificial Intelligence; Databases as Topic; Diagnosis, Differential; Diagnostic Techniques and Procedures; Ear Diseases, diagnosis, genetics; Genetics; Humans}, pmid = {10526849} }
Young, A.S., Rosengren, S.M. and Welgampola, M.S.	Disorders of the inner-ear balance organs and their pathways. [Abstract] [BibTeX]	2018	Handbook of clinical neurology Vol. 159, pp. 385-401	article	DOI
Abstract: Disorders of the inner-ear balance organs can be grouped by their manner of presentation into acute, episodic, or chronic vestibular syndromes. A sudden unilateral vestibular injury produces severe vertigo, nausea, and imbalance lasting days, known as the acute vestibular syndrome (AVS). A bedside head impulse and oculomotor examination helps separate vestibular neuritis, the more common and innocuous cause of AVS, from stroke. Benign positional vertigo, a common cause of episodic positional vertigo, occurs when otoconia overlying the otolith membrane falls into the semicircular canals, producing brief spells of spinning vertigo triggered by head movement. Benign positional vertigo is diagnosed by a positional test, which triggers paroxysmal positional nystagmus in the plane of the affected semicircular canal. Episodic spontaneous vertigo caused by vestibular migraine and Ménière's disease can sometimes prove hard to separate. Typically, Ménière's disease is associated with spinning vertigo lasting hours, aural fullness, tinnitus, and fluctuating hearing loss while VM can produce spinning, rocking, or tilting sensations and light-headedness lasting minutes to days, sometimes but not always associated with migraine headaches or photophobia. Injury to both vestibular end-organs results in ataxia and oscillopsia rather than vertigo. Head impulse testing, dynamic visual acuity, and matted Romberg tests are abnormal while conventional neurologic assessments are normal. A defect in the bony roof overlying the superior semicircular canal produces vertigo and oscillopsia provoked by loud sound and pressure (when coughing or sneezing). Three-dimensional temporal bone computed tomography scan and vestibular evoked myogenic potential testing help confirm the diagnosis of superior canal dehiscence. Collectively, these clinical syndromes account for a large proportion of dizzy and unbalanced patients.
BibTeX: @article{Young2018a, author = {Young, Allison S and Rosengren, Sally M and Welgampola, Miriam S}, title = {Disorders of the inner-ear balance organs and their pathways.}, journal = {Handbook of clinical neurology}, year = {2018}, volume = {159}, pages = {385--401}, doi = {https://doi.org/10.1016/B978-0-444-63916-5.00025-2}, keywords = {BPV; Ménière's disease; vertigo; vestibular migraine}, pmid = {30482329} }
Kim, M.-B., Huh, S.H. and Ban, J.H.	Diversity of head shaking nystagmus in peripheral vestibular disease. [Abstract] [BibTeX]	2012	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 33(4), pp. 634-639	article	DOI
Abstract: To evaluate the characteristics of head shaking nystagmus in various peripheral vestibular diseases. Retrospective case series. Tertiary referral center. Data of 235 patients with peripheral vestibular diseases including vestibular neuritis, Ménière's disease, and benign paroxysmal positional vertigo, were retrospectively analyzed. All subjects presented between August 2009 and July 2010. Patients were tested for vestibular function including head shaking nystagmus and caloric information. Regarding vestibular neuritis, all tests were again performed during the 1-month follow-up. Head shaking nystagmus was classified as monophasic or biphasic and, according to the affected ear, was divided as ipsilesional or contralesional. Of the 235 patients, 87 patients revealed positive head shaking nystagmus. According to each disease, positive rates of head shaking nystagmus were as follows: 35 (100%) of 35 cases of vestibular neuritis, 11 (68.8%) of 16 cases of Ménière's disease, and 41 (22.2%) of 184 cases of benign paroxysmal positional vertigo. All cases of vestibular neuritis initially presented as a monophasic, contralesional beating, head shaking nystagmus. However, 1 month after first visit, the direction of nystagmus was changed to biphasic (contralesional first then ipsilesional beating) in 25 cases (72.5%) but not in 10 cases (27.5%). There was a significant correlation between the degree of initial caloric weakness and the biphasic conversion of head shaking nystagmus (p = 0.02). In 72.5% of vestibular neuritis cases, head shaking nystagmus was converted to biphasic during the subacute period. The larger the initial canal paresis was present, the more frequent the biphasic conversion of head shaking nystagmus occurred. However, Ménière's disease and benign paroxysmal positional vertigo did not have specific patterns of head shaking nystagmus.
BibTeX: @article{Kim2012b, author = {Kim, Min-Beom and Huh, Se Hyung and Ban, Jae Ho}, title = {Diversity of head shaking nystagmus in peripheral vestibular disease.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2012}, volume = {33}, issue = {4}, pages = {634--639}, doi = {https://doi.org/10.1097/MAO.0b013e31824950c7}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo; Caloric Tests; Female; Follow-Up Studies; Head, physiology; Humans; Male; Meniere Disease, complications; Middle Aged; Nystagmus, Pathologic, complications, diagnosis, physiopathology; Retrospective Studies; Vertigo, complications; Vestibular Diseases, complications; Vestibular Neuronitis, complications}, pmid = {22525213} }
Syed, I., Ahmed, W. and Selvadurai, D.	Dix-Hallpike and Epley manoeuvres. [BibTeX]	2012	British journal of hospital medicine (London, England : 2005) Vol. 73(10), pp. C149-C151	article
BibTeX: @article{Syed2012, author = {Syed, Irfan and Ahmed, Waseem and Selvadurai, David}, title = {Dix-Hallpike and Epley manoeuvres.}, journal = {British journal of hospital medicine (London, England : 2005)}, year = {2012}, volume = {73}, issue = {10}, pages = {C149--C151}, keywords = {Benign Paroxysmal Positional Vertigo; Humans; Musculoskeletal Manipulations, methods; Patient Positioning, methods; Physical Examination; Semicircular Canals, anatomy & histology; Vertigo, therapy}, pmid = {23124198} }
Prokopakis, E.P., Lachanas, V.A., Christodoulou, P.N. and Velegrakis, G.A.	Dizziness after canalith repositioning procedure for benign paroxysmal positional vertigo. [BibTeX]	2007	Auris, nasus, larynx Vol. 34(3), pp. 435; author reply 437	article	DOI
BibTeX: @article{Prokopakis2007, author = {Prokopakis, Emmanuel P and Lachanas, Vassilios A and Christodoulou, Panagiotis N and Velegrakis, George A}, title = {Dizziness after canalith repositioning procedure for benign paroxysmal positional vertigo.}, journal = {Auris, nasus, larynx}, year = {2007}, volume = {34}, issue = {3}, pages = {435; author reply 437}, doi = {https://doi.org/10.1016/j.anl.2007.03.012}, keywords = {Dizziness, etiology, physiopathology; Humans; Otolithic Membrane, physiology; Saccule and Utricle, physiopathology; Semicircular Canals, physiopathology; Vertigo, physiopathology, rehabilitation}, pmid = {17482398} }
Iwasaki, S. and Yamasoba, T.	Dizziness and Imbalance in the Elderly: Age-related Decline in the Vestibular System. [Abstract] [BibTeX]	2015	Aging and disease Vol. 6(1), pp. 38-47	article	DOI
Abstract: Dizziness and imbalance are amongst the most common complaints in older people, and are a growing public health concern since they put older people at a significantly higher risk of falling. Although the causes of dizziness in older people are multifactorial, peripheral vestibular dysfunction is one of the most frequent causes. Benign paroxysmal positional vertigo is the most frequent form of vestibular dysfunction in the elderly, followed by Meniere's disease. Every factor associated with the maintenance of postural stability deteriorates during aging. Age-related deterioration of peripheral vestibular function has been demonstrated through quantitative measurements of the vestibulo-ocular reflex with rotational testing and of the vestibulo-collic reflex with testing of vestibular evoked myogenic potentials. Age-related decline of vestibular function has been shown to correlate with the age-related decrease in the number of vestibular hair cells and neurons. The mechanism of age-related cellular loss in the vestibular endorgan is unclear, but it is thought that genetic predisposition and cumulative effect of oxidative stress may both play an important role. Since the causes of dizziness in older people are multi-factorial, management of this disease should be customized according to the etiologies of each individual. Vestibular rehabilitation is found to be effective in treating both unilateral and bilateral vestibular dysfunction. Various prosthetic devices have also been developed to improve postural balance in older people. Although there have been no medical treatments improving age-related vestibular dysfunction, new medical treatments such as mitochondrial antioxidants or caloric restriction, which have been effective in preventing age-related hearing loss, should be ienvestigated in the future.
BibTeX: @article{Iwasaki2015, author = {Iwasaki, Shinichi and Yamasoba, Tatsuya}, title = {Dizziness and Imbalance in the Elderly: Age-related Decline in the Vestibular System.}, journal = {Aging and disease}, year = {2015}, volume = {6}, issue = {1}, pages = {38--47}, doi = {https://doi.org/10.14336/AD.2014.0128}, keywords = {aging; fall; rehabilitation; vestibular}, pmid = {25657851} }
Wipperman, J.	Dizziness and vertigo. [Abstract] [BibTeX]	2014	Primary care Vol. 41(1), pp. 115-131	article	DOI
Abstract: Dizziness is a common and challenging condition seen in the primary care office. Because dizziness is a vague term that can include a wide array of medical disorders, it is important to use a stepwise approach to differentiate between causes. This article focuses on vertigo and its four most common causes: benign paroxysmal peripheral vertigo, vestibular neuritis, vestibular migraine, and Meniere's disease.
BibTeX: @article{Wipperman2014, author = {Wipperman, Jennifer}, title = {Dizziness and vertigo.}, journal = {Primary care}, year = {2014}, volume = {41}, issue = {1}, pages = {115--131}, doi = {https://doi.org/10.1016/j.pop.2013.10.004}, keywords = {Benign Paroxysmal Positional Vertigo; Diagnosis, Differential; Dizziness, etiology; Humans; Labyrinthitis, complications, diagnosis, therapy; Meniere Disease, complications, diagnosis, therapy; Migraine Disorders, complications, diagnosis; Vertigo, diagnosis, etiology, therapy; Acute labyrinthitis; Benign paroxysmal peripheral vertigo; Meniere's disease; Migrainous vertigo; Vestibular migraine; Vestibular neuritis}, pmid = {24439886} }
Rah, Y.C., Park, J.H., Park, J.H., Choi, B.Y. and Koo, J.-W.	Dizziness and vestibular function before and after cochlear implantation. [Abstract] [BibTeX]	2016	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 273(11), pp. 3615-3621	article	DOI
Abstract: Vestibular problems after cochlear implantation (CI) were explored by categorizing them according to clinical course and changes in objective vestibular function. The changes in vestibular function of 62 patients (66 ears) were analyzed and vestibular symptoms were divided into three categories by their time course and nature. Etiologies were determined by analyzing the symptoms in combination with changes in objective vestibular function, measured using the caloric and/or video head impulse test. Before surgery, vestibular function was normal in 31 cases (47.0 %), unilaterally hypofunctional in 14 (21.2 %), and bilaterally hypofunctional in 21 (31.8 %). Eight cases (12.1 %) reported dizziness before surgery. A total of 18 cases (27.3 %) experienced postoperative dizziness. Ten patients experienced immediate transient dizziness (including 2 cases of benign positional paroxysmal vertigo); four experienced immediate prolonged dizziness (including 3 cases of bilateral vestibular hypofunction); and four experienced recurrent episodic dizziness (including 3 cases of suspicious endolymphatic hydrops). The sums of the maximal slow-phase velocities (SPVs) of the implanted ears were changed from 22.70 ± 17.31 to 12.55 ± 12.02°/s after implantation (p = 0.004) with very little changes in the other side (32.65 ± 24.85-31.40 ± 29.10°/s). Careful review of vestibular status is an important step, especially when deciding implantation in the only vestibular functioning ear or bilateral implantation.
BibTeX: @article{Rah2016, author = {Rah, Yoon Chan and Park, Joo Hyun and Park, Jae Hong and Choi, Byung Yoon and Koo, Ja-Won}, title = {Dizziness and vestibular function before and after cochlear implantation.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2016}, volume = {273}, issue = {11}, pages = {3615--3621}, doi = {https://doi.org/10.1007/s00405-016-3988-3}, keywords = {Adult; Caloric Tests; Cochlear Implantation, adverse effects; Dizziness, etiology; Endolymphatic Hydrops, diagnosis; Female; Head Impulse Test; Humans; Male; Middle Aged; Postoperative Complications; Preoperative Period; Vestibular Diseases, diagnosis; Cochlear implantation; Dizziness; Vestibular function}, pmid = {27001256} }
Davies, R.A. and Luxon, L.M.	Dizziness following head injury: a neuro-otological study. [Abstract] [BibTeX]	1995	Journal of neurology Vol. 242(4), pp. 222-230	article
Abstract: Dizziness is a frequent and debilitating complications of head injury and accounts for increasing numbers of medico-legal claims. A detailed neuro-otological study was carried out from the records of 100 patients with post-traumatic dizziness to explore the neuro-otological basis of their symptoms: 50 patients presenting for medico-legal purposes (group I) and 50 presenting for management of their vestibular symptoms (group II). The two groups showed a similar sex distribution, a similar range of causes of head injury and similar severity of head injury (72 minor, 24 moderate and 4 severe). Of the 100, 88 showed at least one audio-vestibular abnormality on testing. Vertigo of the benign positional paroxysmal type was the commonest vestibular diagnosis in both groups (61/100), and only 8 patients showed central vestibular abnormalities. Fifty-three patients had audiometric abnormalities attributable to the head injury, the commonest of which was a high-tone sensorineural hearing loss. There was no significant difference in the incidence of any of the abnormalities in the medico-legal group (group I) when compared with the symptom management group (group II). The results provide strong evidence for an organic basis to recurring dizziness after head injury, whether or not a claim for compensation is pending, and emphasize the need for specialist neuro-otological investigation if abnormalities are to be identified and managed correctly.
BibTeX: @article{Davies1995, author = {Davies, R A and Luxon, L M}, title = {Dizziness following head injury: a neuro-otological study.}, journal = {Journal of neurology}, year = {1995}, volume = {242}, issue = {4}, pages = {222--230}, keywords = {Adult; Craniocerebral Trauma, complications; Dizziness, etiology; Evaluation Studies as Topic; Female; Forensic Medicine; Hearing Disorders, epidemiology, etiology; Humans; Male; Middle Aged; Posture, physiology; Retrospective Studies; Sex Distribution; Vertigo, epidemiology, etiology; Vestibular Function Tests}, pmid = {7798121} }
Das, S., Chakraborty, S. and Shekar, S.	Dizziness in a Tertiary Care Centre in Sikkim: Our Experience and Limitations. [Abstract] [BibTeX]	2017	Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India Vol. 69(4), pp. 443-448	article	DOI
Abstract: Dizziness is a common symptom and though most of the causes are benign yet some may be potentially life threatening. Diagnosis can be a challenge sometimes due to lack of dedicated vestibular lab and injudicious use of vestibular suppressant medications. A 2 year retrospective study of the hospital records from September 2014 to August 2016 was done to study the causes of dizziness and the limitations and challenges in the diagnosis. 75 complete records of patients presenting with dizziness were accessed and analysed. 54.7% of the patients were males and most patients were young adults. Most of the cases were benign and Benign paroxysmal positional vertigo was the commonest diagnosed case (20%). Potentially life threatening cases diagnosed were cerebellar infarct and posterior fossa space occupying lesion (5.3%). Complete evaluation of a dizzy patient must be done to arrive at a causal diagnosis. Injudicious use of vestibular sedatives should be discouraged. Proper training and education to the primary care physician should be imparted so that they can adopt a practical approach for evaluation and management of a dizzy person.
BibTeX: @article{Das2017, author = {Das, Soumyajit and Chakraborty, Suvamoy and Shekar, Sridutt}, title = {Dizziness in a Tertiary Care Centre in Sikkim: Our Experience and Limitations.}, journal = {Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India}, year = {2017}, volume = {69}, issue = {4}, pages = {443--448}, doi = {https://doi.org/10.1007/s12070-017-1221-3}, keywords = {Central vertigo; Cervicogenic; Dizziness; Migraine vestibulopathy; Peripheral vertigo; Positional; Rehabilitation; Suppressants}, pmid = {29238671} }
Faralli, M., Ricci, G., Ibba, M.C., Crognoletti, M., Longari, F. and Frenguelli, A.	Dizziness in patients with recent episodes of benign paroxysmal positional vertigo: real otolithic dysfunction or mental stress? [Abstract] [BibTeX]	2009	Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale Vol. 38(3), pp. 375-380	article
Abstract: Our goal was to verify the existence of otolithic dysfunction or mental stress in patients with dizziness following an episode of benign paroxysmal positional vertigo (BPPV) that was treated and resolved. Prospective study. Forty patients with BPPV were examined 2, 7, and 14 days after resolution. Based on residual symptoms reported during three follow-ups, they were classified as type A (with dizziness) or type B (without dizziness). During the first follow-up, they were asked to compile a self-rating anxiety scale (SAS), and we then determined subjective visual vertical (SVV). The determination of SVV was repeated during the subsequent follow-ups. For each patient, we also evaluated the rate of BPPV episodes that were recurrent and resistant to treatment and examined distribution by age and gender during the follow-ups. A comparison of type A (1.20 +/- 0.45) and type B (0.64 +/- 0.58) patients showed a significant difference in determining SVV only at the first follow-up (p = .002). Among type A patients, the rate of resistant BPPV was 75%, whereas the rate of recurrent BPPV was 100% at the third follow-up, during which the SAS revealed a significant increase (p = .005) among type A (52 +/- 3.74) versus type B (41.6 +/- 4.7) patients; the male to female ratio was 1:5 (type A) and 4:5 (type B), and the mean ages were, respectively, 56.4 +/- 4.98 and 43.6 +/- 10.2. Otolithic dysfunction explains only brief dizziness. The persistence of dizziness is correlated with mental stress that is affected by the duration and recurrence of BPPV, age, and gender.
BibTeX: @article{Faralli2009, author = {Faralli, Mario and Ricci, Giampietro and Ibba, Maria Cristina and Crognoletti, Marianna and Longari, Fabrizlo and Frenguelli, Antonio}, title = {Dizziness in patients with recent episodes of benign paroxysmal positional vertigo: real otolithic dysfunction or mental stress?}, journal = {Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale}, year = {2009}, volume = {38}, issue = {3}, pages = {375--380}, keywords = {Adult; Comorbidity; Dizziness, physiopathology, psychology; Female; Humans; Incidence; Male; Middle Aged; Prospective Studies; Recurrence; Stress, Psychological, epidemiology; Time Factors; Vertigo, epidemiology, physiopathology, psychology}, pmid = {19476771} }
van Leeuwen, R.B. and Bruintjes, T.D.	Dizziness in the elderly: diagnosing its causes in a multidisciplinary dizziness unit. [Abstract] [BibTeX]	2014	Ear, nose, & throat journal Vol. 93(4-5), pp. 162, 164, 166-162, 164, 167	article
Abstract: We conducted a study to determine the causes of dizziness in patients aged 70 years and older who had been referred to our multidisciplinary dizziness clinic between Nov. 1, 2000, and Dec. 31, 2008. This population was made up of 731 patients--254 men (34.7%) and 477 women (65.3%). During their consultations, all of these patients were evaluated simultaneously by an ENT surgeon and a neurologist. We were able to identify the cause of dizziness in 620 of these patients (84.8%). The two most common causes were benign paroxysmal positional vertigo (BPPV), which was found in 202 patients (27.6%), and hyperventilation/anxiety, which was diagnosed in 112 patients (15.3%). Based on our findings, we conclude that the cause of dizziness can be established in the vast majority of elderly patients. We also compare our findings in these older patients with those of a group of 2,556 younger patients who were seen at our hospital and with the findings reported in other studies.
BibTeX: @article{Leeuwen2014, author = {van Leeuwen, Roeland B and Bruintjes, Tjasse D}, title = {Dizziness in the elderly: diagnosing its causes in a multidisciplinary dizziness unit.}, journal = {Ear, nose, & throat journal}, year = {2014}, volume = {93}, issue = {4-5}, pages = {162, 164, 166--162, 164, 167}, keywords = {Aged; Anxiety, complications, diagnosis; Benign Paroxysmal Positional Vertigo, complications, diagnosis; Dizziness, etiology; Female; Humans; Hyperventilation, complications, diagnosis; Male; Meniere Disease, complications, diagnosis; Migraine Disorders, complications, diagnosis; Neurology; Otolaryngology; Referral and Consultation; Vestibular Neuronitis, complications, diagnosis}, pmid = {24817230} }
Royl, G., Ploner, C.J. and Leithner, C.	Dizziness in the emergency room: diagnoses and misdiagnoses. [Abstract] [BibTeX]	2011	European neurology Vol. 66(5), pp. 256-263	article	DOI
Abstract: Dizziness is among the most frequent neurological chief complaints in emergency room (ER) patients. Although the majority of underlying disorders are benign, serious causes that require immediate in-hospital treatment may occur that are difficult to identify clinically. Retrospective study of 475 consecutive ER neurological consultations with dizziness as the chief complaint. Of all ER dizziness patients, 73% were initially assigned to benign and 27% to serious diagnoses. The two most frequent disorders were benign paroxysmal positional vertigo (22%) and stroke (20%). On follow-up (available in 124 patients), 43% of all ER diagnoses were corrected: 6% of benign ER diagnoses were corrected to serious diagnoses, 23% of serious ER diagnoses were revised to benign. The most frequent corrections concerned patients with an ER diagnosis of stroke or vestibular neuronitis. In the patient sample studied here, serious causes of dizziness were more prevalent than can be expected from population-based surveys or data from specialized outpatient departments. However, inappropriate assignment of dizziness patients to benign diagnoses still occurred in a relevant proportion of patients. ER clinical pathways, planning of imaging resources and follow-up of patients in- and outside the hospital must take these points into consideration.
BibTeX: @article{Royl2011, author = {Royl, Georg and Ploner, Christoph J and Leithner, Christoph}, title = {Dizziness in the emergency room: diagnoses and misdiagnoses.}, journal = {European neurology}, year = {2011}, volume = {66}, issue = {5}, pages = {256--263}, doi = {https://doi.org/10.1159/000331046}, keywords = {Diagnostic Errors; Dizziness, diagnosis, epidemiology; Emergency Service, Hospital, statistics & numerical data; Female; Follow-Up Studies; Humans; Male; Middle Aged; Retrospective Studies}, pmid = {21986277} }
Fife, T.D.	Dizziness in the Outpatient Care Setting. [Abstract] [BibTeX]	2017	Continuum (Minneapolis, Minn.) Vol. 23(2, Selected Topics in Outpatient Neurology), pp. 359-395	article	DOI
Abstract: This article summarizes an approach to evaluating dizziness for the general neurologist and reviews common and important causes of dizziness and vertigo. Improved methods of diagnosing patients with vertigo and dizziness have been evolving, including additional diagnostic criteria and characterization of some common conditions that cause dizziness (eg, vestibular migraine, benign paroxysmal positional vertigo, chronic subjective dizziness). Other uncommon causes of dizziness (eg, superior canal dehiscence syndrome, episodic ataxia type 2) have also been better clarified. Distinguishing between central and peripheral causes of vertigo can be accomplished reliably through history and examination, but imaging techniques have further added to accuracy. What has not changed is the necessity of obtaining a basic history of the patient's symptoms to narrow the list of possible causes. Dizziness and vertigo are extremely common symptoms that also affect function at home and at work. Improvements in the diagnosis and management of the syndromes that cause dizziness and vertigo will enhance patient care and cost efficiencies in a health care system with limited resources. Clinicians who evaluate patients with dizziness will serve their patient population well by continuing to manage patients with well-focused workup and attentive care.
BibTeX: @article{Fife2017a, author = {Fife, Terry D}, title = {Dizziness in the Outpatient Care Setting.}, journal = {Continuum (Minneapolis, Minn.)}, year = {2017}, volume = {23}, issue = {2, Selected Topics in Outpatient Neurology}, pages = {359--395}, doi = {https://doi.org/10.1212/CON.0000000000000450}, keywords = {Aged; Ambulatory Care; Dizziness, diagnosis, etiology, physiopathology; Female; Humans; Male; Middle Aged; Vertigo, diagnosis, etiology, physiopathology}, pmid = {28375910} }
Kerber, K.A., Callaghan, B.C., Telian, S.A., Meurer, W.J., Skolarus, L.E., Carender, W. and Burke, J.F.	Dizziness Symptom Type Prevalence and Overlap: A US Nationally Representative Survey. [Abstract] [BibTeX]	2017	The American journal of medicine Vol. 130(12), pp. 1465.e1-1465.e9	article	DOI
Abstract: The traditional approach to dizziness encourages providers to emphasize the type of dizziness. However, symptom types might substantially overlap in individual patients, thus limiting the clinical value of this approach. We aimed to describe the overlap of types of dizziness using a US nationally representative sample. The 2008 US National Health Interview Survey was examined for prevalence and overlap of types of dizziness. The data were also separately examined among people who otherwise had typical features of traditionally vertigo-based disorders (ie, benign paroxysmal positional vertigo and Meniere's disease). Data analysis also included exploratory factor analysis. Twelve-month prevalence of problems with dizziness or balance was 14.8%, representing 33.4 million individuals. The mean number of dizziness symptoms was 2.4 (95% confidence interval [CI], 2.3-2.4), with 61.1% reporting more than one type. Of subjects who otherwise had typical features of traditionally vertigo-based disorders, the mean number of dizziness types was 3.1 (95% CI, 3.0-3.3), and only 24.6% (95% CI, 21.0%-28.7%) reported vertigo as the primary type. Exploratory factor analysis found that symptom types loaded onto a single factor without other clinical or demographic variables. Substantial overlap of dizziness types exists among US adults with dizziness. People otherwise having features of traditionally vertigo-based disorders also typically report multiple dizziness types and do not typically report vertigo as the primary type. Symptom types correlate more strongly with each other than with other clinical or demographic variables. These findings suggest that the traditional emphasis on dizziness types is likely of limited clinical utility.
BibTeX: @article{Kerber2017, author = {Kerber, Kevin A and Callaghan, Brian C and Telian, Steven A and Meurer, William J and Skolarus, Lesli E and Carender, Wendy and Burke, James F}, title = {Dizziness Symptom Type Prevalence and Overlap: A US Nationally Representative Survey.}, journal = {The American journal of medicine}, year = {2017}, volume = {130}, issue = {12}, pages = {1465.e1--1465.e9}, doi = {https://doi.org/10.1016/j.amjmed.2017.05.048}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Dizziness, classification, diagnosis, epidemiology; Female; Health Surveys; Humans; Male; Middle Aged; Prevalence; Symptom Assessment; United Nations; Young Adult; Dizziness; Population health; Symptoms; Vertigo; Vestibular}, pmid = {28739195} }
Philip, R. and Prepageran, N.	Dizziness, a review of walk-in patients at a specialised neurotology clinic. [Abstract] [BibTeX]	2009	The Medical journal of Malaysia Vol. 64(1), pp. 56-58	article
Abstract: A retrospective review of 100 walk-in patients at a specialized neurotology clinic in dizziness at a tertiary referral centre is presented. The most common cause of dizziness was BPPV, forming 31% of the cases. Other causes in order of frequency include recurrent vestibulopathy, idiopathic causes, Meniere's disease and central causes.
BibTeX: @article{Philip2009, author = {Philip, R and Prepageran, N}, title = {Dizziness, a review of walk-in patients at a specialised neurotology clinic.}, journal = {The Medical journal of Malaysia}, year = {2009}, volume = {64}, issue = {1}, pages = {56--58}, keywords = {Adolescent; Adult; Aged; Child; Dizziness, etiology; Female; Humans; Male; Middle Aged; Retrospective Studies; Vertigo, complications; Vestibular Neuronitis, complications}, pmid = {19852323} }
Mendel, B., Bergenius, J. and Langius-Eklöf, A.	Dizziness: A common, troublesome symptom but often treatable. [Abstract] [BibTeX]	2010	Journal of vestibular research : equilibrium & orientation Vol. 20(5), pp. 391-398	article	DOI
Abstract: To investigate the prevalence of self-rated dizziness/unsteadiness and health as well as to estimate the proportion of participants with peripheral vestibular disorders. Altogether, 2547 participants (66%) participated in an epidemiological cross-sectional study, including self-rated questions about dizziness/unsteadiness, concomitant auditory symptoms and self-rated general, psychosocial and mental health. The overall prevalence of dizziness was 21% and higher among women (27%) than men (14%) (p< 0.001). Dizziness, provoked by the movement of lying-down (benign paroxysmal positional vertigo), was noted in 5% of the participants with the symptom occurring more often in women than in men (p< 0.001). Twenty-four percent of the men and 21% of the women with dizziness simultaneously experienced a sense of rotation and loss of hearing and tinnitus. Fifteen percent reported falls because of dizziness. Both men and women suffering from dizziness symptoms perceived worse self-rated health generally, psychosocially and mentally than those without symptoms of dizziness (p< 0.001). Dizziness-related symptoms are common in all age groups and may manifest worse self-rated health. About 50% of the participants had symptoms indicating origin of peripheral vestibular disorders. Self-rated questions seem capable of identifying patients for referral to clinical examinations and subsequently those who can be successfully treated.
BibTeX: @article{Mendel2010, author = {Mendel, Barbro and Bergenius, Johan and Langius-Eklöf, Ann}, title = {Dizziness: A common, troublesome symptom but often treatable.}, journal = {Journal of vestibular research : equilibrium & orientation}, year = {2010}, volume = {20}, issue = {5}, pages = {391--398}, doi = {https://doi.org/10.3233/VES-2010-0370}, keywords = {Adult; Aged; Cross-Sectional Studies; Dizziness, diagnosis, epidemiology, etiology; Female; Health Status; Humans; Male; Middle Aged; Prevalence; Quality of Life; Sweden, epidemiology; Tinnitus, complications; Vertigo, diagnosis; Vestibular Diseases, complications}, pmid = {20826938} }
Post, R.E. and Dickerson, L.M.	Dizziness: a diagnostic approach. [Abstract] [BibTeX]	2010	American family physician Vol. 82(4), pp. 361-8, 369	article
Abstract: Dizziness accounts for an estimated 5 percent of primary care clinic visits. The patient history can generally classify dizziness into one of four categories: vertigo, disequilibrium, presyncope, or lightheadedness. The main causes of vertigo are benign paroxysmal positional vertigo, Meniere disease, vestibular neuritis, and labyrinthitis. Many medications can cause presyncope, and regimens should be assessed in patients with this type of dizziness. Parkinson disease and diabetic neuropathy should be considered with the diagnosis of disequilibrium. Psychiatric disorders, such as depression, anxiety, and hyperventilation syndrome, can cause vague lightheadedness. The differential diagnosis of dizziness can be narrowed with easy-to-perform physical examination tests, including evaluation for nystagmus, the Dix-Hallpike maneuver, and orthostatic blood pressure testing. Laboratory testing and radiography play little role in diagnosis. A final diagnosis is not obtained in about 20 percent of cases. Treatment of vertigo includes the Epley maneuver (canalith repositioning) and vestibular rehabilitation for benign paroxysmal positional vertigo, intratympanic dexamethasone or gentamicin for Meniere disease, and steroids for vestibular neuritis. Orthostatic hypotension that causes presyncope can be treated with alpha agonists, mineralocorticoids, or lifestyle changes. Disequilibrium and lightheadedness can be alleviated by treating the underlying cause.
BibTeX: @article{Post2010, author = {Post, Robert E and Dickerson, Lori M}, title = {Dizziness: a diagnostic approach.}, journal = {American family physician}, year = {2010}, volume = {82}, issue = {4}, pages = {361--8, 369}, keywords = {Diagnosis, Differential; Dizziness, chemically induced, diagnosis, etiology; Humans; Medical History Taking; Physical Examination; Postural Balance; Syncope, diagnosis; Vertigo, diagnosis}, pmid = {20704166} }
Muncie, H.L., Sirmans, S.M. and James, E.	Dizziness: Approach to Evaluation and Management. [Abstract] [BibTeX]	2017	American family physician Vol. 95(3), pp. 154-162	article
Abstract: Dizziness is a common yet imprecise symptom. It was traditionally divided into four categories based on the patient's history: vertigo, presyncope, disequilibrium, and light-headedness. However, the distinction between these symptoms is of limited clinical usefulness. Patients have difficulty describing the quality of their symptoms but can more consistently identify the timing and triggers. Episodic vertigo triggered by head motion may be due to benign paroxysmal positional vertigo. Vertigo with unilateral hearing loss suggests Meniere disease. Episodic vertigo not associated with any trigger may be a symptom of vestibular neuritis. Evaluation focuses on determining whether the etiology is peripheral or central. Peripheral etiologies are usually benign. Central etiologies often require urgent treatment. The HINTS (head-impulse, nystagmus, test of skew) examination can help distinguish peripheral from central etiologies. The physical examination includes orthostatic blood pressure measurement, a full cardiac and neurologic examination, assessment for nystagmus, and the Dix-Hallpike maneuver. Laboratory testing and imaging are not required and are usually not helpful. Benign paroxysmal positional vertigo can be treated with a canalith repositioning procedure (e.g., Epley maneuver). Treatment of Meniere disease includes salt restriction and diuretics. Symptoms of vestibular neuritis are relieved with vestibular suppressant medications and vestibular rehabilitation.
BibTeX: @article{Muncie2017, author = {Muncie, Herbert L and Sirmans, Susan M and James, Ernest}, title = {Dizziness: Approach to Evaluation and Management.}, journal = {American family physician}, year = {2017}, volume = {95}, issue = {3}, pages = {154--162}, keywords = {Benign Paroxysmal Positional Vertigo, complications, diagnosis, therapy; Diagnosis, Differential; Dizziness, diagnosis, etiology, therapy; Humans; Meniere Disease, complications, diagnosis, therapy; Migraine Disorders, complications, diagnosis, therapy; Physical Examination; Postural Balance; Syncope, diagnosis, etiology, therapy; Vertebrobasilar Insufficiency, complications, diagnosis, therapy; Vestibular Neuronitis, complications, diagnosis, therapy}, pmid = {28145669} }
	Dizziness: increased risk for fractures. [Abstract] [BibTeX]	2015	The Journal of orthopaedic and sports physical therapy Vol. 45(5), pp. 413	article	DOI
Abstract: Dizziness is a common problem that can affect a person at any age. One common, easily treatable cause of transient dizziness is called "benign paroxysmal positional vertigo," or BPPV. Dizziness can negatively affect one's quality of life and is associated with an increased risk of falls. This may be especially problematic for older people, who have a greater chance of falling and breaking bones. A study published in the May 2015 issue of JOSPT investigated whether BPPV is associated with an increased risk of falls that result in fractures.
BibTeX: @article{2015,, title = {Dizziness: increased risk for fractures.}, journal = {The Journal of orthopaedic and sports physical therapy}, year = {2015}, volume = {45}, issue = {5}, pages = {413}, doi = {https://doi.org/10.2519/jospt.2015.0502}, keywords = {Benign Paroxysmal Positional Vertigo, complications; Dizziness, complications, etiology; Fractures, Bone, etiology; Humans; Risk Factors; BPPV; age; benign paroxysmal positional vertigo; falls}, pmid = {25929161} }
Whitman, G.T.	Dizziness. [Abstract] [BibTeX]	2018	The American journal of medicine Vol. 131(12), pp. 1431-1437	article	DOI
Abstract: Dizziness is a common symptom encountered by all physicians. Dizziness and related symptoms are frequently linked to 1 or more of a list of contributors that includes benign paroxysmal positional vertigo, Ménière disease, migraine, acute peripheral vestibulopathy, cerebral ischemia, and anxiety disorders. Awareness of these common clinical patterns increases the likelihood of making a rapid, accurate diagnosis.
BibTeX: @article{Whitman2018, author = {Whitman, Gregory T}, title = {Dizziness.}, journal = {The American journal of medicine}, year = {2018}, volume = {131}, issue = {12}, pages = {1431--1437}, doi = {https://doi.org/10.1016/j.amjmed.2018.05.014}, keywords = {Dizziness; Vertigo; Vestibular}, pmid = {29859806} }
Baloh, R.W. and Baringer, J.R.	Dizzy patients: the varieties of vertigo. [Abstract] [BibTeX]	1998	Hospital practice (1995) Vol. 33(6), pp. 55-8, 61-3, passim; discussion 76-7	article
Abstract: Some vertigo results from acute viral labyrinthitis or a cerebrovascular event; many cases are due to loose particulate matter within the semicircular canals. In the vast majority of patients, a careful history and appropriate clinical tests will suffice to identify the cause of the vertigo--and with benign paroxysmal positional vertigo, a simple clinical maneuver can also provide a cure.
BibTeX: @article{Baloh1998a, author = {Baloh, R W and Baringer, J R}, title = {Dizzy patients: the varieties of vertigo.}, journal = {Hospital practice (1995)}, year = {1998}, volume = {33}, issue = {6}, pages = {55--8, 61-3, passim; discussion 76-7}, keywords = {Aged; Algorithms; Decision Trees; Diagnosis, Differential; Female; Humans; Ischemic Attack, Transient, complications; Labyrinthitis, complications; Male; Middle Aged; Posture; Vertigo, diagnosis, etiology, therapy; Vestibular Function Tests; Virus Diseases, complications}, pmid = {9636351} }
Fife, D. and FitzGerald, J.E.	Do patients with benign paroxysmal positional vertigo receive prompt treatment? Analysis of waiting times and human and financial costs associated with current practice. [Abstract] [BibTeX]	2005	International journal of audiology Vol. 44(1), pp. 50-57	article
Abstract: This study retrospectively analysed how 20 patients with posterior canal benign paroxysmal positional vertigo (BPPV) were managed from primary care, to treatment in tertiary care. The average time from first referral to treatment was 93 weeks, with an average of 58 weeks within primary care and 40 weeks within hospital care. At least 85% of cases had classical symptoms of BPPV and could have been easily identified by Primary Care Physicians at first referral, had they been trained to recognise and diagnose the condition. It was concluded that patients could be treated more efficiently and at less cost if the condition was identified at first referral in primary care, and treated in either primary care or dedicated BPPV clinics receiving referrals from primary care. A dedicated clinic for BPPV is recommended, which will substantially reduce waiting time for treatment and save primary care and hospitals time and money by avoiding unnecessary appointments and medication.
BibTeX: @article{Fife2005, author = {Fife, Debbie and FitzGerald, John E}, title = {Do patients with benign paroxysmal positional vertigo receive prompt treatment? Analysis of waiting times and human and financial costs associated with current practice.}, journal = {International journal of audiology}, year = {2005}, volume = {44}, issue = {1}, pages = {50--57}, keywords = {Adult; Aged; Aged, 80 and over; Ambulatory Care Facilities, statistics & numerical data; Efficiency; Family Practice, statistics & numerical data; Female; Financing, Personal, statistics & numerical data; Humans; Male; Middle Aged; Needs Assessment; Patient Admission, economics; Patient Care Team, economics; Quality of Life; Referral and Consultation, statistics & numerical data; Retrospective Studies; Vertigo, economics, therapy; Waiting Lists}, pmid = {15796102} }
Celikbilek, A., Tanik, N., Zararsiz, G. and Celikbilek, M.	Do platelet indices have a role in benign paroxysmal positional vertigo? [Abstract] [BibTeX]	2014	Neurological research Vol. 36(8), pp. 763-768	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is a frequently encountered condition that can severely affect quality of life. Present study was undertaken to investigate whether the platelet (PLT) indices, including mean platelet volume (MPV), platelet distribution width (PDW), and platelet crit (PCT), could serve as diagnostic tools in patients with BPPV. Consecutive 45 BPPV patients and age- and sex-matched 40 control subjects were enrolled in this cross-sectional prospective study. Benign paroxysmal positional vertigo patients underwent a complete audio-vestibular test battery including Dix-Hallpike maneuver. Routine laboratory analyses were performed in both of the groups. In BPPV patients, PLT, MPV, and PDW were found significantly higher than in controls (P < 0·05). Platelet and mean platelet volume were independently associated with BPPV (P = 0·002 and P < 0·001, respectively). Platelet and platelet crit were significantly higher in patients with BPPV involving the left labyrinth than in those with the right affected side (P < 0·05). Mean platelet volume and platelet distribution width were to be significantly higher in the BPPV patients with recurrent vertigo attack than in those with first-ever attack (P < 0·001). A cutoff value of 8·75 for MPV and 16·65 for PDW parameters were obtained to identify the recurrence in BPPV patients in the receiving operating characteristic (ROC) analysis. Elevated PLT indices were associated with BPPV requiring further efforts to better clarify this issue.
BibTeX: @article{Celikbilek2014, author = {Celikbilek, Asuman and Tanik, Nermin and Zararsiz, Gokmen and Celikbilek, Mehmet}, title = {Do platelet indices have a role in benign paroxysmal positional vertigo?}, journal = {Neurological research}, year = {2014}, volume = {36}, issue = {8}, pages = {763--768}, doi = {https://doi.org/10.1179/1743132813Y.0000000315}, keywords = {Adult; Benign Paroxysmal Positional Vertigo, blood, diagnosis, physiopathology; Blood Cell Count; Blood Platelets, metabolism, pathology; Cross-Sectional Studies; Female; Humans; Male; Platelet Count; Prospective Studies; Benign paroxysmal positional vertigo,; Mean platelet volume,; Platelet crit,; Platelet distribution width,; Platelet indices; Platelet,}, pmid = {24620977} }
Hanci, D., Ulusoy, S., Muluk, N.B. and Cingi, C.	Do viral infections have a role in benign paroxysmal positional vertigo? [Abstract] [BibTeX]	2015	B-ENT Vol. 11(3), pp. 211-218	article
Abstract: To investigate the role of viral infection in benign paroxysmal positional vertigo (BPPV). In this retrospective study, 483 patients with BPPV were included in the study group. The control group consisted of 461 healthy subjects. In both groups, serologic analysis of viral agents (HSV1, HSV2, Herpes zoster, EBV, CMV, adenovirus, influenza, and parainfluenza virus) was performed. With the exception of influenza and parainfluenza, all viral serology values were higher in the BBPV group than the control group. We also observed seasonal variation. The BPPV group exhibited elevated values for HSV1 and adenovirus in March and May, for Herpes zoster, adenovirus, and influenza in April, for HSV1 in June, and for HSV1 and CMV in September, compared to the control group. In October, the BPPV group showed increased values for all of the viruses studied, compared to the control group. BPPV is associated with positive viral serology, particularly during certain months of the year, mainly in spring and autumn. Viral infection might promote BPPV attacks due to the development of vestibulopathy or induce secondary BPPV via viral infection-related neurolabyrinthitis.
BibTeX: @article{Hanci2015, author = {Hanci, D and Ulusoy, S and Muluk, N B and Cingi, C}, title = {Do viral infections have a role in benign paroxysmal positional vertigo?}, journal = {B-ENT}, year = {2015}, volume = {11}, issue = {3}, pages = {211--218}, keywords = {Adolescent; Adult; Aged; Antibodies, Viral, analysis; Benign Paroxysmal Positional Vertigo, epidemiology, etiology; Child; Female; Follow-Up Studies; Humans; Incidence; Male; Middle Aged; Retrospective Studies; Turkey, epidemiology; Virus Diseases, complications, virology; Viruses, immunology; Young Adult}, pmid = {26601554} }
Wang, J., Chi, F.-L., Jia, X.-H., Tian, L. and Richard-Vitton, T.	Does benign paroxysmal positional vertigo explain age and gender variation in patients with vertigo by mechanical assistance maneuvers? [Abstract] [BibTeX]	2014	Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology Vol. 35(11), pp. 1731-1736	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is one of the most common peripheral vestibular diseases. The aim of this study was to explore the prevalence of BPPV in vertigo patients and the characteristics of BPPV in diagnosis and repositioning using mechanical assistance maneuvers and to analyze and summarize the reasons showing these characteristics. Seven hundred and twenty-six patients with vertigo were enrolled in this study. All patients were inspected by TRV armchair (SYNAPSYS, model TRV, France). BPPV patients were identified by the examination results. The characteristics and results using TRV armchair in diagnosis and treatment of BPPV were compared and analyzed. Of 726 vertigo patients, 209 BPPV patients were diagnosed, including 58 men and 151 women, aged from 16 to 87 (mean 52.90 ± 11.93) years. There were significant differences in the proportion of BPPV in male and female vertigo patients (P = 0.0233), but no differences among all age groups (P = 0.3201). Of 209 BPPV patients, 208 cases were repositioned by TRV armchair and no one appeared to have otolithic debris relocated into another canal in the repositioning procedures. 202 cases (97.12 %) were successful and six cases (2.87 %) were effective. None of them failed. This study suggests that BPPV is one of the most common diseases in the young vertigo patients, just like that in the old ones. Female of the species has predilection for BPPV and the site of predilection is the right posterior semicircular canals (PC-BPPV). The results of repositioning are perfect using mechanical assistance maneuvers.
BibTeX: @article{Wang2014a, author = {Wang, Jing and Chi, Fang-Lu and Jia, Xian-Hao and Tian, Liang and Richard-Vitton, Th}, title = {Does benign paroxysmal positional vertigo explain age and gender variation in patients with vertigo by mechanical assistance maneuvers?}, journal = {Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology}, year = {2014}, volume = {35}, issue = {11}, pages = {1731--1736}, doi = {https://doi.org/10.1007/s10072-014-1822-5}, keywords = {Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, diagnosis, epidemiology; Female; Humans; Male; Middle Aged; Patient Positioning, methods; Prevalence; Sex Characteristics; Vertigo; Young Adult}, pmid = {24844790} }
Sugita-Kitajima, A., Sato, S., Mikami, K., Mukaide, M. and Koizuka, I.	Does vertigo disappear only by rolling over? Rehabilitation for benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2010	Acta oto-laryngologica Vol. 130(1), pp. 84-88	article	DOI
Abstract: We propose that the rolling-over maneuver (ROM) is as effective as the canalith repositioning maneuver (CRP) for the treatment of benign paroxysmal positional vertigo (BPPV). ROM involves easy movements, with only a small load. This therapy is suitable for most BPPV patients, even for those without an indication for CRP. BPPV is a common vestibular disorder. CRP is known to be an effective therapy for the treatment of BPPV. Because of its various movements of the head and body, it is impossible to perform CRP in BPPV patients with orthopedic impairments or in the elderly. For these patients, we perform a maneuver called ROM, which involves easy movements. In this study, we compared the efficacy of ROM with that of CRP in patients with posterior semicircular canal-type BPPV. The study included 22 patients with BPPV who were randomized and divided into the following 2 groups: 1) those treated by the modified Epley maneuver as CRP; and 2) those treated by ROM. We found no significant difference between the two groups in the number of days from onset to remission of both nystagmus and vertigo.
BibTeX: @article{Sugita-Kitajima2010, author = {Sugita-Kitajima, Akemi and Sato, Shigeki and Mikami, Koshi and Mukaide, Mitsuhiro and Koizuka, Izumi}, title = {Does vertigo disappear only by rolling over? Rehabilitation for benign paroxysmal positional vertigo.}, journal = {Acta oto-laryngologica}, year = {2010}, volume = {130}, issue = {1}, pages = {84--88}, doi = {https://doi.org/10.3109/00016480902968086}, keywords = {Adult; Aged; Female; Head Movements, physiology; Humans; Male; Middle Aged; Physical Therapy Modalities; Posture, physiology; Semicircular Canals, physiopathology; Vertigo, physiopathology, rehabilitation}, pmid = {19579144} }
Banfield, G.K., Wood, C. and Knight, J.	Does vestibular habituation still have a place in the treatment of benign paroxysmal positional vertigo? [Abstract] [BibTeX]	2000	The Journal of laryngology and otology Vol. 114(7), pp. 501-505	article
Abstract: Particle repositioning procedures such as the Epley manoeuvre have become popular in the management of benign paroxysmal positional vertigo (BPPV) at the expense of more traditional therapies such as vestibular habituation. We prospectively analysed the response of consecutive patients presenting with BPPV to treatment with vestibular habituation exercises using a symptom score sheet before and after treatment. This same patient group was then followed up, on average three years, eight months after discharge, to determine their long-term response to treatment. The results of the study demonstrated an excellent short-term response rate to treatment but a high level of recurrence after discharge. Most patients who experienced further symptoms following discharge were however self-reliant and were able to return to their habituation exercises without the need for further medical input. The aim in the management of these patients must be to provide long-term self reliance as well as short-term cure and it may be that this has not yet been well demonstrated with the Epley manoeuvre. It must also be remembered that particle repositioning manoeuvres cannot be used in all patients for example those who suffer with cervical or thoracic spine pathology and that some will fail to respond at all. We believe that vestibular habituation retains a useful role in the treatment of BPPV.
BibTeX: @article{Banfield2000, author = {Banfield, G K and Wood, C and Knight, J}, title = {Does vestibular habituation still have a place in the treatment of benign paroxysmal positional vertigo?}, journal = {The Journal of laryngology and otology}, year = {2000}, volume = {114}, issue = {7}, pages = {501--505}, keywords = {Adult; Aged; Aged, 80 and over; Exercise Therapy, methods; Female; Follow-Up Studies; Humans; Male; Middle Aged; Prospective Studies; Treatment Outcome; Vertigo, rehabilitation}, pmid = {10992929} }
Mandalà, M., Santoro, G.P., Asprella Libonati, G., Casani, A.P., Faralli, M., Giannoni, B., Gufoni, M., Marcelli, V., Marchetti, P., Pepponi, E., Vannucchi, P. and Nuti, D.	Double-blind randomized trial on short-term efficacy of the Semont maneuver for the treatment of posterior canal benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2012	Journal of neurology Vol. 259(5), pp. 882-885	article	DOI
Abstract: The need for Class I and II studies on the efficacy of Semont's liberatory maneuver (SLM) in the treatment of posterior canal benign paroxysmal positional vertigo (PC-BPPV) motivated the present double-blind randomized trial on the short-term efficacy of SLM. A total of 342 patients with unilateral PC-BPPV were recruited for a multicenter study. Patients were randomly assigned to treatment by SLM (n = 174) or sham treatment (n = 168). Subjects were followed up twice (1 and 24 h) with the Dix-Hallpike maneuver by blinded examiners. At the 1 and 24 h follow-up, 79.3 and 86.8%, respectively, of patients undergoing SLM had recovered from vertigo, compared to none of the patients undergoing the sham maneuver (p < 0.0001). Patients who manifested liberatory nystagmus at the end of SLM showed a significantly higher percentage of recovery (87.1 vs. 55.7%; p < 0.0001). To the best of our knowledge, this is the first Class I study on the efficacy of SLM. SLM proved highly effective with respect to the sham maneuver (p < 0.0001). Liberatory nystagmus was demonstrated to be a useful prognostic factor for the efficacy of treatment. The present Class I study of efficacy of SLM changes the level of recommendation of the maneuver for treating PC-BPPV from level C to level B.
BibTeX: @article{Mandala2012, author = {Mandalà, Marco and Santoro, Giovanni Paolo and Asprella Libonati, Giacinto and Casani, Augusto Pietro and Faralli, Mario and Giannoni, Beatrice and Gufoni, Mauro and Marcelli, Vincenzo and Marchetti, Pierpaolo and Pepponi, Emanuela and Vannucchi, Paolo and Nuti, Daniele}, title = {Double-blind randomized trial on short-term efficacy of the Semont maneuver for the treatment of posterior canal benign paroxysmal positional vertigo.}, journal = {Journal of neurology}, year = {2012}, volume = {259}, issue = {5}, pages = {882--885}, doi = {https://doi.org/10.1007/s00415-011-6272-x}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo; Double-Blind Method; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, etiology, rehabilitation; Physical Therapy Modalities; Treatment Outcome; Vertigo, complications, rehabilitation}, pmid = {22008871} }
Mandalà, M., Pepponi, E., Santoro, G.P., Cambi, J., Casani, A., Faralli, M., Giannoni, B., Gufoni, M., Marcelli, V., Trabalzini, F., Vannucchi, P. and Nuti, D.	Double-blind randomized trial on the efficacy of the Gufoni maneuver for treatment of lateral canal BPPV. [Abstract] [BibTeX]	2013	The Laryngoscope Vol. 123(7), pp. 1782-1786	article	DOI
Abstract: The need for class I and II studies on the efficacy of liberatory maneuvers in the treatment of lateral canal benign paroxysmal positional vertigo (LC-BPPV) motivated the present double-blind randomized trial on the short-term efficacy of the Gufoni liberatory maneuver (GLM). Double-blind randomized controlled trial. Seventy-two patients with unilateral LC-BPPV were recruited for a multicentric study. Patients were randomly assigned to treatment by GLM (n = 37) or sham treatment (n = 35). Subjects were followed up twice (at 1 hour and 24 hours) with the supine roll test by blinded examiners. At 1- and 24-hour follow-up, 75.7% and 83.8% of patients, respectively, undergoing GLM had recovered from vertigo, compared to around 10% of patients undergoing the sham maneuver (P < 0.0001). To the best of our knowledge, this is the first class I study on the efficacy of the GLM in the treatment of LC-BPPV in both geotropic and apogeotropic forms. GLM proved highly effective compared to the sham maneuver (P < 0.0001). The present class I study of the efficacy of the GLM changes the level of recommendation of the method for treating LC-BPPV from level U to level B for the geotropic variant and from level B to level A for the apogeotropic variant of LC-BPPV.
BibTeX: @article{Mandala2013, author = {Mandalà, Marco and Pepponi, Emanuela and Santoro, Giovanni Paolo and Cambi, Jacopo and Casani, Augusto and Faralli, Mario and Giannoni, Beatrice and Gufoni, Mauro and Marcelli, Vincenzo and Trabalzini, Franco and Vannucchi, Paolo and Nuti, Daniele}, title = {Double-blind randomized trial on the efficacy of the Gufoni maneuver for treatment of lateral canal BPPV.}, journal = {The Laryngoscope}, year = {2013}, volume = {123}, issue = {7}, pages = {1782--1786}, doi = {https://doi.org/10.1002/lary.23918}, keywords = {Benign Paroxysmal Positional Vertigo; Double-Blind Method; Female; Humans; Italy; Male; Middle Aged; Physical Therapy Modalities; Treatment Outcome; Vertigo, therapy}, pmid = {23382081} }
Zapala, D.A.	Down-beating nystagmus in anterior canal benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2008	Journal of the American Academy of Audiology Vol. 19(3), pp. 257-266	article
Abstract: Down-beating positional nystagmus is typically associated with central nervous system disease. Anterior canal benign paroxysmal positional vertigo (AC-BPPV) can mimic down-beating positional nystagmus of central origin, particularly when it is bilateral. Factors that increase the probability of bilateral AC-BPPV include a history of bilateral multicanal BPPV, transient down-beating and torsional nystagmus that follows the plane of the provoked canal, and the absence of co-occurring neurologic signs and symptoms of central nervous system dysfunction. With neurologic clearance for canalith repositioning, exploration for AC-BPPV and canalith repositioning trials may alleviate symptoms even when the nystagmus does not appear to fatigue. In the case presented, the use of a side-lying maneuver with the nose down to provoke AC-BPPV symptoms and the use of a reversed Epley to clear AC-BPPV symptoms are highlighted. This approach is helpful when the diagnosis is unclear and neck hyperextension is to be avoided.
BibTeX: @article{Zapala2008, author = {Zapala, David A}, title = {Down-beating nystagmus in anterior canal benign paroxysmal positional vertigo.}, journal = {Journal of the American Academy of Audiology}, year = {2008}, volume = {19}, issue = {3}, pages = {257--266}, keywords = {Aged; Female; Head Movements; Humans; Posture; Semicircular Canals, physiopathology; Vertigo, diagnosis, etiology, physiopathology}, pmid = {18672654} }
Balatsouras, D.G., Aspris, A., Ganelis, P., Koukoutsis, G., Moukos, A., Fassolis, A. and Katotomichelakis, M.	Duration of benign paroxysmal positional vertigo as a predictor for therapy. [Abstract] [BibTeX]	2015	B-ENT Vol. 11(3), pp. 199-203	article
Abstract: To evaluate the prognostic significance of the duration of disease in patients with benign paroxysmal positional vertigo (BPPV). We studied all patients with idiopathic BPPV of the posterior semicircular canal who were treated during 3 consecutive years, divided into 2 groups: those with recent disease onset (within 4 weeks) and those with more remote disease onset. Outcome of treatment by repositioning maneuver and rate of recurrence were compared. 110 patients had BPPV of recent onset and 121 of more remote onset (mean ages 51.3 and 58.2, respectively). Treatment outcomes were similar in both groups, but the rate of recurrence was higher in patients with BPPV of longer duration (21.5% versus 10%). Long duration of the disease does not affect the treatment outcome in patients with idiopathic BPPV, but is correlated with increased rate of recurrence. Older age of these patients is probably a contributing factor for recurrence.
BibTeX: @article{Balatsouras2015, author = {Balatsouras, D G and Aspris, A and Ganelis, P and Koukoutsis, G and Moukos, A and Fassolis, A and Katotomichelakis, M}, title = {Duration of benign paroxysmal positional vertigo as a predictor for therapy.}, journal = {B-ENT}, year = {2015}, volume = {11}, issue = {3}, pages = {199--203}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, diagnosis, physiopathology; Female; Follow-Up Studies; Humans; Male; Middle Aged; Prognosis; Recurrence; Retrospective Studies; Semicircular Canals, physiopathology; Time Factors}, pmid = {26601552} }
Lopez-Escamez, J.A., Zapata, C., Molina, M.I. and Palma, M.J.	Dynamics of canal response to head-shaking test in benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2007	Acta oto-laryngologica Vol. 127(12), pp. 1246-1254	article	DOI
Abstract: Time constant and maximum slow phase velocity (SPV) of head-shaking nystagmus (HSN) demonstrated a differential canal response to head shaking in 24% of patients with posterior canal benign paroxysmal positional vertigo (BPPV). We suggest that vestibular lithiasis has a limited contribution to the mechanism that generates HSN. To determine the canal response to head shaking in BPPV. This was a case-control study including 104 individuals with BPPV. The diagnosis was based on the presence of vertigo and nystagmus during the positional test. Subjects were examined by the horizontal and vertical head-shaking test. Eye movements were recorded on a video camera to analyze the nystagmus. The head was shaken passively in the horizontal and sagittal planes, respectively, for horizontal and vertical HSN at a frequency of 2 Hz. HSN was considered when six consecutive beats of nystagmus with an SPV of at least 2 degrees/s were detected. Main outcome measures were the presence of horizontal and vertical HSN, maximum SPV of HSN, time constant of HSN, and canal paresis. Maximum SPV of vertical HSN was higher in BPPV patients with posterior canal BPPV (n = 10) than in controls (p = 0.04). Moreover, the time constant of vertical HSN was significantly lower for posterior canal BPPV when compared with controls (p < 0.02).
BibTeX: @article{Lopez-Escamez2007a, author = {Lopez-Escamez, Jose A and Zapata, Cristobal and Molina, Maria I and Palma, Maria J}, title = {Dynamics of canal response to head-shaking test in benign paroxysmal positional vertigo.}, journal = {Acta oto-laryngologica}, year = {2007}, volume = {127}, issue = {12}, pages = {1246--1254}, doi = {https://doi.org/10.1080/00016480701275253}, keywords = {Adult; Aged; Aged, 80 and over; Caloric Tests; Case-Control Studies; Endolymph, physiology; Female; Humans; Lithiasis, physiopathology; Male; Middle Aged; Nystagmus, Pathologic, physiopathology; Nystagmus, Physiologic, physiology; Prospective Studies; Semicircular Canals, physiopathology; Time Factors; Vertigo, physiopathology}, pmid = {17851954} }
Sekine, K., Imai, T., Nakamae, K., Miura, K., Fujioka, H. and Takeda, N.	Dynamics of the vestibulo-ocular reflex in patients with the horizontal semicircular canal variant of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2004	Acta oto-laryngologica Vol. 124(5), pp. 587-594	article
Abstract: Two types of direction-changing positional nystagmus, the geotropic and apogeotropic variants, are observed in patients with the horizontal semicircular canal (HSCC) type of benign paroxysmal positional vertigo (H-BPPV). In this study, we assessed the dynamics of the vestibulo-ocular reflex (VOR) of the HSCC in patients with H-BPPV. Patients were rotated about the earth-vertical axis at frequencies of 0.1, 0.3, 0.5, 0.7 and 1.0 Hz with a maximum angular velocity of 50 degrees/s. Eye movements were recorded on a video imaging system using an infrared charge-coupled device (CCD) camera, and our new technique for analyzing the rotation vector of eye movements in three dimensions was used. In the patients with geotropic positional nystagmus, there were no differences in VOR gain between rotation to the affected and unaffected sides at frequencies of 0.1-1.0 Hz. Although no differences in VOR gain at frequencies of 0.3-1.0 Hz were noticed in patients with apogeotropic positional nystagmus, the VOR gain at 0.1 Hz was significantly smaller on rotation to the affected compared to the unaffected side. The results indicate that cupulolithiasis in the HSCC affected the dynamics of the HSCC-ocular reflex at 0.1 Hz, but not at higher frequencies, and that canalolithiasis in the HSCC does not change the VOR gain of the HSCC at any frequency. It is suggested that cupulolithiasis causes transient impairment of HSCC function by means of its mechanical restriction of movements of the cupula.
BibTeX: @article{Sekine2004a, author = {Sekine, Kazunori and Imai, Takao and Nakamae, Koji and Miura, Katsuyoshi and Fujioka, Hiromu and Takeda, Noriaki}, title = {Dynamics of the vestibulo-ocular reflex in patients with the horizontal semicircular canal variant of benign paroxysmal positional vertigo.}, journal = {Acta oto-laryngologica}, year = {2004}, volume = {124}, issue = {5}, pages = {587--594}, keywords = {Adult; Aged; Electronystagmography; Female; Gravitropism, physiology; Humans; Male; Middle Aged; Nystagmus, Pathologic, physiopathology; Nystagmus, Physiologic, physiology; Reflex, Vestibulo-Ocular, physiology; Semicircular Canals, physiopathology; Vertigo, physiopathology; Vestibular Function Tests, methods}, pmid = {15267177} }
Seemungal, B., Kaski, D. and Lopez-Escamez, J.A.	Early Diagnosis and Management of Acute Vertigo from Vestibular Migraine and Ménière's Disease. [Abstract] [BibTeX]	2015	Neurologic clinics Vol. 33(3), pp. 619-28, ix	article	DOI
Abstract: Vestibular migraine is the most common cause of acute episodic vestibular symptoms after benign paroxysmal positional vertigo. In contrast, Ménière's disease is an uncommon disorder. For both conditions, early and accurate diagnosis (or its exclusion) enables the correct management of patients with acute episodic vestibular symptoms. Long-term management of migraine requires changes in lifestyle to avoid triggers of migraine and/or prophylactic drugs if attacks become too frequent. The long-term management of Ménière's disease also involves lifestyle changes (low salt diet), medications (betahistine, steroids), and ablative therapy applied to the diseased ear (eg, intratympanic gentamicin).
BibTeX: @article{Seemungal2015, author = {Seemungal, Barry and Kaski, Diego and Lopez-Escamez, Jose Antonio}, title = {Early Diagnosis and Management of Acute Vertigo from Vestibular Migraine and Ménière's Disease.}, journal = {Neurologic clinics}, year = {2015}, volume = {33}, issue = {3}, pages = {619--28, ix}, doi = {https://doi.org/10.1016/j.ncl.2015.04.008}, keywords = {Disease Management; Early Diagnosis; Humans; Meniere Disease, diagnosis, therapy; Migraine Disorders, diagnosis, etiology, therapy; Vertigo, diagnosis, therapy; Vestibular Diseases, complications; Hearing loss; Migraine; Ménière’s disease; Tinnitus; Vertigo; Vestibular disorders}, pmid = {26231275} }
Power, L., Murray, K. and Szmulewicz, D.	Early experience with a multi-axial, whole body positioning system in the treatment of Benign Paroxysmal Positional Vertigo (BPPV). [BibTeX]	2018	Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia	article	DOI
BibTeX: @article{Power2018, author = {Power, L and Murray, K and Szmulewicz, D}, title = {Early experience with a multi-axial, whole body positioning system in the treatment of Benign Paroxysmal Positional Vertigo (BPPV).}, journal = {Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia}, year = {2018}, doi = {https://doi.org/10.1016/j.jocn.2018.10.039}, keywords = {Benign Paroxysmal Positional Vertigo; Omniax; Positioning system}, pmid = {30377044} }
Pirodda, A., Ferri, G.G. and Borghi, C.	Early management of hearing and balance disorders: a review of literature and a proposal to overcome possible uncertainties. [Abstract] [BibTeX]	2010	Minerva medica Vol. 101(6), pp. 439-443	article
Abstract: The lack of a correct diagnostic and therapeutic planning of vestibular diseases is still often observed, and some difficulties are still to deal with in clinical practice, even when treating acute hearing problems, although the needed competence is more easily identified as otologic. A review of the international literature confirms the existence of such a problem, and permits to underline the scarcity of connections between otology and neurotology, on one hand, and principles of basic sciences and general and internal medicine, on the other hand: this can explain some therapeutic contradictions in treating inner ear disorders, their frequent labelling as idiopathic and the persisting uncertainties concerning a correct diagnostic and therapeutic management. In order to overcome the difficulties deriving to insufficient interdisciplinary cooperation, the institution of hospital audiovestibular services with a strictly linked net of cooperation with internal medicine units could represent a progress. This could help prevent clinically and economically inadequate management, contributing to minimize the possibility of expensive and/or health-threatening mistakes; moreover, it could represent an example to easily improve the practical aspects of both pre graduate and postgraduate curricula, and to form more open-minded clinicians, starting both from an ear. Nose and throat (ENT)/audiological and from an Internal Medicine extraction.
BibTeX: @article{Pirodda2010, author = {Pirodda, A and Ferri, G G and Borghi, C}, title = {Early management of hearing and balance disorders: a review of literature and a proposal to overcome possible uncertainties.}, journal = {Minerva medica}, year = {2010}, volume = {101}, issue = {6}, pages = {439--443}, keywords = {Benign Paroxysmal Positional Vertigo; Hearing Loss, Sensorineural, diagnosis, therapy; Hearing Loss, Sudden, diagnosis, therapy; Humans; Vertigo, diagnosis, therapy}, pmid = {21196903} }
Franco-Gutiérrez, V. and Pérez, P.	Editorial commentary: Benign paroxysmal positional vertigo, the great unknown. [BibTeX]	2017	Acta otorrinolaringologica espanola Vol. 68(6), pp. 361-362	article	DOI
BibTeX: @article{Franco-Gutierrez2017, author = {Franco-Gutiérrez, Virginia and Pérez, Paz}, title = {Editorial commentary: Benign paroxysmal positional vertigo, the great unknown.}, journal = {Acta otorrinolaringologica espanola}, year = {2017}, volume = {68}, issue = {6}, pages = {361--362}, doi = {https://doi.org/10.1016/j.otorri.2017.02.004}, pmid = {28522134} }
Badawy, W.M.A., Gad El-Mawla, E.K., Chedid, A.E.F. and Mustafa, A.H.A.	Effect of a hybrid maneuver in treating posterior canal benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2015	Journal of the American Academy of Audiology Vol. 26(2), pp. 138-144	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most common disorder of the vestibular system of the inner ear, which is a vital part of maintaining balance. Although the efficacy of the Epley maneuver-also known as the canalith repositioning maneuver (CRM)-is well established, data comparing CRM versus a hybrid treatment are lacking. The purpose of this study was to determine the effect of a hybrid treatment, the Gans repositioning maneuver (GRM) either with or without postmaneuver restrictions, compared with CRM on treatment of posterior canal BPPV (PC-BPPV). Study design was a randomized controlled trial. A total of 45 patients (30 males and 15 females) with unilateral PC-BPPV were randomly allocated to one of three equal groups on the basis of the date of the first visit with matched assignment for gender: a GRMR group (GRM with postmaneuver restrictions), a GRM group, and a CRM group. Patients received weekly administration of the maneuver until resolution of symptoms. The Dix-Hallpike test was performed before treatment at every appointment, and finally after 1 mo from the last maneuver. Nystagmus duration and vertigo intensity were recorded. The supine roll test was performed in case the Dix-Hallpike test was negative to test otoconial migration. Data were analyzed with repeated-measures analysis of variance, paired t-tests with a Bonferroni correction, and the Spearman rank correlation coefficient. All patients showed improvement within the groups, and PC-BPPV symptoms were resolved by an average of 2, 1.7, and 1.6 maneuvers for GRMR, GRM, and CRM, respectively, with no statistical differences among the three groups (p > 0.05). Only two patients had recurrence, and one patient had horizontal BPPV at 1 mo follow-up. We demonstrated that the GRM as a new treatment is effective in treating PC-BPPV with no benefits to postmaneuver restrictions.
BibTeX: @article{Badawy2015, author = {Badawy, Wanees M A and Gad El-Mawla, Ebtessam K and Chedid, Ahmed E F and Mustafa, Ahmed H A}, title = {Effect of a hybrid maneuver in treating posterior canal benign paroxysmal positional vertigo.}, journal = {Journal of the American Academy of Audiology}, year = {2015}, volume = {26}, issue = {2}, pages = {138--144}, doi = {https://doi.org/10.3766/jaaa.26.2.4}, keywords = {Adult; Benign Paroxysmal Positional Vertigo, therapy; Female; Head Movements; Humans; Male; Middle Aged; Musculoskeletal Manipulations, methods; Patient Positioning, methods; Range of Motion, Articular; Treatment Outcome}, pmid = {25690774} }
Pereira, A.B., Santos, J.N. and Volpe, F.M.	Effect of Epley's maneuver on the quality of life of paroxismal positional benign vertigo patients. [Abstract] [BibTeX]	2010	Brazilian journal of otorhinolaryngology Vol. 76(6), pp. 704-708	article
Abstract: Quality of life (QoL) is significantly impaired by vertigo. The effect of specific treatments on QoL deserves investigation. To assess the effect of repositioning maneuvers on the QoL of benign paroxysmal positioning vertigo (BPPV) patients. A retrospective study design consiting of reviews of charts of BPPV patients in a vestibular rehabilitation unit at a teaching institution in Belo Horizonte, MG, Brazil, from 2007 to 2008. Pre- and post-therapy (Epley's repositioning maneuver) scores on the physical, functional and emotional dimensions of the Dizziness Handicap Inventory (DHI) were analyzed. Twenty-one patients were included, eighteen (86%) were females; the average age was 53.2 years. Ten patients presented bilateral BPPV; in eleven it was unilateral. The mean interval between assessments (pre- and post-treatment) was 21 days. The average number of required maneuvers was 2.3 (±1.1). Pre-treatment DHI results showed a significant impact of BPPV on quality of life. Initial scores for physical (17.5), functional (17.3), emotional (13.2) dimensions decreased with therapy: respectively 3.7, 3.9, and 3.2 (p<0.001). In the present sample, Epley's maneuver had a positive and significant effect on emotional, physical and functional dimensions of quality of life, as measured by the DHI scores before and after therapy.
BibTeX: @article{Pereira2010, author = {Pereira, Alcione Botelho and Santos, Juliana Nunes and Volpe, Fernando Madalena}, title = {Effect of Epley's maneuver on the quality of life of paroxismal positional benign vertigo patients.}, journal = {Brazilian journal of otorhinolaryngology}, year = {2010}, volume = {76}, issue = {6}, pages = {704--708}, keywords = {Adult; Aged; Brazil; Dizziness, therapy; Female; Head Movements; Humans; Male; Middle Aged; Patient Positioning, methods; Physical Therapy Modalities; Quality of Life; Retrospective Studies; Surveys and Questionnaires; Treatment Outcome; Vertigo, therapy}, pmid = {21180936} }
Park, J.S., Kim, S.Y. and Kim, M.-B.	Effect of intratympanic steroid injection in light cupula. [Abstract] [BibTeX]	2018	Acta oto-laryngologica Vol. 138(9), pp. 769-774	article	DOI
Abstract: To evaluate the effects of intratympanic steroid injection (ITS) in light cupula. A total of 47 patients showing persistent geotropic direction-changing positional nystagmus with null point (light cupula) were randomly classified into three groups: ITS (n = 15), vestibular suppressant (VS, n = 16) and canalith repositioning procedure (CRP, n = 16). Positional nystagmus and dizziness severity by dizziness handicap inventory (DHI) and visual analogue scale (VAS) were conducted before and 3 d and 1 week after first treatment to compare the effect of each treatment. DHI and VAS scores had decreased after each treatment; however, there were no differences among the three groups. A week after the first treatment, 7, 6 and 7 patients showed resolution of direction-changing positional nystagmus (DCPN) in the ITS, CRP and VS groups, respectively. There were no significant differences between the three groups. In the ITS group only, however, reversal of the stronger side on head roll test was observed in 6 patients, and 2 of them showed resolution of DCPN at the third day. ITS was not effective for patients with light cupula at 1-week follow-up. However, some patients in the ITS group showed resolution of DCPN at earlier follow-up.
BibTeX: @article{Park2018, author = {Park, Jin Su and Kim, So Yean and Kim, Min-Beom}, title = {Effect of intratympanic steroid injection in light cupula.}, journal = {Acta oto-laryngologica}, year = {2018}, volume = {138}, issue = {9}, pages = {769--774}, doi = {https://doi.org/10.1080/00016489.2018.1467135}, keywords = {Benign Paroxysmal Positional Vertigo, complications, drug therapy; Cochlea, pathology; Female; Humans; Injection, Intratympanic; Male; Middle Aged; Nystagmus, Pathologic, complications, diagnosis, drug therapy; Patient Positioning; Prospective Studies; Semicircular Canals; Steroids, administration & dosage; Vestibular Function Tests; Vestibule, Labyrinth, physiopathology; Visual Analog Scale; Light cupula; canalith repositioning procedure; direction-changing positional nystagmus; intratympanic steroid injection}, pmid = {29764271} }
Motamed, M., Osinubi, O. and Cook, J.A.	Effect of mastoid oscillation on the outcome of the canalith repositioning procedure. [Abstract] [BibTeX]	2004	The Laryngoscope Vol. 114(7), pp. 1296-1298	article	DOI
Abstract: The canalith repositioning procedure (CRP), as described by Epley, is a well-established method of treatment for benign paroxysmal positional vertigo (BPPV). Debate exists as to whether simultaneous application of a mastoid oscillator confers any added benefit. The aim of this study was to examine this question. Prospective randomized study. Eighty-four subjects with unilateral posterior canal BPPV were randomized into two groups. The oscillator group was treated by CRP with mastoid oscillation and the nonoscillator group was treated by CRP alone. Positive outcome was regarded as complete resolution of symptoms and a negative Dix-Hallpike's test after a 4 to 6 week follow-up period. Five patients were lost to follow-up. Twenty-eight (72%) patients from the oscillator group and 26 (65%) patients from the nonoscillator group had a positive outcome. This difference was not significant (chi = 0.17, P =.68) For the treatment of posterior canal BPPV, concurrent mastoid oscillation with CRP does not significantly alter the short-term outcome.
BibTeX: @article{Motamed2004, author = {Motamed, M and Osinubi, O and Cook, J A}, title = {Effect of mastoid oscillation on the outcome of the canalith repositioning procedure.}, journal = {The Laryngoscope}, year = {2004}, volume = {114}, issue = {7}, pages = {1296--1298}, doi = {https://doi.org/10.1097/00005537-200407000-00029}, keywords = {Chi-Square Distribution; Female; Humans; Male; Mastoid; Middle Aged; Otolithic Membrane, physiopathology; Posture, physiology; Prospective Studies; Statistics, Nonparametric; Vertigo, rehabilitation; Vibration}, pmid = {15235364} }
Brocchetti, F., Garaventa, G., Ameli, F., Baricalla, F., Chiarlone, M., Peirano, M., Presta, A. and Fibbi, A.	Effect of repetition of Semont's manoeuvre on benign paroxysmal positional vertigo of posterior semicircular canal. [Abstract] [BibTeX]	2003	Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale Vol. 23(6), pp. 428-435	article
Abstract: If Semont's liberating manoeuvre does not lead to relief of symptoms in benign paroxysmal positional vertigo of posterior semicircular canal after the first session, it can be repeated once again, in refractory cases, whilst symptomatic patients after second manoeuvre require rehabilitation therapy Repeating Semont's manoeuvre several times has proven to progressively increase the percentage of cured patients or it may convert posterior semicircular canal forms to typical incomplete or lateral semicircular canal forms, hence requiring other manoeuvres to achieve vertigo resolution. Aim of study was to assess the effect of liberating manoeuvres repeated up to 4 times and to establish possible passages from one canal to the other during manoeuvres as well as percentage of cases refractory to this therapy, who would then need rehabilitation. Benign paroxysmal positional vertigo was diagnosed in 448 cases of whom 344 (76.8%) of the posterior semicircular canal, 20 (0.45%) the incomplete form of the posterior semicircular canal, 20 (0.45%) subjective positional vertigo and 74 of the lateral semicircular canal (4.2%). Right side was affected in 58.4% of cases, left in 34.5%, and bilateral in 7.1%. All 344 patients underwent Semont's liberating manoeuvre (1st manoeuvre) with first control after 48 hours: if symptoms (typical, atypical nystagmus or paroxysmal vertigo evoked by Dix-Hallpike's manoeuvre) persisted, Semont's liberating manoeuvre was repeated (2nd manoeuvre). In presence of lateral semicircular canal benign paroxysmal positional vertigo conversion, Lempert's manoeuvre was performed instead. Second control was performed after 48 hours and in cases of persistent typical, atypical or lateral semicircular canal nystagmus 3rd manoeuvre was performed. After further 48 hours, third control was carried out: symptomatic patients with typical forms were submitted to 4th manoeuvre, while typical incomplete forms or forms of the lateral semicircular canal underwent Lempert's manoeuvre. In conclusion, symptoms disappeared after 1st manoeuvre in 61.6% of cases; further manoeuvres, carried out in view of possible changes in semeiology of vertigo, increased the percentage of cured patients to 82.5% after the 2nd, 90.7% after 3rd and 94.1% after the 4th. Repeated positioning manoeuvres in benign paroxysmal positional vertigo led to a progressive increase in percentage of cured vertigo, at the same time, allowing detection of those cases converted to multicanal pathology, hence offering the possibility to proceed with appropriate liberating manoeuvres.
BibTeX: @article{Brocchetti2003, author = {Brocchetti, F and Garaventa, G and Ameli, F and Baricalla, F and Chiarlone, M and Peirano, M and Presta, A and Fibbi, A}, title = {Effect of repetition of Semont's manoeuvre on benign paroxysmal positional vertigo of posterior semicircular canal.}, journal = {Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale}, year = {2003}, volume = {23}, issue = {6}, pages = {428--435}, keywords = {Adult; Female; Head; Humans; Male; Periodicity; Posture; Rotation; Semicircular Canals, physiopathology; Treatment Outcome; Vertigo, physiopathology, therapy}, pmid = {15198044} }
Toupet, M., Ferrary, E. and Bozorg Grayeli, A.	Effect of repositioning maneuver type and postmaneuver restrictions on vertigo and dizziness in benign positional paroxysmal vertigo. [Abstract] [BibTeX]	2012	TheScientificWorldJournal Vol. 2012, pp. 162123	article	DOI
Abstract: To compare the efficiency of Epley (Ep) and Sémont-Toupet (ST) repositioning maneuvers and to evaluate postmaneuver restriction effect on short-term vertigo and dizziness after repositioning maneuvers by an analog visual scale (VAS) in benign positional paroxysmal vertigo (BPPV). 226 consecutive adult patients with posterior canal BPPV were included. Patients were randomized into 2 different maneuver sequence groups (n = 113): 2 ST then 1 Ep or 2 Ep then 1 ST. Each group of sequence was randomized into 2 subgroups: with or without postmaneuver restrictions. Vertigo and dizziness were assessed from days 0 to 5 by VAS. There was no difference between vertigo scores between Ep and ST groups. Dizziness scores were higher in Ep group during the first 3 days but became similar to those of ST group at days 4 and 5. ST maneuvers induced liberatory signs more frequently than Ep (58% versus 42% resp., P < 0.01, Fisher's test). After repositioning maneuvers, VAS scores decreased similarly in patients with and without liberatory signs. Postmaneuver restrictions did not influence VAS scores. Even if ST showed a higher rate of liberatory signs than Ep in this series, VAS scores were not influenced by these signs.
BibTeX: @article{Toupet2012, author = {Toupet, Michel and Ferrary, Evelyne and Bozorg Grayeli, Alexis}, title = {Effect of repositioning maneuver type and postmaneuver restrictions on vertigo and dizziness in benign positional paroxysmal vertigo.}, journal = {TheScientificWorldJournal}, year = {2012}, volume = {2012}, pages = {162123}, doi = {https://doi.org/10.1100/2012/162123}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Dizziness, pathology, therapy; Ear, Inner, pathology; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, therapy; Patient Positioning, methods; Physical Therapy Modalities; Time Factors; Treatment Outcome; Vertigo, pathology, therapy}, pmid = {22973168} }
Gacek, M.R., Gacek, R.R. and Martell, R.	Effect of singular neurectomy on the caloric response. [Abstract] [BibTeX]	1995	American journal of otolaryngology Vol. 16(6), pp. 362-366	article
Abstract: This study was performed to determine the contribution of the posterior semicircular canal to the vestibulo-ocular responses (VOR) from caloric stimulation of the labyrinth. Seven consecutive patients with disabling benign paroxysmal positional vertigo, which was treated with singular neurectomy, were tested before and after surgery with bithermal stimulation of the operated and nonoperated ears. There was a significant (P = .0156) decrease in the VOR from stimulation of the operated ear following singular neurectomy. The nonoperated ear showed a variety of changes that may have resulted from compensatory mechanisms and/or utricular dysfunction. We conclude that the posterior canal together with the lateral and superior canals are responsible for the VOR following caloric stimulation of the labyrinth.
BibTeX: @article{Gacek1995, author = {Gacek, M R and Gacek, R R and Martell, R}, title = {Effect of singular neurectomy on the caloric response.}, journal = {American journal of otolaryngology}, year = {1995}, volume = {16}, issue = {6}, pages = {362--366}, keywords = {Adult; Aged; Caloric Tests; Ear, Inner, innervation, physiopathology; Electronystagmography; Eye Movements; Female; Humans; Male; Middle Aged; Posture; Prospective Studies; Reflex, Vestibulo-Ocular, physiology; Saccule and Utricle, physiopathology; Semicircular Canals, innervation, physiopathology; Vertigo, physiopathology, surgery; Vestibular Nerve, surgery}, pmid = {8572252} }
Iwasaki, S., Chihara, Y., Ushio, M., Ochi, A., Murofushi, T. and Yamasoba, T.	Effect of the canalith repositioning procedure on subjective visual horizontal in patients with posterior canal benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2011	Acta oto-laryngologica Vol. 131(1), pp. 41-45	article	DOI
Abstract: Substantial numbers of patients with posterior canal benign paroxysmal positional vertigo (p-BPPV) have signs of utricular dysfunction at baseline. This improves after performing the canalith repositioning procedure. To evaluate the changes of subjective visual horizontal (SVH) in patients with p-BPPV before and after treatment with the canalith repositioning procedure. Twenty-six patients with p-BPPV were treated with the canalith repositioning procedure, Epley's maneuver, according to the affected side. Baseline SVH measurements were taken before performing the Dix-Hallpike maneuver and Epley's maneuver, for comparison with measurements taken just after Epley's maneuver, and 2 weeks after Epley's maneuver. Among 26 patients with p-BPPV, 11 (42%) showed abnormal deviation of SVH at baseline. Just after performing Epley's maneuver, the number of patients who showed an abnormal deviation of SVH decreased significantly to 15% (4 of 26 patients; p < 0.05). Two weeks after performing Epley's maneuver, only two patients (8%) showed an abnormal deviation of SVH (p < 0.001).
BibTeX: @article{Iwasaki2011, author = {Iwasaki, Shinichi and Chihara, Yasuhiro and Ushio, Munetaka and Ochi, Atsushi and Murofushi, Toshihisa and Yamasoba, Tatsuya}, title = {Effect of the canalith repositioning procedure on subjective visual horizontal in patients with posterior canal benign paroxysmal positional vertigo.}, journal = {Acta oto-laryngologica}, year = {2011}, volume = {131}, issue = {1}, pages = {41--45}, doi = {https://doi.org/10.3109/00016489.2010.514008}, keywords = {Adult; Aged; Female; Humans; Male; Middle Aged; Orientation, physiology; Otolithic Membrane, physiopathology; Physical Therapy Modalities; Postural Balance, physiology; Saccule and Utricle, physiopathology; Vertigo, physiopathology, rehabilitation, therapy; Visual Perception, physiology; Young Adult}, pmid = {20961271} }
Stambolieva, K. and Angov, G.	Effect of treatment with betahistine dihydrochloride on the postural stability in patients with different duration of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2010	The international tinnitus journal Vol. 16(1), pp. 32-36	article
Abstract: The effect of betahistine dihydrochloride on the postural stability after repositioning Epley's maneuver (EM) in patients with BPPV was evaluated by static posturography in open and closed eyes conditions. Ninety patients were divided into four groups by duration (less and above 60 days of BPPV) and by treatment (with and without treatment with betahistine). The investigation was made one hour after the positive Dix-Hallpike test, 10 and 20 days after the treatment with EM. "Sway velocity" (SV) was calculated to evaluate postural stability. The results show dependence between efficacy of treatment with betahistine applied after EM and duration of BPPV. Betahistine normalized postural stability of patients with duration of BPPV less than 60 days after 10 days of treatment and had less effect on patients with duration of BPPV above 60 days. We assume that after removing the otoconia betahistine plays an important role for improving blood flow in the inner ear. The short presence of otoconia didn't damage sensory receptor, and restoring the normal function of motion-sensitive hairs cells and stabilizing the posture was observed.
BibTeX: @article{Stambolieva2010, author = {Stambolieva, Katerina and Angov, Georgi}, title = {Effect of treatment with betahistine dihydrochloride on the postural stability in patients with different duration of benign paroxysmal positional vertigo.}, journal = {The international tinnitus journal}, year = {2010}, volume = {16}, issue = {1}, pages = {32--36}, keywords = {Adult; Betahistine, administration & dosage; Humans; Postural Balance, drug effects, physiology; Posture, physiology; Vasodilator Agents, administration & dosage; Vertigo, drug therapy, physiopathology; Vestibule, Labyrinth, blood supply, drug effects, physiology}, pmid = {21609911} }
Parnes, L.S. and McClure, J.A.	Effect on brainstem auditory evoked responses of posterior semicircular canal occlusion in guinea pigs. [Abstract] [BibTeX]	1985	The Journal of otolaryngology Vol. 14(3), pp. 145-150	article
Abstract: The site of origin of benign paroxysmal positional vertigo is the posterior semicircular canal and when persistent, the condition is known as cupulolithiasis. Singular neurectomy is the current procedure of choice for the treatment of incapacitating cupulolithiasis. The neurectomy is difficult to learn and carries a significant risk of hearing loss. An alternative procedure, whereby the posterior canal is occluded, is discussed. This was performed on 11 guinea pigs and the effect on hearing was measured using brainstem evoked audiometry. Eight animals showed no hearing loss while the other three had a mild to moderate loss of hearing due to intra-operative complications. The effect of canal plugging on hearing compares favorably with the hearing results obtained with singular neurectomy. Posterior semicircular canal occlusion is suggested as a safer and technically easier treatment for incapacitating cupulolithiasis.
BibTeX: @article{Parnes1985, author = {Parnes, L S and McClure, J A}, title = {Effect on brainstem auditory evoked responses of posterior semicircular canal occlusion in guinea pigs.}, journal = {The Journal of otolaryngology}, year = {1985}, volume = {14}, issue = {3}, pages = {145--150}, keywords = {Animals; Auditory Threshold; Brain Stem, physiology; Evoked Potentials, Auditory; Guinea Pigs; Male; Semicircular Canals, physiology, physiopathology; Vertigo, physiopathology}, pmid = {4068108} }
Tevzadze, N. and Shakarishvili, R.	Effectiveness of canalith repositioning manoeuvers (CRM) in patients with benign paroxysmal positional vertigo (BPPV). [Abstract] [BibTeX]	2007	Georgian medical news(148-149), pp. 40-44	article
Abstract: BPPV is the most common disorder of the vestibular system affected up to 21% of vertigo patients, characterised by short-lasting episodes of vertigo in association with rapid changes in head position. We have detected, treated and followed up 204 patients with BPPV during two years. 204 patients (163 women 41men) were enrolled in this study, at the time of evolution the duration of symptoms varied from several days to several months. We evaluated idiophatic forms of BPPV in 126 cases and secondary types BPPV in 78 cases. All patients with typical history of BPPV underwent neurological examination, including Dix-Hallpike (to detect posterior and anterior canal BPPV) and Roll Test (to detect horizontal canal BPPV). We treat patients with CRM and followed up them in 48 hours and 7 days, one month, 6 month and one year after initial management. Posterior semicircular canal was involved in 170 patients, remain 34 patients suffered from canalolithiasis of horisontal (31 patients) and anterior (3 patients) semicircular canal. After a single treatment session the symptoms disappeared completely in 139 patients, in 40 patients after twice, 16 patients after 3 times and 9 patients after 4 times maneuver sessions. No effectiveness was found in 5 patients; during follow-up 7 successfully treated patients experienced a recurrence between 1 and 6 months, in two cases after one year; they were retreated and all achieved a positive result. It is concluded that diagnosis of BPPV is simple and save, do not need expensive neuroradiological tests; CRM provides effective and long term control of symptoms in patients with BPPV.
BibTeX: @article{Tevzadze2007, author = {Tevzadze, N and Shakarishvili, R}, title = {Effectiveness of canalith repositioning manoeuvers (CRM) in patients with benign paroxysmal positional vertigo (BPPV).}, journal = {Georgian medical news}, year = {2007}, issue = {148-149}, pages = {40--44}, keywords = {Adult; Aged; Exercise Movement Techniques; Female; Humans; Male; Middle Aged; Treatment Outcome; Vertigo, diagnosis, etiology, therapy; Vestibular Function Tests}, pmid = {17921542} }
Ribeiro, K.F., Oliveira, B.S., Freitas, R.V., Ferreira, L.M., Deshpande, N. and Guerra, R.O.	Effectiveness of Otolith Repositioning Maneuvers and Vestibular Rehabilitation exercises in elderly people with Benign Paroxysmal Positional Vertigo: a systematic review. [Abstract] [BibTeX]	2017	Brazilian journal of otorhinolaryngology	article	DOI
Abstract: Benign Paroxysmal Positional Vertigo is highly prevalent in elderly people. This condition is related to vertigo, hearing loss, tinnitus, poor balance, gait disturbance, and an increase in risk of falls, leading to postural changes and quality of life decreasing. To evaluate the outcomes obtained by clinical trials on the effectiveness of Otolith Repositioning Maneuver and Vestibular Rehabilitation exercises in the treatment of Benign Paroxysmal Positional Vertigo in elderly. The literature research was performed using PubMed, Scopus, Web of Science and PEDro databases, and included randomized controlled clinical trials in English, Spanish and Portuguese, published during January 2000 to August 2016. The methodological quality of the studies was assessed by PEDro score and the outcomes analysis was done by critical revision of content. Six studies were fully reviewed. The average age of participants ranged between 67.2 and 74.5 years. The articles were classified from 2 to 7/10 through the PEDro score. The main outcome measures analyzed were vertigo, positional nystagmus and postural balance. Additionally, the number of maneuvers necessary for remission of the symptoms, the quality of life, and the functionality were also assessed. The majority of the clinical trials used Otolith Repositioning Maneuver (n=5) and 3 articles performed Vestibular Rehabilitation exercises in addition to Otolith Repositioning Maneuver or pharmacotherapy. One study showed that the addition of movement restrictions after maneuver did not influence the outcomes. There was a trend of improvement in Benign Paroxysmal Positional Vertigo symptomatology in elderly patients who underwent Otolith Repositioning Maneuver. There is sparse evidence from methodologically robust clinical trials that examined the effects of Otolith Repositioning Maneuver and Vestibular Rehabilitation exercises for treating Benign Paroxysmal Positional Vertigo in the elderly. Randomized controlled clinical trials with comprehensive assessment of symptoms, quality of life, function and long-term follow up are warranted.
BibTeX: @article{Ribeiro2017, author = {Ribeiro, Karyna Figueiredo and Oliveira, Bruna Steffeni and Freitas, Raysa V and Ferreira, Lidiane M and Deshpande, Nandini and Guerra, Ricardo O}, title = {Effectiveness of Otolith Repositioning Maneuvers and Vestibular Rehabilitation exercises in elderly people with Benign Paroxysmal Positional Vertigo: a systematic review.}, journal = {Brazilian journal of otorhinolaryngology}, year = {2017}, doi = {https://doi.org/10.1016/j.bjorl.2017.06.003}, keywords = {Benign Paroxysmal Positional Vertigo; Dizziness; Elderly; Idosos; Reabilitação; Rehabilitation; Tontura; Vertigem; Vertigem posicional paroxística benigna; Vertigo}, pmid = {28716503} }
Helminski, J.O., Zee, D.S., Janssen, I. and Hain, T.C.	Effectiveness of particle repositioning maneuvers in the treatment of benign paroxysmal positional vertigo: a systematic review. [Abstract] [BibTeX]	2010	Physical therapy Vol. 90(5), pp. 663-678	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo. The purpose of this systematic review was to determine whether patients diagnosed with posterior canal (PC) BPPV, based on positional testing, and treated with a particle repositioning maneuver will show the resolution of benign paroxysmal positional nystagmus (BPPN) on the Dix-Hallpike Test performed 24 hours or more after treatment. Data were obtained from an electronic search of the MEDLINE, EMBASE, and CINAHL databases from 1966 through September 2009. The study topics were randomized controlled trials (RCTs), quasi-RCTs, the diagnosis of PC BPPV, treatment with the particle repositioning maneuver, and outcome measured with a positional test 24 hours or more after treatment. Data extracted were study descriptors and the information used to code for effect size. In 2 double-blind RCTs, the odds in favor of the resolution of BPPN were 22 times (95% confidence interval=3.41-141.73) and 37 times (95% confidence interval=8.75-159.22) higher in people receiving the canalith repositioning procedure (CRP) than in people receiving a sham treatment. This finding was supported by the results reported in 8 nonmasked quasi-RCTs. Studies with limited methodological quality suggested that a liberatory maneuver (LM) was more effective than a control intervention; there was no significant difference in the effectiveness of the LM and the effectiveness of the CRP; the self-administered CRP was more effective than the self-administered LM; and the CRP administered together with the self-administered CRP was more effective than the CRP administered alone. The Brandt-Daroff exercises were the least effective self-administered treatments. The limitations included the methodological quality of the studies, the lack of quality-of-life measures, and confounding factors in reporting vertigo. Randomized controlled trials provided strong evidence that the CRP resolves PC BPPN, and quasi-RCTs suggested that the CRP or the LM performed by a clinician or with proper instruction at home by the patient resolves PC BPPN. There were no data on the effects of the maneuvers on outcomes relevant to patients.
BibTeX: @article{Helminski2010, author = {Helminski, Janet Odry and Zee, David Samuel and Janssen, Imke and Hain, Timothy Carl}, title = {Effectiveness of particle repositioning maneuvers in the treatment of benign paroxysmal positional vertigo: a systematic review.}, journal = {Physical therapy}, year = {2010}, volume = {90}, issue = {5}, pages = {663--678}, doi = {https://doi.org/10.2522/ptj.20090071}, keywords = {Head Movements; Humans; Nystagmus, Physiologic; Physical Therapy Modalities; Posture, physiology; Randomized Controlled Trials as Topic; Semicircular Canals, physiopathology; Vertigo, rehabilitation}, pmid = {20338918} }
Helminski, J.O.	Effectiveness of the canalith repositioning procedure in the treatment of benign paroxysmal positional vertigo. [BibTeX]	2014	Physical therapy Vol. 94(10), pp. 1373-1382	article	DOI
BibTeX: @article{Helminski2014, author = {Helminski, Janet O}, title = {Effectiveness of the canalith repositioning procedure in the treatment of benign paroxysmal positional vertigo.}, journal = {Physical therapy}, year = {2014}, volume = {94}, issue = {10}, pages = {1373--1382}, doi = {https://doi.org/10.2522/ptj.20130239}, keywords = {Exercise Therapy; Humans; Physical Therapy Modalities, nursing; Posture; Semicircular Canals; Treatment Outcome; Vertigo, therapy}, pmid = {24903112} }
Moreno, J.L.B., Muñoz, R.C., Matos, Y.R., Balboa, I.V., Puértolas, O.C., Ortega, J.A., Perez, E.R., Curto, X.M., Ripollès, C.R., Farres, N.M., Agudelo, O.L.A., Cantera, C.M. and Ledesma, R.A.	Effectiveness of the Epley manoeuvre in posterior canal benign paroxysmal positional vertigo: a randomised clinical trial in primary care. [Abstract] [BibTeX]	2019	The British journal of general practice : the journal of the Royal College of General Practitioners Vol. 69(678), pp. e52-e60	article	DOI
Abstract: Evidence on the effectiveness of the Epley manoeuvre in primary care is scarce. To evaluate effectiveness at 1 week, 1 month, and 1 year of a single Epley manoeuvre versus a sham manoeuvre in primary care. Multicentre, double-blind randomised controlled trial in two primary care practices in Spain from November 2012 to January 2015. Patients were ≥18 years diagnosed with subjective or objective posterior benign paroxysmal positional vertigo (vertigo only, or vertigo and nystagmus after a Dix-Hallpike test [DHT]). The intervention group received the Epley manoeuvre, and the control group received a sham manoeuvre. Betahistine was prescribed following the same regimen in both groups. The main outcome measures were the DHT result classified as negative (neither vertigo nor nystagmus) or positive. Positive results were further divided into a positive result for both vertigo and nystagmus (positive DHT with nystagmus), and a positive result for vertigo only (positive DHT without nystagmus); self-reported resolution of vertigo; and self-reported severity of vertigo evaluated on a 10-point Likert scale (10 = worst imaginable vertigo). In total, 134 patients were randomised to either the intervention group ( = 66) or the sham group ( = 68). The intervention group showed better results in the unadjusted analyses at 1 week, with a lower rate of positive DHT with nystagmus ( = 0.022). A positive baseline DHT with nystagmus was associated with a reduction in vertigo severity (marginal effect for 10-point Likert-like question -1.73, 95% confidence interval [CI] = -2.95 to -0.51) and better positive DHT rates in the intervention group (adjusted odds ratio 0.09, 95% CI = 0.01 to 0.92) in the multivariate analyses. A single Epley manoeuvre performed in primary care is an effective treatment for reversing a positive DHT and reducing vertigo severity in patients with baseline nystagmus in the DHT.
BibTeX: @article{Moreno2019, author = {Moreno, José Luis Ballvé and Muñoz, Ricard Carrillo and Matos, Yolanda Rando and Balboa, Iván Villar and Puértolas, Oriol Cunillera and Ortega, Jesús Almeda and Perez, Estrella Rodero and Curto, Xavier Monteverde and Ripollès, Carles Rubio and Farres, Noemí Moreno and Agudelo, Olga Lucia Arias and Cantera, Carlos Martin and Ledesma, Rafael Azagra}, title = {Effectiveness of the Epley manoeuvre in posterior canal benign paroxysmal positional vertigo: a randomised clinical trial in primary care.}, journal = {The British journal of general practice : the journal of the Royal College of General Practitioners}, year = {2019}, volume = {69}, issue = {678}, pages = {e52--e60}, doi = {https://doi.org/10.3399/bjgp18X700253}, keywords = {Epley manoeuvre; benign paroxysmal positional vertigo; primary health care; randomised controlled trial}, pmid = {30510098} }
Ballve Moreno, J.L., Carrillo Muñoz, R., Villar Balboa, I., Rando Matos, Y., Arias Agudelo, O.L., Vasudeva, A., Bigas Aguilera, O., Almeda Ortega, J., Capella Guillén, A., Buitrago Olaya, C.J., Monteverde Curto, X., Rodero Perez, E., Rubio Ripollès, C., Sepulveda Palacios, P.C., Moreno Farres, N., Hernández Sánchez, A.M., Martin Cantera, C. and Azagra Ledesma, R.	Effectiveness of the Epley's maneuver performed in primary care to treat posterior canal benign paroxysmal positional vertigo: study protocol for a randomized controlled trial. [Abstract] [BibTeX]	2014	Trials Vol. 15, pp. 179	article	DOI
Abstract: Vertigo is a common medical condition with a broad spectrum of diagnoses which requires an integrated approach to patients through a structured clinical interview and physical examination. The main cause of vertigo in primary care is benign paroxysmal positional vertigo (BPPV), which should be confirmed by a positive D-H positional test and treated with repositioning maneuvers. The objective of this study is to evaluate the effectiveness of Epley's maneuver performed by general practitioners (GPs) in the treatment of BPPV. This study is a randomized clinical trial conducted in the primary care setting. The study's scope will include two urban primary care centers which provide care for approximately 49,400 patients. All patients attending these two primary care centers, who are newly diagnosed with benign paroxysmal positional vertigo, will be invited to participate in the study and will be randomly assigned either to the treatment group (Epley's maneuver) or to the control group (a sham maneuver). Both groups will receive betahistine. Outcome variables will be: response to the D-H test, patients' report on presence or absence of vertigo during the previous week (dichotomous variable: yes/no), intensity of vertigo symptoms on a Likert-type scale in the previous week, total score on the Dizziness Handicap Inventory (DHI) and quantity of betahistine taken. Positive results from our study will highlight that treatment of benign paroxysmal positional vertigo can be performed by trained general practitioners (GPs) and, therefore, its widespread practice may contribute to improve the quality of life of BPPV patients. ClinicalTrials.gov Identifier: NCT01969513.
BibTeX: @article{BallveMoreno2014, author = {Ballve Moreno, José Luis and Carrillo Muñoz, Ricard and Villar Balboa, Iván and Rando Matos, Yolanda and Arias Agudelo, Olga Lucia and Vasudeva, Asha and Bigas Aguilera, Olga and Almeda Ortega, Jesús and Capella Guillén, Alicia and Buitrago Olaya, Clara Johanna and Monteverde Curto, Xavier and Rodero Perez, Estrella and Rubio Ripollès, Carles and Sepulveda Palacios, Pamela Catalina and Moreno Farres, Noemí and Hernández Sánchez, Anabella María and Martin Cantera, Carlos and Azagra Ledesma, Rafael}, title = {Effectiveness of the Epley's maneuver performed in primary care to treat posterior canal benign paroxysmal positional vertigo: study protocol for a randomized controlled trial.}, journal = {Trials}, year = {2014}, volume = {15}, pages = {179}, doi = {https://doi.org/10.1186/1745-6215-15-179}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis, physiopathology, therapy; Betahistine, therapeutic use; Clinical Protocols; General Practitioners; Histamine Agonists, pharmacology; Humans; Physical Therapy Modalities; Primary Health Care, methods; Research Design; Spain; Time Factors; Treatment Outcome; Urban Health Services}, pmid = {24886338} }
Kinne, B.L. and Leafman, J.S.	Effectiveness of the Parnes particle repositioning manoeuvre for posterior canal benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2015	The Journal of laryngology and otology Vol. 129(12), pp. 1188-1193	article	DOI
Abstract: Benign paroxysmal positional vertigo is a common vestibular disorder that negatively affects an individual's health-related quality of life. This study aimed to examine the effectiveness of the Parnes particle repositioning manoeuvre as an intervention for individuals with posterior canal benign paroxysmal positional vertigo. The de-identified records of 155 individuals treated with the Parnes manoeuvre were examined. Descriptive statistics were calculated, including the frequency and valid per cent of participants whose nystagmus was resolved with the Parnes manoeuvre. In all, nystagmus was resolved with the Parnes manoeuvre in 145 participants (93.5 per cent). The mean number of manoeuvres needed to resolve the nystagmus was 1.3. The Parnes manoeuvre proved to be as effective as the Epley canalith repositioning manoeuvre, currently the most common intervention, in treating individuals with posterior canal benign paroxysmal positional vertigo.
BibTeX: @article{Kinne2015, author = {Kinne, B L and Leafman, J S}, title = {Effectiveness of the Parnes particle repositioning manoeuvre for posterior canal benign paroxysmal positional vertigo.}, journal = {The Journal of laryngology and otology}, year = {2015}, volume = {129}, issue = {12}, pages = {1188--1193}, doi = {https://doi.org/10.1017/S0022215115002704}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, diagnosis, psychology, rehabilitation; Cohort Studies; Exercise Movement Techniques; Female; Humans; Male; Middle Aged; Patient Positioning, methods; Quality of Life; Retrospective Studies; Risk Assessment; Semicircular Canals; Severity of Illness Index; Treatment Outcome; Semicircular Canals; Vertigo; Vestibular Diseases}, pmid = {26456180} }
Pollak, L., Davies, R.A. and Luxon, L.L.	Effectiveness of the particle repositioning maneuver in benign paroxysmal positional vertigo with and without additional vestibular pathology. [Abstract] [BibTeX]	2002	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 23(1), pp. 79-83	article
Abstract: We compared the treatment outcome of patients with benign paroxysmal positional vertigo unassociated with additional objective evidence of vestibular pathology (BPPV) with that in patients who did demonstrate additional vestibular pathology on standard neurotologic testing (BPPV+). An open, retrospective, record-based study. Specialized outpatient dizziness clinic. We reviewed 58 unselected patients with a Dix-Hallpike test demonstrating positioning nystagmus characteristic of BPPV, who were treated during the past 4 years with the particle repositioning maneuver. Before treatment, all patients underwent detailed clinical and laboratory neurotological testing. The treatment outcome was assessed with regard to persistence of symptoms and the presence of positioning nystagmus on Dix-Hallpike testing. Seventy-eight percent of patients with BPPV no longer demonstrated characteristic positional nystagmus after 1 particle repositioning maneuver compared with 71% of patients with BPPV+ (p = 0.56) who did, whereas 13% of the BPPV and 14% of the BPPV+ group required more than 1 treatment to be rendered nystagmus negative on Dix-Hallpike testing (p = 0.89). However, 14% of patients with BPPV remained dizzy, compared with 63% patients from the BPPV+ group, despite a negative Dix-Hallpike test after treatment (p = 0.0018). Patients with horizontal canal paresis (n = 15) had a better outcome than patients with central vestibular dysfunction (n = 7, p = 0.006). Etiologic factors seemed to affect outcome-patients with idiopathic BPPV and those with a preceding acute vestibular neuronitis had a tendency for a better outcome than BPPV patients with any other etiology (p = 0.058). Our study demonstrates that patients with BPPV+ do not have a worse prognosis with respect to resolution of positional nystagmus, on performing the particle repositioning procedure, compared with patients with uncomplicated BPPV. However, they do suffer incomplete resolution of symptoms because of a coincidental anterior or horizontal canal dysfunction and otolithic or central vestibular dysfunction. It appears that the majority of patients with BPPV+ need further vestibular rehabilitation after the particle repositioning maneuver.
BibTeX: @article{Pollak2002, author = {Pollak, Lea and Davies, Rosalyn A and Luxon, Linda L}, title = {Effectiveness of the particle repositioning maneuver in benign paroxysmal positional vertigo with and without additional vestibular pathology.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2002}, volume = {23}, issue = {1}, pages = {79--83}, keywords = {Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Female; Humans; Labyrinthitis, diagnosis, physiopathology; Male; Middle Aged; Nystagmus, Physiologic, physiology; Posture; Reflex, Vestibulo-Ocular; Retrospective Studies; Saccades, physiology; Semicircular Canals, physiopathology; Severity of Illness Index; Vertigo, etiology, physiopathology, therapy; Vestibular Neuronitis, diagnosis, physiopathology; Vestibule, Labyrinth, physiopathology}, pmid = {11773852} }
O'Reilly, R.C., Elford, B. and Slater, R.	Effectiveness of the particle repositioning maneuver in subtypes of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2000	The Laryngoscope Vol. 110(8), pp. 1385-1388	article	DOI
Abstract: To assess the efficacy of the particle repositioning maneuver (PRM) in patients presenting with idiopathic benign paroxysmal positional vertigo (BPPV) compared with those with evidence of additional peripheral vestibulopathies. Retrospective administration of the Dizziness Handicap Inventory (DHI) to 41 patients with primary BPPV and 31 patients with secondary BPPV to subjectively evaluate their symptoms before and after the PRM. Both groups indicated a marked improvement in symptoms after the PRM. Only two patients reported an increase in their symptoms after the PRM and both had secondary BPPV. The PRM was found to be highly effective in all forms of BPPV, but careful history and judicious testing may identify patients requiring additional intervention to relieve their symptoms.
BibTeX: @article{OReilly2000, author = {O'Reilly, R C and Elford, B and Slater, R}, title = {Effectiveness of the particle repositioning maneuver in subtypes of benign paroxysmal positional vertigo.}, journal = {The Laryngoscope}, year = {2000}, volume = {110}, issue = {8}, pages = {1385--1388}, doi = {https://doi.org/10.1097/00005537-200008000-00031}, keywords = {Adult; Aged; Aged, 80 and over; Female; Humans; Male; Meniere Disease, therapy; Middle Aged; Treatment Outcome; Vestibular Diseases, therapy}, pmid = {10942146} }
Steenerson, R.L., Cronin, G.W. and Marbach, P.M.	Effectiveness of treatment techniques in 923 cases of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2005	The Laryngoscope Vol. 115(2), pp. 226-231	article	DOI
Abstract: To present treatment effectiveness of 923 consecutive cases of benign paroxysmal positional vertigo (BPPV) using canalith repositioning, liberatory, and log roll maneuvers combined with redistribution exercises. Retrospective case review. Patients presented with either posterior semicircular canal (P-SCC) BPPV or horizontal semicircular canal (H-SCC) BPPV. Diagnosis was based on patient history of transient paroxysmal vertigo and a positive Dix-Hallpike response with either torsional or horizontal nystagmus. Patients with P-SCC BPPV numbered 840, and 83 patients had H-SCC BPPV. In the original study, there were 1,000 patients; however, 77 patients were dropped from the study because of lack of follow-through. Intervention was canalith repositioning, liberatory maneuvers, log roll maneuvers, and redistribution exercises. Patients numbering 607 were treated with canalith repositioning, 233 patients had liberatory maneuvers, and 83 received log roll maneuvers. All patients received redistribution exercises before treatment maneuvers. After intervention, patients were reassessed at 6 months. There were 601 women and 322 men from ages 12 to 94 (median 55) years. The average duration of symptoms before intervention was 30 months. Outcome measures were considered met when symptoms of BPPV had abated and patients demonstrated a negative Dix-Hallpike response. In the repositioning group, 94% of patients were symptom free or improved, 98% in the liberatory maneuver group and 100% in the log roll group. The average number of sessions was three for all groups. Recurrence of symptoms was demonstrated in 140 (16%) patients at 6 months. Treatment of BPPV can be effective using either repositioning, liberatory, or log roll maneuvers in combination with redistribution exercises.
BibTeX: @article{Steenerson2005, author = {Steenerson, Ronald Leif and Cronin, Gaye W and Marbach, Peggy M}, title = {Effectiveness of treatment techniques in 923 cases of benign paroxysmal positional vertigo.}, journal = {The Laryngoscope}, year = {2005}, volume = {115}, issue = {2}, pages = {226--231}, doi = {https://doi.org/10.1097/01.mlg.0000154723.55044.b5}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Child; Female; Humans; Male; Middle Aged; Recurrence; Vertigo, therapy}, pmid = {15689740} }
Cohen, H.S. and Kimball, K.T.	Effectiveness of treatments for benign paroxysmal positional vertigo of the posterior canal. [Abstract] [BibTeX]	2005	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 26(5), pp. 1034-1040	article
Abstract: To determine which common, nonpharmacological, nonsurgical treatments are most effective for treatment of benign paroxysmal positional vertigo (BPPV). Prospective, randomized, sham-controlled. Patients (n = 124) with BPPV of the posterior semicircular canal. Tertiary care center. Random assignment to one of five groups: modified canalith repositioning maneuver (CRP), modified liberatory maneuver (LM), sham maneuver, Brandt and Daroff's exercise, and vertigo habituation exercises. Subjects received a standard educational lecture about BPPV and the purpose of the intervention. No vestibular-suppressant medication or special instructions for head positioning were used. Post-tests were given at 1 week after treatment and at approximately 3 months and 6 months later. Vertigo intensity and frequency. Multilevel analyses showed that vertigo decreased significantly after LM, CRP, and Brandt-Daroff exercise; those three groups did not differ significantly. The habituation group did not differ from sham, Brandt-Daroff, LM, or CRP groups. Changes in scores were maintained throughout the 6-month follow-up period. LM, CRP, and exercises are all effective interventions; patient education plus the sham maneuver, however, had some beneficial effect. These results support two possible mechanisms of BPPV: displaced otoconia and a neural mechanism affecting interpretation of semicircular canal signals.
BibTeX: @article{Cohen2005, author = {Cohen, Helen S and Kimball, Kay T}, title = {Effectiveness of treatments for benign paroxysmal positional vertigo of the posterior canal.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2005}, volume = {26}, issue = {5}, pages = {1034--1040}, keywords = {Adult; Aged; Aged, 80 and over; Female; Follow-Up Studies; Humans; Male; Middle Aged; Physical Therapy Modalities; Treatment Outcome; Vertigo, therapy}, pmid = {16151355} }
Ribeiro, K.M.O.B.d.F., Freitas, R.V.d.M., Ferreira, L.M.d.B.M., Deshpande, N. and Guerra, R.O.	Effects of balance Vestibular Rehabilitation Therapy in elderly with Benign Paroxysmal Positional Vertigo: a randomized controlled trial. [Abstract] [BibTeX]	2017	Disability and rehabilitation Vol. 39(12), pp. 1198-1206	article	DOI
Abstract: To evaluate short-term effects of balance Vestibular Rehabilitation Therapy (VRT) on balance, dizziness symptoms and quality of life of the elderly with chronic Benign Paroxysmal Positional Vertigo (BPPV). In this randomized, single-blind and controlled trial, older adults with chronic BPPV were randomized into two groups, the experimental group (n = 7, age: 69 (65-78) years) and the control group (n = 7, age: 73 (65-76) years). Patients in the experimental group underwent balance VRT (50 min per session, two times a week) and Canalith Repositioning Maneuver (CRM) as required, for 13 weeks. The control group was treated using only CRM as required. Standing and dynamic balance, dizziness symptoms and quality of life were measured at the baseline, and at one, five, nine and thirteen weeks. There were no between-group differences in dizziness, quality of life and standing balance over the 13 weeks. Significant differences were observed in dynamic balance measures between groups (p < 0.05 for most tests) through assessments. In intragroup analysis, both groups showed improvements in all measurements except no improvement was found in majority of the dynamic balance tests in the control group. The patients who received additional balance VRT demonstrated better results in dynamic balance than those who received only CRM. Implications for Rehabilitation The findings that balance VRT in addition to CRM improves dynamic balance in elderly people with BPPV should be useful in guiding rehabilitation professionals' clinical decision making to design interventions for seniors suffering from BPPV; Improvements in tests of dynamic balance suggest that the risk of adverse consequences of BPPV in the elderly such as falls and fractures can be potentially reduced through implementation of CRM in conjunction with balance VRT; Lack of additional improvement in Visual Analogue Scale of dizziness and Dizziness Handicap Index suggests that addition of balance VRT does not influence dizziness symptomatology, per se, and CRM alone is effective to ameliorate vertiginous symptoms and potentially improve quality of life.
BibTeX: @article{Ribeiro2017a, author = {Ribeiro, Karyna Myrelly Oliveira Bezerra de Figueiredo and Freitas, Raysa Vanessa de Medeiros and Ferreira, Lidiane Maria de Brito Macedo and Deshpande, Nandini and Guerra, Ricardo Oliveira}, title = {Effects of balance Vestibular Rehabilitation Therapy in elderly with Benign Paroxysmal Positional Vertigo: a randomized controlled trial.}, journal = {Disability and rehabilitation}, year = {2017}, volume = {39}, issue = {12}, pages = {1198--1206}, doi = {https://doi.org/10.1080/09638288.2016.1190870}, keywords = {Accidental Falls, prevention & control; Aged; Benign Paroxysmal Positional Vertigo, rehabilitation; Brazil; Dizziness, rehabilitation; Female; Humans; Male; Postural Balance; Quality of Life; Single-Blind Method; Visual Analog Scale; Aged; Benign paroxysmal positional vertigo; dizziness; postural balance; rehabilitation}, pmid = {27340939} }
Sunami, K., Tochino, R., Tokuhara, Y., Yamamoto, H., Tomita, S., Koshimo, N. and Yamane, H.	Effects of cigarettes and alcohol consumption in benign paroxysmal positioning vertigo. [Abstract] [BibTeX]	2006	Acta oto-laryngologica Vol. 126(8), pp. 834-838	article	DOI
Abstract: Smoking was associated with a lower incidence of benign paroxysmal positioning vertigo (BPPV). A larger study is required to establish the role of smoking in BPPV. To evaluate the effect of cigarette and alcohol consumption on BPPV. One hundred and fifty-six patients with BPPV and 155 age- and sex-matched normal subjects were compared according to their cigarette and alcohol consumption. Patients with BPPV who had had a recurrence of the disease and those who had not were also compared as to their cigarette and alcohol consumption. The question of whether the length of time until recovery was influenced by cigarette or alcohol consumption was also investigated. Control subjects smoked significantly more often than BPPV patients, and patients without recurrence more frequently than patients with recurrence. Alcohol consumption was also more common in control subjects than in BPPV patients, but there was no difference between patients with recurrence and without recurrence. There was a tendency for smoking patients to recover sooner than non-smoking patients. Alcohol consumption did not affect the length of time until recovery.
BibTeX: @article{Sunami2006, author = {Sunami, Kishiko and Tochino, Rie and Tokuhara, Yasutake and Yamamoto, Hidefumi and Tomita, Satoshi and Koshimo, Naomi and Yamane, Hideo}, title = {Effects of cigarettes and alcohol consumption in benign paroxysmal positioning vertigo.}, journal = {Acta oto-laryngologica}, year = {2006}, volume = {126}, issue = {8}, pages = {834--838}, doi = {https://doi.org/10.1080/00016480500527474}, keywords = {Adult; Aged; Alcohol Drinking, adverse effects, epidemiology; Female; Humans; Japan; Male; Middle Aged; Recovery of Function; Recurrence; Reference Values; Risk Factors; Smoking, adverse effects, epidemiology; Statistics as Topic; Vertigo, epidemiology, etiology}, pmid = {16846926} }
Kendall, J.C., Hartvigsen, J., Azari, M.F. and French, S.D.	Effects of Nonpharmacological Interventions for Dizziness in Older People: Systematic Review. [Abstract] [BibTeX]	2016	Physical therapy Vol. 96(5), pp. 641-649	article	DOI
Abstract: Nonpharmacological interventions have been shown to have some effectiveness in adults with dizziness; however, the effectiveness of these interventions in older people is unknown. The aim of this study was to determine the effects of conservative nonpharmacological interventions for dizziness in older people. The Cochrane Central Register of Controlled Trials, PubMed, EMBASE, SCOPUS, CINAHL, AMED, Index to Chiropractic Literature, PsycINFO, and MANTIS were searched from inception to May 2014. Two investigators independently screened controlled trials with participants who were more than 60 years old and experienced dizziness. Studies of participants with dizziness from a specific diagnosis, such as Ménière disease and benign paroxysmal positional vertigo, were excluded. Outcome measures from the selected studies included self-reported dizziness and postural balance. Two investigators independently extracted data on participants, interventions, comparison group, outcome measures, and results. The risk of bias of the included studies was assessed with Cochrane guidelines. Seven articles consisting of 7 controlled trials were included. All studies involved some form of exercise, including vestibular rehabilitation exercises, postural balance exercises, and tai chi exercise, as the main intervention. The studies had a high risk of bias because of the lack of adequate randomization and allocation concealment, the lack of reporting on cointerventions, the lack of reporting on reasons for dropouts, and the lack of reporting on participant adherence. Heterogeneity among the included studies in interventions and outcome measures prohibited a meta-analysis. Only 2 studies reported a significant difference between the intervention group and the comparison group for self-reported dizziness. There is insufficient evidence to determine the effectiveness of nonpharmacological treatments for dizziness in older people. Current evidence is hampered by a high risk of bias, and well-designed trials with adequate masking, randomization, and adherence are needed.
BibTeX: @article{Kendall2016, author = {Kendall, Julie C and Hartvigsen, Jan and Azari, Michael F and French, Simon D}, title = {Effects of Nonpharmacological Interventions for Dizziness in Older People: Systematic Review.}, journal = {Physical therapy}, year = {2016}, volume = {96}, issue = {5}, pages = {641--649}, doi = {https://doi.org/10.2522/ptj.20150349}, keywords = {Aged; Aged, 80 and over; Conservative Treatment; Dizziness, therapy; Exercise Therapy, methods; Humans; Middle Aged; Postural Balance; Self Report; Treatment Outcome}, pmid = {26450972} }
Balikci, H.H. and Ozbay, I.	Effects of postural restriction after modified Epley maneuver on recurrence of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2014	Auris, nasus, larynx Vol. 41(5), pp. 428-431	article	DOI
Abstract: In the present study, we calculated the success rate of the modified Epley maneuver and determined the effectiveness of post-maneuver positional restriction in terms of the prevention of early and late recurrence. The present study was conducted on 78 patients who had unilateral benign paroxysmal positional vertigo (BPPV) of the posterior semicircular canal (SCC) and who were treated in the Otorhinolaryngology Department of Susehri State Hospital. The Dix-Hallpike test was performed on all patients. After the involved canal was identified using this test, we guided patients through the modified Epley repositioning maneuver. A maximum of two maneuvers were performed in the same session. The patients were randomly divided into two groups. One group was not advised any positional restriction, while the second group was advised positional restriction for 10 days after the procedure. Recurrences during 1-90 days after the treatment were noted as early recurrences, while those that occurred after 90 days were noted as late recurrences. In the restriction group (n=39), repositioning was successful after a single maneuver in 32 (82.05%) patients and after two maneuvers in 5 (12.8%) patients. Repositioning failed in two (5.1%) patients. In the non-restriction group (n=39), repositioning was successful after a single maneuver in 31 (79.4%) patients and after two maneuvers in 6 (15.3%) patients. Repositioning failed in two (5.1%) patients. Thus, the success rate was 94.8% in each group. Early recurrence occurred in 3 (8.1%) of 37 patients in the restriction group and 2 (5.4%) of 37 patients in the non-restriction group (p>0.05). Late recurrence occurred in 5 (13.5%) of 37 patients in both the restriction and non-restriction groups (p>0.05). Postural restriction after a canalith repositioning procedure does not improve procedural success or decrease early and late recurrence rates. However, the number of patients was too small to detect a difference between both treatment groups.
BibTeX: @article{Balikci2014, author = {Balikci, Hasan Huseyin and Ozbay, Isa}, title = {Effects of postural restriction after modified Epley maneuver on recurrence of benign paroxysmal positional vertigo.}, journal = {Auris, nasus, larynx}, year = {2014}, volume = {41}, issue = {5}, pages = {428--431}, doi = {https://doi.org/10.1016/j.anl.2014.05.007}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo, prevention & control, therapy; Female; Humans; Male; Middle Aged; Patient Positioning; Physical Therapy Modalities; Posture; Recurrence; Young Adult; Benign paroxysmal positional vertigo; Canalith repositioning maneuver; Posterior semicircular canals; Vertigo}, pmid = {24882587} }
Zhang, X., Qian, X., Lu, L., Chen, J., Liu, J., Lin, C. and Gao, X.	Effects of Semont maneuver on benign paroxysmal positional vertigo: a meta-analysis. [Abstract] [BibTeX]	2017	Acta oto-laryngologica Vol. 137(1), pp. 63-70	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most common type of peripheral vertigo. This study aimed to evaluate the effects of the Semont maneuver (SM) for BPPV treatment, compared with other methods. Studies were selected in relevant databases under pre-defined criteria up to June 2015. The Cochrane evaluation system was used to assess the quality of the studies. Effect size was indicated as a risk-ratio (RR) with corresponding 95% confidential interval (CI). Statistical analysis was conducted under a randomized- or fixed-effects model. Sub-group analysis was performed. Ten studies were included in the meta-analysis. All of the studies presented a low attrition bias, but a high selection and reporting bias. SM had a much higher recovery rate (SM vs no treatment: RR = 2.60, 95% CI = 1.97-3.44, p < 0.01; SM vs sham: RR = 4.89, 95% CI = 3.01-7.94, p < 0.01), and lower recurrence rate than those from controls (SM vs no treatment: RR = 0.11, 95% CI = 0.04-0.31, p < 0.01). Overall, SM had similar outcomes with Epley maneuver (EM) and Brandt-Daroff exercise (BDE) in terms of recovery rate, recurrence rate, and side-effects. SM is as effective as EM and BDE for BPPV treatment.
BibTeX: @article{Zhang2017a, author = {Zhang, Xiaoli and Qian, Xiaoyun and Lu, Ling and Chen, Jie and Liu, Jing and Lin, Chuanyao and Gao, Xia}, title = {Effects of Semont maneuver on benign paroxysmal positional vertigo: a meta-analysis.}, journal = {Acta oto-laryngologica}, year = {2017}, volume = {137}, issue = {1}, pages = {63--70}, doi = {https://doi.org/10.1080/00016489.2016.1212265}, keywords = {Benign Paroxysmal Positional Vertigo, therapy; Humans; Physical Therapy Modalities; Recovery of Function; Recurrence; Benign paroxysmal positional vertigo; Brandt-Daroff exercise; Epley maneuver; Semont maneuver; meta-analysis; randomized controlled trails}, pmid = {27683970} }
Sato, G., Sekine, K., Matsuda, K. and Takeda, N.	Effects of sleep position on time course in remission of positional vertigo in patients with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2012	Acta oto-laryngologica Vol. 132(6), pp. 614-617	article	DOI
Abstract: The findings suggest that it is easy for otoconial debris dislodged from the utricle to fall into the posterior semicircular canal (PSCC) or the horizontal semicircular canal (HSCC) of the undermost ear during sleep, but not to exit from the uppermost ear in patients with benign paroxysmal positional vertigo (BPPV). The aims of the present study were two-fold. (1) To examine the association between the preferred side of head-lying during sleep and the side of the affected ear in patients with both posterior canal BPPV (P-BPPV) and horizontal canal BPPV (H-BPPV). (2) To see whether that position affects the time course in remission of their positional vertigo. One hundred and sixteen patients with P-BPPV and 40 patients with H-BPPV who showed a habitual preference for right or left side sleeping position were included in this study. The side of the affected ear was significantly associated with the head-lying side during sleep in patients with P-BPPV and was closely but not significantly associated with it in patients with H-BPPV. However, the head-lying side during sleep did not affect the remission rate of their positional vertigo.
BibTeX: @article{Sato2012, author = {Sato, Go and Sekine, Kazunori and Matsuda, Kazunori and Takeda, Noriaki}, title = {Effects of sleep position on time course in remission of positional vertigo in patients with benign paroxysmal positional vertigo.}, journal = {Acta oto-laryngologica}, year = {2012}, volume = {132}, issue = {6}, pages = {614--617}, doi = {https://doi.org/10.3109/00016489.2012.655860}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Female; Follow-Up Studies; Humans; Male; Middle Aged; Posture; Remission Induction, methods; Retrospective Studies; Sleep; Time Factors; Treatment Outcome; Vertigo, physiopathology, therapy; Young Adult}, pmid = {22384815} }
Gunes, A. and Yuzbasioglu, Y.	Effects of treatment on anxiety levels among patients with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2019	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery	article	DOI
Abstract: The association of vertigo with anxiety disorders is well known. Herein, we aimed to determine the relationship between pre-treatment and post-treatment anxiety levels, assessed with Beck anxiety inventory, with educational status among patients diagnosed with and treated for Benign paroxysmal positional vertigo (BPPV), and to evaluate the effect of treatment on the sub-parameters of the Beck anxiety inventory. Our study included a total of 33 patients that presented to the otorhinolaryngology outpatient clinic with acute vertigo and were diagnosed to have posterior canal BPPV. Patients diagnosed with posterior BPPV were applied Beck anxiety inventory prior to the treatment as well as 1 week and 4 weeks after the treatment. Compared to the control group, statistically significant changes were observed in relation to pre-treatment and post-treatment inventory scores (p < 0.05). A comparison of the pre-treatment and post-treatment assessments revealed significant differences (p < 0.05). Improvements were observed in 48% (10/21) of the subparameters by the end of the first week at the earliest. Educational status had no significant effect on inventory scores (p > 0.05). Anxiety-related subjective symptoms mostly started to improve 1 week after the treatment at the earliest, and symptoms showed persistence at a certain level even at the end of the first month. Inequalities between the patients' educational levels affect anxiety levels. It should be remembered that educational status should be considered when approaching patients.
BibTeX: @article{Gunes2019, author = {Gunes, Akif and Yuzbasioglu, Yucel}, title = {Effects of treatment on anxiety levels among patients with benign paroxysmal positional vertigo.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2019}, doi = {https://doi.org/10.1007/s00405-019-05297-9}, keywords = {Anxiety; BPPV; Beck anxiety inventory; Benign paroxysmal positional vertigo; Vertigo}, pmid = {30666439} }
Byrd, M.T. and Bergstrom, H.C.	Effects of Very Short-Term Dynamic Constant External Resistance Exercise on Strength and Barbell Velocity in Untrained Individuals. [Abstract] [BibTeX]	2018	International journal of exercise science Vol. 11(1), pp. 867-874	article
Abstract: This study examined the effect of an upper body dynamic constant external resistance (DCER) exercise (barbell bench press [BP]), using the very short-term training (VST) model on strength and barbell velocity. Ten (5 females, 5 males) subjects (mean ± SD age: 21.4 ± 2.8 yrs; height: 1.75 ± 0.12 m; body mass: 83 ± 8.8 kg) completed two pre-test visits (pre-test 1 and pretest 2) to serve as the within subjects control, three training visits, and one post-test visit. The subject's 1 repetition maximum (1RM) for the BP as well as the mean (BP ) and peak (BP ) barbell velocities were determined during pre-test 1, pre-test 2 and post-test visits. The barbell bench press throw (BT) mean (BT ) and peak (BT ) velocities were also measured utilizing 35% of the subject's BP 1RM as resistance. The three training visits consisted of 5 sets of 6 repetitions, at 65% of the subject's 1RM. Statistical analyses included one-way repeated measures ANOVAs and paired samples t-tests (alpha level of p≤0.05). The post-test 1RM, BT , and BT were all significantly greater than pre-test 1 (p=0.002, p=0.0001, and p=0.002) and pre-test 2 (p=0.008, p=0.034, and p=0.015), with no significant differences seen between pre-test 1 and pre-test 2 for any of the variables. The posttest BP and BP were significantly greater than pre-test 1 (p=0.024 and p=0.005), but not pre-test 2 (p=0.131 and p=0.069). These findings showed the VST model, utilizing an upper body DCER exercise improved strength and barbell velocity in untrained subjects.
BibTeX: @article{Byrd2018, author = {Byrd, M Travis and Bergstrom, Haley C}, title = {Effects of Very Short-Term Dynamic Constant External Resistance Exercise on Strength and Barbell Velocity in Untrained Individuals.}, journal = {International journal of exercise science}, year = {2018}, volume = {11}, issue = {1}, pages = {867--874}, keywords = {DCER; VST; bench press; bench throw}, pmid = {29997728} }
Gacek, R.R.	Efferent system degeneration in the human temporal bone. [Abstract] [BibTeX]	2003	The Annals of otology, rhinology, and laryngology Vol. 112(11), pp. 947-954	article	DOI
Abstract: Sense organ deposits have been described in temporal bones from patients with vestibular neuronitis, Meniere's disease, and benign paroxysmal positional vertigo that are not found in a comparable series of temporal bones without vestibulopathy. Because the recurrent vestibulopathies are caused by vestibular ganglionitis and the vestibulocochlear anastomosis was degenerated in these temporal bones, the deposits may represent the end buds of regenerating efferent axons injured in passage through the vestibular ganglion. Such neural buds have been described with transmission electron microscopy in animals after vestibular nerve transection and in a human temporal bone with endolymphatic hydrops. The buds may be visible by light microscopy, because their size is comparable to that of hair cell nuclei and they stain blue with hematoxylin because of their nucleic acid content. The variable location and size of these deposits (buds) in the labyrinthine sense organs is described to aid in the recognition of efferent system injury in human temporal bones.
BibTeX: @article{Gacek2003, author = {Gacek, Richard R}, title = {Efferent system degeneration in the human temporal bone.}, journal = {The Annals of otology, rhinology, and laryngology}, year = {2003}, volume = {112}, issue = {11}, pages = {947--954}, doi = {https://doi.org/10.1177/000348940311201106}, keywords = {Animals; Efferent Pathways, pathology; Humans; Nerve Degeneration, pathology; Nerve Regeneration, physiology; Neurons, Efferent, pathology; Organ of Corti, pathology; Temporal Bone, innervation; Vestibular Neuronitis, pathology; Vestibulocochlear Nerve, pathology}, pmid = {14653363} }
Ramakrishna, J., Goebel, J.A. and Parnes, L.S.	Efficacy and safety of bilateral posterior canal occlusion in patients with refractory benign paroxysmal positional vertigo: case report series. [Abstract] [BibTeX]	2012	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 33(4), pp. 640-642	article	DOI
Abstract: To highlight the effectiveness, safety, and adverse effects of treating intractable posterior canal benign paroxysmal positional vertigo (BPPV) with bilateral posterior canal occlusions. Included in this study are 6 patients diagnosed with bilateral BPPV refractory to medical treatment and particle repositioning maneuvers (PRMs) who underwent bilateral posterior semicircular canal occlusions. Patients were selected from tertiary hospital referral centers in London, Ontario, Canada, and St. Louis, Missouri, USA. This study used the following interventions: preoperative and postoperative audiogram testing to monitor long-term changes in hearing, computed tomography of the head to rule out central lesions and confirm normal inner ear anatomy before surgery, magnetic resonance imaging of the head as needed to rule out posterior fossa lesions causing persistent vertigo, Dix-Hallpike maneuver to diagnose BPPV, PRM and physiotherapy vestibular rehabilitation to attempt treating BPPV before surgical intervention, and sequential transmastoid posterior semicircular canal occlusion for treatment of intractable BPPV. Postoperative resolution of vertigo induced by head movement and hearing preservation by audiometric testing and postural stability. All patients with severe debilitating bilateral BPPV refractory to medical treatment and PRM had complete resolution of their positional vertigo after bilateral sequential posterior semicircular canal occlusion. Hearing was preserved at the preoperative level in all but 1 patient who developed bilateral postoperative, mild, high-tone sensorineural loss. Residual postoperative adverse effects included transient imbalance in all patients and episodic, nonpositional vertigo in 1 patient. When stressed by extreme head motion, some patients had mild residual instability. There were no other significant long-term complications. Bilateral sequential posterior semicircular canal occlusion is a definitive, effective, and safe treatment modality for intractable bilateral BPPV, providing patients with resolution of their vertiginous symptoms. All 6 patients stated that the alleviation of their BPPV symptoms far out-weighed the residual motion sensitivity resulting from the occluded canals.
BibTeX: @article{Ramakrishna2012, author = {Ramakrishna, Jayant and Goebel, Joel A and Parnes, Lorne S}, title = {Efficacy and safety of bilateral posterior canal occlusion in patients with refractory benign paroxysmal positional vertigo: case report series.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2012}, volume = {33}, issue = {4}, pages = {640--642}, doi = {https://doi.org/10.1097/MAO.0b013e31824bae56}, keywords = {Aged; Benign Paroxysmal Positional Vertigo; Female; Head Movements, physiology; Hearing, physiology; Hearing Loss, Sensorineural, complications; Humans; Male; Middle Aged; Postoperative Complications; Semicircular Canals, pathology, surgery; Tomography, X-Ray Computed; Vertigo, complications, surgery}, pmid = {22429946} }
Zhu, Q., Liu, C., Lin, C., Chen, X., Liu, T., Lin, S. and Fan, J.	Efficacy and safety of semicircular canal occlusion for intractable horizontal semicircular benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2015	The Annals of otology, rhinology, and laryngology Vol. 124(4), pp. 257-260	article	DOI
Abstract: Some studies have suggested that semicircular canal occlusion is effective and safe for treating intractable posterior semicircular benign paroxysmal positional vertigo (PSC-BPPV), and adverse effects of canal occlusions for intractable horizontal semicircular BPPV (HSC-BPPV) were rarely reported. The aim of this study was to retrospectively discuss the efficacy of semicircular canal occlusion for intractable HSC-BPPV with at least 2 years of follow-up. From 2000 to 2011, 3 female patients (average age=60±6.9 years), with a diagnosis of HSC-BPPV refractory to head-shake and barbecue roll maneuver, underwent semicircular canal occlusion treatment in our hospital. The supine roll test was performed to diagnose HSC-BPPV and evaluate the treatment efficacy. All patients with intractable HSC-BPPV had complete resolution of their positional vertigo after semicircular canal occlusion with a negative supine roll test. All patients reported transient postoperative disequilibrium, nausea, and vomiting, which resolved within 2 weeks. In addition, 1 patient (33.3%) had transient tinnitus, which resolved after 4 months. There were no other significant long-term complications. Semicircular canal occlusion appears to be a safe and well-tolerated treatment modality for intractable HSC-BPPV. However, further studies with large sample sizes are needed to confirm our conclusion.
BibTeX: @article{Zhu2015, author = {Zhu, Qiubei and Liu, Chang and Lin, Cheng and Chen, Xian and Liu, Tao and Lin, Shunzhang and Fan, Jingping}, title = {Efficacy and safety of semicircular canal occlusion for intractable horizontal semicircular benign paroxysmal positional vertigo.}, journal = {The Annals of otology, rhinology, and laryngology}, year = {2015}, volume = {124}, issue = {4}, pages = {257--260}, doi = {https://doi.org/10.1177/0003489414556307}, keywords = {Aged; Benign Paroxysmal Positional Vertigo, physiopathology, surgery; Female; Follow-Up Studies; Humans; Male; Middle Aged; Otologic Surgical Procedures, methods; Posture, physiology; Retrospective Studies; Semicircular Canals, surgery; Time Factors; Treatment Outcome; benign paroxysmal positional vertigo; canalolithiasis; cupulolithiasis; nystagmus; semicircular canal occlusion; supine roll test}, pmid = {25358608} }
Kulcu, D.G., Yanik, B., Boynukalin, S. and Kurtais, Y.	Efficacy of a home-based exercise program on benign paroxysmal positional vertigo compared with betahistine. [Abstract] [BibTeX]	2008	Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale Vol. 37(3), pp. 373-379	article
Abstract: To determine the efficacy of a home-based exercise program by comparing it with betahistine in patients with benign paroxysmal positional vertigo (BPPV). Prospective, randomized, controlled study. Outpatient clinic of a university hospital. Thirty-eight patients (10 males, 28 females; mean age 46 +/- 13 years) diagnosed as having BPPV. Patients were randomly assigned to either an exercise or a medication group. In the medication group, betahistine was prescribed at 24 mg/d for 1 month. The exercise group was required to perform Cawthorne-Cooksey exercises six times/day for 4 weeks. The Vertigo, Dizziness, Imbalance Questionnaire (VDI), which consists of two subscales, the VDI symptom subscale (VDI-ss) and the VDI health-related quality of life (VDI-HRQoL) subscale, and the Vertigo Symptom Scale (VSS) were used for assessment at the beginning of the study and after 2 months. The mean scores of the two components of the VDI and the VSS decreased in the exercise group by the fourth week. In the medication group, VSI mean scores, VDIss mean scores, and VSS mean scores decreased in the second week and VDI-HRQoL mean scores decreased in the fourth week. However, there were no significant differences between baseline and week 8. There were significant differences between groups regarding the change in the mean scores of the VDI (p = .001) and the VSS (p = .001) at the end of the study in favour of the exercise group. Exercise was found to be a better treatment choice than medication and may be preferable for patients with persistent or chronic vertigo.
BibTeX: @article{Kulcu2008, author = {Kulcu, Duygu Geler and Yanik, Burcu and Boynukalin, Serife and Kurtais, Yesim}, title = {Efficacy of a home-based exercise program on benign paroxysmal positional vertigo compared with betahistine.}, journal = {Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale}, year = {2008}, volume = {37}, issue = {3}, pages = {373--379}, keywords = {Betahistine, administration & dosage, therapeutic use; Dose-Response Relationship, Drug; Electronystagmography; Exercise Therapy, methods; Eye Movements, physiology; Female; Follow-Up Studies; Histamine Antagonists, administration & dosage, therapeutic use; Humans; Male; Middle Aged; Outpatient Clinics, Hospital; Outpatients; Postural Balance, physiology; Prospective Studies; Surveys and Questionnaires; Treatment Outcome; Vertigo, physiopathology, therapy}, pmid = {19128642} }
Bromwich, M., Hughes, B., Raymond, M., Sukerman, S. and Parnes, L.	Efficacy of a new home treatment device for benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2010	Archives of otolaryngology--head & neck surgery Vol. 136(7), pp. 682-685	article	DOI
Abstract: To prospectively test the efficacy of a device for the home treatment of benign paroxysmal positional vertigo (BPPV). Multicenter prospective cohort study. Community and tertiary care clinic offices and patient homes. Forty patients with active BPPV. Training on and treatment with a home treatment device (The DizzyFIX) as their primary therapy technique. The Dix-Hallpike maneuver at 1 week after treatment. Patients using the home treatment device had no evidence of nystagmus in posttreatment Dix-Hallpike maneuvers at 1 week in 88% of cases (n = 40). This rate was comparable to standard treatment. There were no significant complications. The use of this device enables patients with an established diagnosis of posterior canal BPPV to safely conduct an effective particle repositioning maneuver and achieve success rates similar to those found with the standard Epley maneuver.
BibTeX: @article{Bromwich2010, author = {Bromwich, Matthew and Hughes, Brian and Raymond, Mark and Sukerman, Sydney and Parnes, Lorne}, title = {Efficacy of a new home treatment device for benign paroxysmal positional vertigo.}, journal = {Archives of otolaryngology--head & neck surgery}, year = {2010}, volume = {136}, issue = {7}, pages = {682--685}, doi = {https://doi.org/10.1001/archoto.2010.105}, keywords = {Adult; Aged; Cohort Studies; Equipment Design; Equipment Safety; Female; Home Nursing, methods; Humans; Male; Middle Aged; Nystagmus, Pathologic, diagnosis, rehabilitation; Patient Satisfaction; Posture; Prospective Studies; Self-Help Devices; Severity of Illness Index; Treatment Outcome; Vertigo, diagnosis, rehabilitation}, pmid = {20644063} }
Roberts, R.A., Gans, R.E. and Montaudo, R.L.	Efficacy of a new treatment maneuver for posterior canal benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2006	Journal of the American Academy of Audiology Vol. 17(8), pp. 598-604	article
Abstract: Existing treatment maneuvers for posterior canal benign paroxysmal positional vertigo (PC-BPPV) include the Semont liberatory maneuver (SLM) and canalith repositioning maneuver (CRM). Independent investigations reveal that these maneuvers provide an excellent outcome for most patients. However, certain aspects of these maneuvers, such as hyperextension of the neck for CRM and brisk lateral motion for the SLM, are contraindicated for patients with vertebrobasilar insufficiency, cervical spondylosis, back problems, and so forth. A hybrid approach, the Gans repositioning maneuver (GRM) was developed for use with these patients. The purpose of this project was to assess efficacy of the GRM for treatment of PC-BPPV. Two-hundred seven participants were enrolled in this prospective study. All participants were treated with the GRM. Six different clinicians performed the treatments. Participants returned for follow-up at one-week intervals until it was determined that the PC-BPPV was clear. On average, 1.25 GRM treatments were required to resolve the PC-BPPV. The majority of the participants (80.2%) were cleared with one GRM treatment, and 95.6% were clear after two treatments. Recurrence rate was 5%. There was no difference in outcome based on clinician. The GRM is an efficacious treatment maneuver for PC-BPPV and may be preferential for use in patients with neck, back, hip, and/or mobility issues that contraindicate the use of SLM or CRM.
BibTeX: @article{Roberts2006, author = {Roberts, Richard A and Gans, Richard E and Montaudo, Renee L}, title = {Efficacy of a new treatment maneuver for posterior canal benign paroxysmal positional vertigo.}, journal = {Journal of the American Academy of Audiology}, year = {2006}, volume = {17}, issue = {8}, pages = {598--604}, keywords = {Adult; Aged; Aged, 80 and over; Contraindications; Female; Humans; Male; Middle Aged; Nystagmus, Physiologic; Physical Therapy Modalities; Posture; Prospective Studies; Recurrence; Treatment Outcome; Vertigo, rehabilitation}, pmid = {16999254} }
Wan, T.-J., Yu, Y.-C., Zhao, X.-G., Tang, P. and Gong, Y.-S.	Efficacy of betahistine plus cognitive behavioral therapy on residual dizziness after successful canalith repositioning procedure for benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2018	Neuropsychiatric disease and treatment Vol. 14, pp. 2965-2971	article	DOI
Abstract: Some patients still complain of residual dizziness after successful canalith repositioning procedure (CRP) for benign paroxysmal positional vertigo (BPPV). Previous study found that compared to the low-dose betahistine, the high-dose betahistine could yield better efficacy in treating residual dizziness. Therefore, this study was conducted to assess whether the addition of cognitive behavioral therapy (CBT) could make low-dose betahistine produce similar results to high-dose betahistine in treating residual dizziness. The recruited patients were randomly assigned to receive either low-dose betahistine (6 mg/time, three times/day) or high-dose betahistine (12 mg/time, three times/day). Patients in the low-dose group also received CBT (twice a week, 1 hour per time). The treatment was continued for 4 weeks. The duration of residual dizziness, 25-item Dizziness Handicap Inventory (DHI), Hamilton Anxiety Rating Scale (HARS), and Hamilton Depression Rating Scale (HDRS) were recorded and analyzed. The duration of residual dizziness and DHI score were the primary outcomes, and the HARS and HDRS scores were the secondary outcomes. Each group had 50 patients. After treatment, the average DHI scores, HDRS scores, and HARS scores were significantly decreased in both groups. The duration of residual dizziness and average DHI score were nonsignificantly different ( =0.08; =0.06) between the two groups, although they were lower in the low-dose group. Compared to the high-dose group, the low-dose group had the significantly lower average HDRS score ( =0.007) and HARS score ( =0.02). Meanwhile, four patients in the high-dose group experienced intolerable stomach upset. These results demonstrated that the addition of CBT could make low-dose beta-histine produce similar results to high-dose betahistine in treating residual dizziness. Moreover, the low-dose betahistine plus CBT showed some advantages over high-dose betahistine in relieving depressive and anxiety symptoms and should be further explored.
BibTeX: @article{Wan2018, author = {Wan, Tian-Ju and Yu, Yi-Chuan and Zhao, Xiao-Gang and Tang, Ping and Gong, Yong-Shu}, title = {Efficacy of betahistine plus cognitive behavioral therapy on residual dizziness after successful canalith repositioning procedure for benign paroxysmal positional vertigo.}, journal = {Neuropsychiatric disease and treatment}, year = {2018}, volume = {14}, pages = {2965--2971}, doi = {https://doi.org/10.2147/NDT.S182809}, keywords = {BPPV; CBT; benign paroxysmal positional vertigo; betahistine; cognitive behavioral therapy; residual dizziness}, pmid = {30464481} }
Singh, N.K. and Apeksha, K.	Efficacy of cervical and ocular vestibular-evoked myogenic potentials in evaluation of benign paroxysmal positional vertigo of posterior semicircular canal. [Abstract] [BibTeX]	2016	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 273(9), pp. 2523-2532	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) constitutes a major proportion of the population with peripheral vestibulopathies. Although the freely floating otoconia within the semicircular canals is responsible for the symptoms of BPPV, the source of the otoconia debris is mainly believed to be the otolith organs. Therefore, the pathology in either or both the otolith organs appears a logical proposition. Cervical and ocular vestibular-evoked myogenic potentials (cVEMP and oVEMP), being the tests for functional integrity of the otolith organs, appear promising for investigating otolith involvement in BPPV. While recent evidences are suggestive of equivocal findings for cVEMP, there are only a few studies on oVEMP. Additionally, both these potentials have never been explored in the same set of individuals with BPPV. Therefore, the present study aimed to evaluate the functional integrity of the otolith organs through cVEMP and oVEMP in individuals with posterior canal BPPV. Thirty-one individuals with unilateral posterior canal BPPV and 31 age- and gender-matched healthy controls underwent 500 Hz tone-burst-evoked cVEMP and oVEMP. The results demonstrated no significant group difference on any of the cVEMP parameters (p > 0.05). A similar trend was noticed for the latency-related parameters of oVEMP. However, the peak-to-peak amplitude was significantly smaller in the affected ears of individuals with BPPV than their unaffected ears and the ears of healthy controls (p < 0.05). The BPPV group showed significantly higher inter-aural amplitude difference ratio than the healthy controls (p < 0.05). Further, the sensitivity and specificity of oVEMP were also found to be far superior to those of cVEMP. Thus, the outcome of the present study revealed involvement of utricle rather than saccule in posterior canal BPPV, and therefore, oVEMP appears to be better suited to clinical investigation than cVEMP in individuals with posterior canal BPPV.
BibTeX: @article{Singh2016a, author = {Singh, Niraj Kumar and Apeksha, Kumari}, title = {Efficacy of cervical and ocular vestibular-evoked myogenic potentials in evaluation of benign paroxysmal positional vertigo of posterior semicircular canal.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2016}, volume = {273}, issue = {9}, pages = {2523--2532}, doi = {https://doi.org/10.1007/s00405-015-3867-3}, keywords = {Adult; Benign Paroxysmal Positional Vertigo, diagnosis, physiopathology; Comparative Effectiveness Research; Female; Humans; Male; Neck, physiopathology; Otolithic Membrane, physiopathology; Semicircular Canals, physiopathology; Sensitivity and Specificity; Vestibular Evoked Myogenic Potentials; Vestibular Function Tests, methods; Benign paroxysmal positional vertigo; Cervical VEMP; Ocular VEMP; Posterior semicircular canal; Sensitivity; Specificity}, pmid = {26718546} }
Shan, X., Peng, X. and Wang, E.	Efficacy of Computer-Controlled and Modified Roll Maneuver for Treatment of Geotropic Lateral Canal Benign Paroxysmal Positional Vertigo. [Abstract] [BibTeX]	2015	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 36(8), pp. 1412-1416	article	DOI
Abstract: To evaluate the short-term efficacy of computer-controlled and modified roll maneuver (CMRM) versus conventional roll maneuver (RM) for treatment of geotropic lateral canal benign paroxysmal positional vertigo (BPPV). Prospective case-controlled study. Academic hospital. One hundred consecutive patients diagnosed as having unilateral idiopathic geotropic lateral canal BPPV with a duration of symptoms of less than 2 weeks. Fifty-two patients (aged 32-80 yr; mean, 55.9 yr; 18 men and 34 women) were treated with CMRM that was composed of three sequential 360-degree rotations and 48 patients (aged 30-71 yr; mean, 52.4 yr; 20 men and 28 women) treated with RM that consisted of one 360-degree rotation. Resolution of vertigo on the supine roll test at 48 hours after initial maneuver and the number of maneuvers required for final resolution of vertigo were main outcome measures to assess the efficacy of treatment. On the supine roll test at 48-hour follow-up after initial maneuver, 44 (84.6%) of 52 CMRM-treated patients and 23 (54.2%) of 48 RM-treated patients had resolution of vertigo (p < 0.01). All patients obtained final resolution of vertigo with a maximum of five maneuvers in each group, but the CMRM group had less mean number of maneuvers required for final resolution of vertigo compared with the RM group (1.23 ± 0.39 versus 1.63 ± 0.68, p < 0.05). No significant adverse effects and complications occurred aside from two patients with conversion into posterior canal BPPV in each treatment. The CMRM consisting of three sequential 360-degree rotations for geotropic lateral canal BPPV has a higher initial success rate compared with the conventional RM consisting of one 360-degree rotation.
BibTeX: @article{Shan2015, author = {Shan, Xizheng and Peng, Xin and Wang, Entong}, title = {Efficacy of Computer-Controlled and Modified Roll Maneuver for Treatment of Geotropic Lateral Canal Benign Paroxysmal Positional Vertigo.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2015}, volume = {36}, issue = {8}, pages = {1412--1416}, doi = {https://doi.org/10.1097/MAO.0000000000000813}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, therapy; Case-Control Studies; Environment; Female; Humans; Male; Middle Aged; Patient Positioning, methods; Prospective Studies; Rotation; Therapy, Computer-Assisted, methods; Treatment Outcome}, pmid = {26134939} }
Shan, X., Peng, X. and Wang, E.	Efficacy of computer-controlled repositioning procedure for benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2015	The Laryngoscope Vol. 125(3), pp. 715-719	article	DOI
Abstract: To evaluate the short-term efficacy of the computer-controlled canalith repositioning procedure (CRP) for treatment of posterior canal benign paroxysmal positional vertigo (BPPV) compared with the current standard CRP. Prospective case series. One hundred thirty-two patients diagnosed as having idiopathic posterior canal BPPV, with an age range of 28 to 86 years (mean 56 years), 47 men and 85 women, were treated with computer-controlled CRP mimicking the Epley maneuver. Resolution of vertigo and nystagmus on the Dix-Hallpike test at 1-week follow-up after treatment was the main outcome measure to assess the efficacy of treatment. At 1-week follow-up after treatment with computer-controlled CRP, 108 (81.8%) of 132 patients had complete resolution of vertigo and nystagmus, nine (6.8%) had resolution of vertigo but presence of nystagmus, and 15 (11.4%) had provoked vertigo and nystagmus on the Dix-Hallpike test. The 81.8% success rate was comparable to those who received current standard CRP treatment in randomized controlled trials at about 80%. No significant adverse effects or complications occurred in the patients treated with computer-controlled CRP, aside from two patients (1.5%) with conversion into lateral canal BPPV. Computer-controlled CRP is effective for the treatment of posterior canal BPPV, with a success rate similar to those treated with the Epley maneuver, and is safe and easy to perform on patients.
BibTeX: @article{Shan2015a, author = {Shan, Xizheng and Peng, Xin and Wang, Entong}, title = {Efficacy of computer-controlled repositioning procedure for benign paroxysmal positional vertigo.}, journal = {The Laryngoscope}, year = {2015}, volume = {125}, issue = {3}, pages = {715--719}, doi = {https://doi.org/10.1002/lary.24961}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, therapy; Female; Follow-Up Studies; Humans; Male; Middle Aged; Patient Positioning, methods; Posture; Prospective Studies; Reproducibility of Results; Semicircular Canals, physiopathology; Therapy, Computer-Assisted, methods; Benign paroxysmal positional vertigo; Dix-Hallpike test; Epley maneuver; computer-controlled canalith repositioning procedure; posterior semicircular canal}, pmid = {25302789} }
Gaur, S., Awasthi, S.K., Bhadouriya, S.K.S., Saxena, R., Pathak, V.K. and Bisht, M.	Efficacy of Epley's Maneuver in Treating BPPV Patients: A Prospective Observational Study. [Abstract] [BibTeX]	2015	International journal of otolaryngology Vol. 2015, pp. 487160	article	DOI
Abstract: Vertigo and balance disorders are among the most common symptoms encountered in patients who visit ENT outpatient department. This is associated with risk of falling and is compounded in elderly persons with other neurologic deficits and chronic medical problems. BPPV is the most common cause of peripheral vertigo. BPPV is a common vestibular disorder leading to significant morbidity, psychosocial impact, and medical costs. The objective of Epley's maneuver, which is noninvasive, inexpensive, and easily administered, is to move the canaliths out of the canal to the utricle where they no longer affect the canal dynamics. Our study aims to analyze the response to Epley's maneuver in a series of patients with posterior canal BPPV and compares the results with those treated exclusively by medical management alone. Even though many studies have been conducted to prove the efficacy of this maneuver, this study reinforces the validity of Epley's maneuver by comparison with the medical management.
BibTeX: @article{Gaur2015, author = {Gaur, Sushil and Awasthi, Sanjeev Kumar and Bhadouriya, Sunil Kumar Singh and Saxena, Rohit and Pathak, Vivek Kumar and Bisht, Mamta}, title = {Efficacy of Epley's Maneuver in Treating BPPV Patients: A Prospective Observational Study.}, journal = {International journal of otolaryngology}, year = {2015}, volume = {2015}, pages = {487160}, doi = {https://doi.org/10.1155/2015/487160}, pmid = {26495002} }
Lin, S.-Z., Fan, J.-P., Sun, A.-H., Guan, J., Liu, H.-B. and Zhu, Q.-B.	Efficacy of laser occlusion of posterior semicircular canal for benign paroxysmal positional vertigo: case report. [Abstract] [BibTeX]	2010	The Journal of laryngology and otology Vol. 124(5), pp. e5	article	DOI
Abstract: To observe the long-term effect of laser occlusion of the posterior semicircular canal for benign paroxysmal positional vertigo. Case report and review of the relevant world literature. We treated a patient with refractory benign paroxysmal positional vertigo using laser occlusion of the posterior semicircular canal, and achieved satisfactory results. Three months after the operation, the patient was able to lead a normal life. There was no recurrence over five years of follow up. To our knowledge, this is the first report in the world literature of a patient with refractory benign paroxysmal positional vertigo being treated with laser occlusion of the posterior semicircular canal. This method had long-term effectiveness, and may be one of the most effective methods of treating patients with refractory benign paroxysmal positional vertigo.
BibTeX: @article{Lin2010, author = {Lin, S-Z and Fan, J-P and Sun, A-H and Guan, J and Liu, H-B and Zhu, Q-B}, title = {Efficacy of laser occlusion of posterior semicircular canal for benign paroxysmal positional vertigo: case report.}, journal = {The Journal of laryngology and otology}, year = {2010}, volume = {124}, issue = {5}, pages = {e5}, doi = {https://doi.org/10.1017/S0022215109991381}, keywords = {Female; Follow-Up Studies; Humans; Laser Therapy, methods; Middle Aged; Semicircular Canals, surgery; Treatment Outcome; Vertigo, surgery}, pmid = {19840431} }
Kim, H.A., Park, S.-W., Kim, J., Kang, B.-G., Lee, J., Han, B.I., Seok, J.I., Chung, E.-J., Kim, J. and Lee, H.	Efficacy of mastoid oscillation and the Gufoni maneuver for treating apogeotropic horizontal benign positional vertigo: a randomized controlled study. [Abstract] [BibTeX]	2017	Journal of neurology Vol. 264(5), pp. 848-855	article	DOI
Abstract: To determine the immediate and short-term efficacies of mastoid oscillation vs. Gufoni maneuver in treating the apogeotropic type of horizontal canal benign paroxysmal positional vertigo (HC-BPPV), we designed a randomized, prospective, sham-controlled study. In eight dizziness clinics in Korea, 209 consecutive patients with apogeotropic HC-BPPV were enrolled. The patients were randomly assigned to receive a single application of Gufoni (n = 70), mastoid oscillation (n = 67), or sham maneuver (n = 72). Immediate and second-day responses were determined based on the results within 1 h after a single trial of each maneuver and the following day, respectively. Second-day response was assessed in patients who were non-responders on the first day. The short-term response was determined based on the cumulative response for 2 days. Successful treatment was defined as a resolution of positional nystagmus or as a transition into geotropic horizontal nystagmus (not requires vertigo symptom resolution). The immediate responses of the Gufoni maneuver (33/70, 47.1%) and mastoid oscillation (32/67, 47.8%) were better than the sham maneuver (14/72, 19.4%) (p = 0.00). The second-day results did not differ among the three groups (p = 0.76). The short-term responses showed better efficacies with the Gufoni maneuver (51/70, 76.1%) and mastoid oscillation (46/67, 71.9%) than with the sham maneuver (38/72, 53.5%) (p = 0.02). Therapeutic efficacies did not differ between the Gufoni and mastoid oscillation groups in terms of both immediate and short-term outcomes (p = 0.94, 0.57). Both the Gufoni maneuver and mastoid oscillation are valid methods for treating apogeotropic HC-BPPV, with a success rate of approximately 70% for a single maneuver during the short-term follow-up. clinicaltrials.gov identifier number: NCT02046980.
BibTeX: @article{Kim2017b, author = {Kim, Hyun Ah and Park, Sang-Won and Kim, Jungil and Kang, Bong-Gu and Lee, Jun and Han, Byung In and Seok, Jung Im and Chung, Eun-Ji and Kim, Jaeyoung and Lee, Hyung}, title = {Efficacy of mastoid oscillation and the Gufoni maneuver for treating apogeotropic horizontal benign positional vertigo: a randomized controlled study.}, journal = {Journal of neurology}, year = {2017}, volume = {264}, issue = {5}, pages = {848--855}, doi = {https://doi.org/10.1007/s00415-017-8422-2}, keywords = {Adult; Aged; Aged, 80 and over; Analysis of Variance; Benign Paroxysmal Positional Vertigo, therapy; Exercise Therapy, methods; Female; Head Movements, physiology; Humans; Male; Mastoid, physiology; Middle Aged; Nystagmus, Physiologic, physiology; Physical Therapy Modalities; Posture; Prospective Studies; Treatment Outcome; Vibration; Young Adult; Benign paroxysmal positional vertigo; Randomized controlled trial; Treatment outcome; Vibration}, pmid = {28220291} }
Acar, B., Karasen, R.M. and Buran, Y.	Efficacy of medical therapy in the prevention of residual dizziness after successful repositioning maneuvers for Benign Paroxysmal Positional Vertigo (BPPV). [Abstract] [BibTeX]	2015	B-ENT Vol. 11(2), pp. 117-121	article
Abstract: The aim of this study was to investigate the efficacy of trimetazidine, betahistine, and ginkgo biloba extract in the treatment of residual dizziness after successful repositioning maneuvers for benign paroxysmal positional vertigo. This was a randomized controlled clinical trial. Complete clinical data were analyzed from 100 patients (27 men and 73 women; mean age 52.16 ± 13.2 years, range 11-80 years) with BPPV who underwent succcessful repositioning maneuvers and then received betahistine, trimetazidine, gingko biloba extract, or no medication (n = 25 for each group) for 1 week. On days 1, 3, and 5 after the repositioning maneuver, scores obtained from the Dizziness Handicap Inventory (DHI) questionnaire were compared. There were no statistically significant differences in the premedication DHI scores of patients with residual dizziness among the four groups (p > 0.005). After 3 and 5 days of treatment, the mean DHI scores of the groups receiving medication did not differ significantly from the the mean DHI score of the control group (p > 0.005). Our study results suggest that betahistine, trimetazidine, and gingko biloba extract do not alleviate residual dizziness after successful repositioning maneuvers.
BibTeX: @article{Acar2015, author = {Acar, B and Karasen, R M and Buran, Y}, title = {Efficacy of medical therapy in the prevention of residual dizziness after successful repositioning maneuvers for Benign Paroxysmal Positional Vertigo (BPPV).}, journal = {B-ENT}, year = {2015}, volume = {11}, issue = {2}, pages = {117--121}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, therapy; Betahistine, therapeutic use; Child; Combined Modality Therapy; Dizziness, therapy; Female; Ginkgo biloba; Humans; Male; Middle Aged; Patient Positioning, methods; Phytotherapy; Plant Extracts, therapeutic use; Treatment Outcome; Trimetazidine, therapeutic use; Vasodilator Agents, therapeutic use; Young Adult}, pmid = {26563011} }
Singh, N.K. and Barman, A.	Efficacy of ocular vestibular-evoked myogenic potential in identifying posterior semicircular canal benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2015	Ear and hearing Vol. 36(2), pp. 261-268	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is a unilateral peripheral vestibular pathology, mostly involving the semicircular canals and the otolith organs. Although equivocal findings exist on the utility of cervical vestibular-evoked myogenic potential in identifying BPPV-associated changes in saccule, ocular vestibular-evoked myogenic potential (oVEMP), which is primarily a utricular response, has sparingly been explored in this population. Hence, the present study aimed at examining oVEMP in individuals with BPPV and comparing them with healthy individuals to illustrate its efficacy in identifying BPPV-associated changes in the utricle. Using a case-control design, oVEMPs were elicited by 500 Hz tone bursts at 125 dB peak sound pressure level and recorded bilaterally from 30 individuals with unilateral posterior canal BPPV and 30 age- and gender-matched healthy controls. There were no inter- or intragroup differences in latency aspects (p > 0.05); however, amplitudes were significantly smaller in BPPV ears compared with the non-BPPV ears of individuals with BPPV as well as ears of healthy controls (p < 0.05). Exceptions to this were five participants with BPPV in whom the affected ears demonstrated larger response amplitude (augmentation) than the unaffected ears. Furthermore, there was significantly larger interaural amplitude ratio in individuals with BPPV compared with the healthy controls (p < 0.05). Interaural amplitude ratio produced the largest effect size among the oVEMP parameters for differentiating BPPV from healthy controls. Large asymmetry ratio of oVEMP, usually exceeding 26.8%, is the most potent characteristic of oVEMP in BPPV. Abnormal oVEMP results confirm utricular pathology in ears with BPPV, and therefore, oVEMP can be used as an objective tool with asymmetry ratio as the parameter of choice for the evaluation of utricular function in persons with posterior canal BPPV.
BibTeX: @article{Singh2015, author = {Singh, Niraj Kumar and Barman, Animesh}, title = {Efficacy of ocular vestibular-evoked myogenic potential in identifying posterior semicircular canal benign paroxysmal positional vertigo.}, journal = {Ear and hearing}, year = {2015}, volume = {36}, issue = {2}, pages = {261--268}, doi = {https://doi.org/10.1097/AUD.0000000000000097}, keywords = {Adult; Benign Paroxysmal Positional Vertigo, diagnosis, physiopathology; Case-Control Studies; Female; Humans; Male; Middle Aged; Saccule and Utricle, physiopathology; Semicircular Canals, physiopathology; Sensitivity and Specificity; Vestibular Evoked Myogenic Potentials, physiology; Vestibular Function Tests}, pmid = {25192134} }
Simhadri, S., Panda, N. and Raghunathan, M.	Efficacy of particle repositioning maneuver in BPPV: a prospective study. [Abstract] [BibTeX]	2003	American journal of otolaryngology Vol. 24(6), pp. 355-360	article
Abstract: A single blinded prospective randomized controlled trial was conducted in 40 patients with benign paroxysmal positional vertigo (BPPV) to determine the efficacy of particle repositioning maneuver (PRM). Out of 40 patients, 20 underwent PRM with the rest receiving a placebo treatment. Postprocedural instructions were given to all the patients who underwent PRM. Follow-up was for 1 year at regular intervals. Analysis was based on the symptomatic status and the Hallpike maneuver at each visit. After the initial week, 95% showed complete resolution of symptoms with none reporting a recurrence after PRM. On the contrary, only 15% of the controls had complete resolution with 14 out of 20 reporting a recurrence of BPPV. Results remained more or less the same at the end of 4 weeks. Six months after PRM, 19 of 20 patients had no vertigo with a meager 5% showing recurrence versus 75% of controls reporting a recurrence with only 3 of 20 reporting a favorable symptom status. At the end of 1 year, 18 of 20 patients had complete relief from symptoms with only 10% showing Hallpike maneuver positive in the study group compared with 3 of 20 reporting a relief from symptoms with 90% turning out to be Hallpike maneuver positive in the control group. This study establishes the efficacy of PRM in short- and long-term management of BPPV; the procedure is easy and simple.
BibTeX: @article{Simhadri2003, author = {Simhadri, Sridhar and Panda, Naresh and Raghunathan, Meena}, title = {Efficacy of particle repositioning maneuver in BPPV: a prospective study.}, journal = {American journal of otolaryngology}, year = {2003}, volume = {24}, issue = {6}, pages = {355--360}, keywords = {Adolescent; Adult; Aged; Exercise Therapy, methods; Female; Follow-Up Studies; Head Movements; Humans; Male; Middle Aged; Posture; Prospective Studies; Recurrence; Single-Blind Method; Treatment Outcome; Vertigo, etiology, therapy}, pmid = {14608565} }
Carnevale, C., Arancibia-Tagle, D.J., Rizzo-Riera, E., Til-Perez, G., Sarría-Echegaray, P.L., Rama-Lopez, J.J., Quer-Canut, S., Fermin-Gamero, G. and Tomas-Barberan, M.D.	Efficacy of particle repositioning manoeuvres in benign positional paroxysmal vertigo: A revision of 176 cases treated in a tertiary care centre. [Abstract] [BibTeX]	2018	Acta otorrinolaringologica espanola Vol. 69(4), pp. 201-207	article	DOI
Abstract: Benign paroxysmal positional vertigo is the most common peripheral vertigo disease. The aim of this paper is to review the results obtained with the different specific particle repositioning manoeuvres, evaluating the possible risk factors linked to a poorer prognosis. One hundred and seventy-six patients with a diagnosis of benign paroxysmal positional vertigo were reviewed retrospectively, of whom 150 had vertigo of the posterior canal, 20 had vertigo of the horizontal canal, 3 had vertigo of the superior canal, and 3 had a double vertigo. The Epley manoeuvre was used to treat the posterior and superior canals, and Lempert manoeuvre was used to treat the horizontal canal. An imaging study by nuclear magnetic resonance with gadolin was always used in refractory cases. The Epley manoeuvre showed an efficacy of 74.6 and 100% at first attempt for posterior and superior canals respectively. The efficacy of the Lempert manoeuvre for the horizontal canal was 72.72% in the patients with canalolithiasis, and 58.33% in the patients with cupulolithiasis. The treatment of patients with more than one affected canal and a history of surgery in the previous month was more difficult. Particle repositioning manoeuvres show a very high success rate, allowing better results in the treatment of the posterior canal. We need more studies to confirm the suspicion that surgery may be a factor of poorer prognosis.
BibTeX: @article{Carnevale2018, author = {Carnevale, Claudio and Arancibia-Tagle, Diego J and Rizzo-Riera, Elena and Til-Perez, Guillermo and Sarría-Echegaray, Pedro L and Rama-Lopez, Julio J and Quer-Canut, Santiago and Fermin-Gamero, German and Tomas-Barberan, Manuel D}, title = {Efficacy of particle repositioning manoeuvres in benign positional paroxysmal vertigo: A revision of 176 cases treated in a tertiary care centre.}, journal = {Acta otorrinolaringologica espanola}, year = {2018}, volume = {69}, issue = {4}, pages = {201--207}, doi = {https://doi.org/10.1016/j.otorri.2017.06.001}, keywords = {Benign paroxysmal positional vertigo; Canales semicirculares; Canalicular reposition manoeuvres; Epley manoeuvre; Maniobra de Epley; Maniobras de reposicionamiento canalicular; Positional vertigo; Semi-circular canals; Vértigo posicional; Vértigo posicional paroxístico benigno}, pmid = {28965618} }
Cakir, B.O., Ercan, I., Cakir, Z.A. and Turgut, S.	Efficacy of postural restriction in treating benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2006	Archives of otolaryngology--head & neck surgery Vol. 132(5), pp. 501-505	article	DOI
Abstract: To investigate the efficacy of postural restriction after canalith repositioning in treating benign paroxysmal positional vertigo (BPPV). Prospective trial of patients with postural restriction vs those without postural restriction after treatment. Patients with classic BPPV and with BPPV without nystagmus were treated using the modified Epley canalith repositioning procedure. Patients were randomly separated into 2 groups. The first group was instructed to wear a cervical collar and to maintain an upright head position for 2 days. The second group had no motion restriction. After 5 days, the patients were followed up and evaluated using the Dix-Hallpike test. In the first group, 56 of 62 ears healed after the first maneuver, and the remaining ears healed after the second. In the second group, 45 of 57 ears healed after the first maneuver, 6 after the second, and 5 (with subsequent postural restriction) after the third (1 ear did not improve). Five patients in the first group and 3 patients in the second group had BPPV without nystagmus; all of these patients healed after a single maneuver. The difference between the 2 groups in the number of maneuvers required for treatment was statistically significant (P<.05). The number of patients who required a third maneuver was significantly higher in the second group (P<.05). Postural restriction enhances the therapeutic effect of canalith repositioning in the treatment of posterior semicircular canal BPPV. The long-term efficacy of postural restriction in preventing BPPV recurrence has not been demonstrated.
BibTeX: @article{Cakir2006a, author = {Cakir, Burak O and Ercan, Ibrahim and Cakir, Zeynep A and Turgut, Suat}, title = {Efficacy of postural restriction in treating benign paroxysmal positional vertigo.}, journal = {Archives of otolaryngology--head & neck surgery}, year = {2006}, volume = {132}, issue = {5}, pages = {501--505}, doi = {https://doi.org/10.1001/archotol.132.5.501}, keywords = {Adult; Aged; Aged, 80 and over; Braces; Female; Humans; Male; Middle Aged; Neck; Nystagmus, Pathologic, physiopathology, rehabilitation; Otolithic Membrane, physiopathology; Posture, physiology; Prospective Studies; Retreatment; Secondary Prevention; Vertigo, physiopathology, rehabilitation}, pmid = {16702565} }
Chen, C.-C., Cho, H.-S., Lee, H.-H. and Hu, C.-J.	Efficacy of Repositioning Therapy in Patients With Benign Paroxysmal Positional Vertigo and Preexisting Central Neurologic Disorders. [Abstract] [BibTeX]	2018	Frontiers in neurology Vol. 9, pp. 486	article	DOI
Abstract: With the exception of migraines, benign paroxysmal positional vertigo (BPPV) in patients with preexisting central neurologic disorders (CND) is rarely discussed in the literature. Demographic features of this patient group and the efficacy of repositioning therapy are still unknown. We hypothesized that a CND may alter the function of the central vestibular pathway, thus changing the pattern of BPPV and outcomes of repositioning. In this study, we enrolled 93 consecutive idiopathic BPPV patients and categorized them into two groups according to the presence or absence of a CND. In our series, 31.2% of BPPV cases had a CND. The most common associated CNDs were cerebrovascular disease and migraines. The two groups showed similar age distributions, canal involvement, success rates of repositioning, and cycles of treatment used to achieve complete resolution. The major differences were the proportion of females (89.7%) and a right-side predominance (75.9%) in the CND group. There was a trend of more residual dizziness (RD) after successful repositioning in the CND group, but the difference was not significant. The reason for the female and right-side predominance in the CND group is unclear. We concluded that the efficacy of repositioning therapy was excellent (with a success rate of 80.6% with one cycle and 93.5% within two cycles of treatment) for BPPV with or without a preexisting CND. Clinicians are encouraged to diagnose and treat BPPV in patients with a preexisting CND as early as possible to improve patients' quality of life, avoid complications, and reduce medical costs.
BibTeX: @article{Chen2018, author = {Chen, Chih-Chung and Cho, Hsiao-Shan and Lee, Hsun-Hua and Hu, Chaur-Jong}, title = {Efficacy of Repositioning Therapy in Patients With Benign Paroxysmal Positional Vertigo and Preexisting Central Neurologic Disorders.}, journal = {Frontiers in neurology}, year = {2018}, volume = {9}, pages = {486}, doi = {https://doi.org/10.3389/fneur.2018.00486}, keywords = {Epley maneuver; Gufoni maneuver; barbecue roll maneuver; benign paroxysmal positional vertigo; repositioning; residual dizziness}, pmid = {30013505} }
Wang, N., Zhou, H., Huang, H., Geng, D., Yang, X., Yu, C. and Shi, D.	Efficacy of SRM-IV Vestibular Function Diagnosis and Treatment System in Treating Benign Paroxysmal Positional Vertigo. [Abstract] [BibTeX]	2018	Iranian journal of public health Vol. 47(5), pp. 641-647	article
Abstract: We determined the diagnostic and therapeutic effects of SRM-IV vestibular function diagnosis and treatment system on benign paroxysmal positional vertigo (BPPV). Overall, 120 patients with BPPV diagnosed in the outpatient and in-patient departments of the Vertigo Treatment Center of the First People's Hospital of Xuzhou from January 2013 to December 2015 were selected for this study. They were randomly divided into three groups. Automatic repositioning procedure was conducted for 40 patients in the equipment repositioning group by SRM-IV vestibular function diagnosis and treatment system, conventional manual repositioning procedure was used for 40 patients in the manual repositioning group, and combination of treatment drugs (alprostadil and safflower injection) with acclimatization training was adopted in 40 patients in the drug therapy group. After 1 week of treatment, the cure rate and total effective rate in the equipment repositioning group and the manual repositioning group were significantly higher than those in drug therapy group ( <0.05). The total effective rate was 100.0% in the equipment-repositioning group and 92.5% in manual repositioning group; the difference between the two groups was not statistically significant. The success rate of one-time treatment of anterior semicircular canal BPPV, posterior semicircular canal BPPV and lateral semicircular canal BPPV in the equipment-repositioning group were higher than those in the manual repositioning group were. The SRM-IV vestibular function diagnosis and treatment system are helpful in achieving effective and standard diagnosis and treatment of BPPV.
BibTeX: @article{Wang2018c, author = {Wang, Nuan and Zhou, Hao and Huang, Hongli and Geng, Deqin and Yang, Xiuhua and Yu, Chunyu and Shi, Di}, title = {Efficacy of SRM-IV Vestibular Function Diagnosis and Treatment System in Treating Benign Paroxysmal Positional Vertigo.}, journal = {Iranian journal of public health}, year = {2018}, volume = {47}, issue = {5}, pages = {641--647}, keywords = {Automatic repositioning; Benign paroxysmal positional vertigo; SRM-IV vestibular function}, pmid = {29922605} }
Lee, J.B., Han, D.H., Choi, S.J., Park, K., Park, H.Y., Sohn, I.K. and Choung, Y.-H.	Efficacy of the "bow and lean test" for the management of horizontal canal benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2010	The Laryngoscope Vol. 120(11), pp. 2339-2346	article	DOI
Abstract: Horizontal semicircular canal (HSC) benign paroxysmal positional vertigo (BPPV) has been reported to have a poorer prognosis than posterior semicircular canal BPPV. Incorrect determination of the affected ear appears to be one of the causes of poorer outcome. The aim of this study was to assess the efficacy of the "bow and lean test" (BLT) for proper determination of the affected ear followed by preferable treatment outcomes of HSC-BPPV. A prospective study. The 211 patients (225 cases) with HSC-BPPV were sequentially classified into two groups by hospital visiting time and diagnostic methods. The head roll test (HRT) group (61 cases) was treated with canalith repositioning procedure (CRP) on the basis of the results of HRT alone between 2001 and 2004. The BLT group (164 cases) was treated based on the results of both BLT and HRT from 2005 to 2008. The remission rates after two sessions of CRPs in the BLT group and the HRT group were 83.1% and 67.4% (P = .041), respectively, for the canalolithiasis type and 74.7% and 61.1% (P = .250), respectively, for the cupulolithiasis type. In the BLT group, 76.8% had bowing and/or leaning nystagmus; 35.7% of them (45 of 126 cases) benefited from BLT with regard to determining the affected ears because HRT was unable to provide the definitive affected ears (17 cases) or showed different localization between two methods (28 cases). BLT is a useful method to improve the remission rates of HSC-BPPV, giving more corrective information regarding affected ears than the HRT alone.
BibTeX: @article{Lee2010a, author = {Lee, Jong Bin and Han, Dong Hee and Choi, Seong Jun and Park, Keehyun and Park, Hun Yi and Sohn, In Kyung and Choung, Yun-Hoon}, title = {Efficacy of the "bow and lean test" for the management of horizontal canal benign paroxysmal positional vertigo.}, journal = {The Laryngoscope}, year = {2010}, volume = {120}, issue = {11}, pages = {2339--2346}, doi = {https://doi.org/10.1002/lary.21117}, keywords = {Adult; Aged; Caloric Tests; Cohort Studies; Diagnostic Techniques, Otological; Electronystagmography; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nystagmus, Physiologic; Posture; Prospective Studies; Semicircular Canals, physiology; Sensitivity and Specificity; Treatment Outcome; Vertigo, diagnosis, therapy}, pmid = {20938976} }
Escher, A., Ruffieux, C. and Maire, R.	Efficacy of the barbecue manoeuvre in benign paroxysmal vertigo of the horizontal canal. [Abstract] [BibTeX]	2007	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 264(10), pp. 1239-1241	article	DOI
Abstract: Five to ten percent of benign paroxysmal positional vertigo are caused by the horizontal semi-circular variant (h-BPPV). In this study, we reviewed the efficacy of the Barbecue repositioning manoeuvre in h-BPPV, and we assessed the possible effect of different factors on the outcome. Barbecue manoeuvre consists in turning the supine patient around his longitudinal axis toward the unaffected side until 360 degrees are accomplished. After every 90 degrees step the patient is maintained in the new position for 30 s. We reviewed 46 patients with h-BPPV, treated by barbecue rotation from 2003 to 2005. After the first Barbecue manoeuvre, the patients were followed-up at intervals of approximately 1 week and the rotation was repeated if h-BPPV persisted (up to three rotations). Factors assessed were age, gender, duration of symptoms before treatment and type of h-BPPV (canalolithiasis vs. cupulolithiasis). Fisher's exact test was used for the analysis. 85% of patients (39/46) were cured after a maximum of 3 rotations. 74% (34/46) were cured after the first manoeuvre and 80% (37/46) after the second one. None of the evaluated factors did significantly affect the efficacy (P > 0.05). The Barbecue manoeuvre is an efficient treatment of h-BPPV demonstrating 85% cure rate after a maximum of three sessions. 74% of the patients are healed after one manoeuvre. The efficacy is not affected by the evaluated factors.
BibTeX: @article{Escher2007, author = {Escher, Anette and Ruffieux, Christiane and Maire, Raphaël}, title = {Efficacy of the barbecue manoeuvre in benign paroxysmal vertigo of the horizontal canal.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2007}, volume = {264}, issue = {10}, pages = {1239--1241}, doi = {https://doi.org/10.1007/s00405-007-0337-6}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Posture; Retrospective Studies; Rotation; Semicircular Canals, physiopathology; Vertigo, physiopathology, therapy}, pmid = {17520267} }
Richard, W., Bruintjes, T.D., Oostenbrink, P. and van Leeuwen, R.B.	Efficacy of the Epley maneuver for posterior canal BPPV: a long-term, controlled study of 81 patients. [Abstract] [BibTeX]	2005	Ear, nose, & throat journal Vol. 84(1), pp. 22-25	article
Abstract: We assessed the efficacy of the Epley maneuver (canalith repositioning) in a study of 81 patients with posterior semicircular canal benign paroxysmal positional vertigo (BPPV). A group of 61 patients underwent the maneuver, while a control group of 20 patients received no therapy. All patients were evaluated at 1 and 6 months. The percentage of patients who experienced subjective improvement was significantly higher in the treatment group at both 1 month (89% vs. 10%) and 6 months (92% vs. 50%). Three patients in the treatment group who did not improve after treatment underwent a second maneuver, and all achieved a positive result. In addition, 4 successfully treated patients experienced a recurrence between 1 and 6 months following treatment; 3 were retreated, and 2 of them responded well. We conclude that the Epley maneuver provides effective and long-term control of symptoms in patients with BPPV.
BibTeX: @article{Richard2005, author = {Richard, Wietske and Bruintjes, Tjasse D and Oostenbrink, Peter and van Leeuwen, Roeland B}, title = {Efficacy of the Epley maneuver for posterior canal BPPV: a long-term, controlled study of 81 patients.}, journal = {Ear, nose, & throat journal}, year = {2005}, volume = {84}, issue = {1}, pages = {22--25}, keywords = {Female; Follow-Up Studies; Head Movements, physiology; Humans; Male; Middle Aged; Musculoskeletal Manipulations; Otolithic Membrane, physiopathology; Posture, physiology; Semicircular Canals, physiopathology; Treatment Outcome; Vertigo, physiopathology, therapy}, pmid = {15742768} }
Li, J., Tian, S. and Zou, S.	Efficacy of the Li maneuver in treating posterior canal benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2017	Acta oto-laryngologica Vol. 137(6), pp. 588-592	article	DOI
Abstract: The Li maneuver is a safe, effective, and simple repositioning method for the treatment of BPPV. It is simple to master and exerts an exact effect. As a rapid repositioning method, the Li maneuver can result in reduced treatment times and increased treatment efficacy, and is, therefore, especially suitable for patients with limited cervical spine movement. To compare the short-term efficacies of the Li and Epley maneuvers in treating posterior canal benign paroxysmal positional vertigo (PC-BPPV). A total of 120 patients with PC-BPPV were randomly treated by either the Li or Epley maneuvers at our department between May 5, 2014 and July 30, 2015. Follow-up examinations were performed 3 days and 1 week after the first repositioning. Of the 120 patients initially enrolled, 113 (72 females; 41 males; average age = 52 years; Li and Epley maneuver groups, 56 and 57 cases, respectively) satisfied the inclusion and exclusion criteria of this study. There were no statistically significant differences between the two groups of patients in terms of the success rates of treatment at either the 3-day or 1-week follow-ups (p = .756 and .520, respectively).
BibTeX: @article{Li2017c, author = {Li, Jinrang and Tian, Shiyu and Zou, Shizhen}, title = {Efficacy of the Li maneuver in treating posterior canal benign paroxysmal positional vertigo.}, journal = {Acta oto-laryngologica}, year = {2017}, volume = {137}, issue = {6}, pages = {588--592}, doi = {https://doi.org/10.1080/00016489.2016.1258731}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, therapy; Female; Humans; Male; Middle Aged; Physical Therapy Modalities; Repositioning maneuver; benign paroxysmal positional vertigo; posterior canal; prospective randomized comparative study}, pmid = {27921448} }
Levrat, E., van Melle, G., Monnier, P. and Maire, R.	Efficacy of the Semont maneuver in benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2003	Archives of otolaryngology--head & neck surgery Vol. 129(6), pp. 629-633	article	DOI
Abstract: To assess the efficacy of the Semont maneuver in the treatment of benign paroxysmal positional vertigo (BPPV) of the posterior semicircular canal and to evaluate the possible effect of various factors on the efficacy of this maneuver. Retrospective study in an outpatient clinic. Two hundred seventy-eight patients presenting with symptomatic, unilateral BPPV of the posterior semicircular canal, exclusively treated with the Semont maneuver. During the first consultation, each patient was treated with a Semont maneuver. When BPPV persisted, this maneuver was repeated during follow-up visits, performed at weekly intervals. Patients were considered cured when vertigo disappeared within 30 days (allowing up to 4 maneuvers). More than 90% of patients were cured after a maximum of 4 maneuvers, and 83.5% were cured after only 2 maneuvers. The efficacy of the maneuver decreased each time it was repeated (from 62.6% at the first maneuver to 18.2% at the fourth). The duration of symptoms before initial consultation and the etiology of BPPV had a significant effect on the maneuver's efficacy (P<.001 and P =.002, respectively), whereas age (P =.12), sex (P =.06), and affected side (P =.20) had no effect. The Semont maneuver demonstrated a 90.3% cure rate after a maximum of 4 sessions. Patients consulting late (>6 months after the beginning of symptoms) or having traumatic BPPV had lower recovery rates than patients without these factors (74.7% vs 96.5%).
BibTeX: @article{Levrat2003, author = {Levrat, Emmanuel and van Melle, Guy and Monnier, Philippe and Maire, Raphaël}, title = {Efficacy of the Semont maneuver in benign paroxysmal positional vertigo.}, journal = {Archives of otolaryngology--head & neck surgery}, year = {2003}, volume = {129}, issue = {6}, pages = {629--633}, doi = {https://doi.org/10.1001/archotol.129.6.629}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Physical Therapy Modalities, methods; Posture, physiology; Retrospective Studies; Treatment Outcome; Vertigo, therapy}, pmid = {12810466} }
Cohen, H.S. and Jerabek, J.	Efficacy of treatments for posterior canal benign paroxysmal positional vertigo. [Abstract] [BibTeX]	1999	The Laryngoscope Vol. 109(4), pp. 584-590	article	DOI
Abstract: This study was performed to determine the relative effectiveness of several passive head maneuvers for treating benign paroxysmal positional vertigo. This prospective study used 87 subjects diagnosed by their physicians with unilateral benign paroxysmal positional vertigo of the posterior semicircular canal. Subjects were randomly assigned to three treatment groups: modified Epley maneuver, modified Epley maneuver with augmented head rotations, and modified Semont maneuver. They were interviewed 1 week after receiving one maneuver. If subjects desired further treatment, they were treated again with the same maneuver, a methodology repeated until subjects desired no further treatment; they were telephoned 3 and 6 months after the last treatment. The groups did not differ significantly, but subjects decreased significantly on vertigo intensity and frequency and improved significantly on independence in activities of daily living. Before treatment, tasks requiring pitch rotations of the head induced vertigo; common comorbid conditions were osteoporosis, cervical spine problems, and head trauma. These data suggest that augmented head rotations are unnecessary and that the modified Epley and Semont maneuvers are equally effective in the remediation of vertigo in this population.
BibTeX: @article{Cohen1999, author = {Cohen, H S and Jerabek, J}, title = {Efficacy of treatments for posterior canal benign paroxysmal positional vertigo.}, journal = {The Laryngoscope}, year = {1999}, volume = {109}, issue = {4}, pages = {584--590}, doi = {https://doi.org/10.1097/00005537-199904000-00012}, keywords = {Adult; Aged; Aged, 80 and over; Analysis of Variance; Craniocerebral Trauma, diagnosis; Female; Humans; Male; Middle Aged; Osteoporosis, diagnosis; Posture; Prospective Studies; Semicircular Canals, physiopathology; Severity of Illness Index; Spinal Diseases, diagnosis; Treatment Outcome; Vertigo, diagnosis, physiopathology, therapy}, pmid = {10201745} }
Ganança, F.F., Gazzola, J.M., Ganança, C.F., Caovilla, H.H., Ganança, M.M. and Cruz, O.L.M.	Elderly falls associated with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2010	Brazilian journal of otorhinolaryngology Vol. 76(1), pp. 113-120	article
Abstract: Benign Paroxysmal Positional Vertigo (BPPV) can cause falls, especially in the elderly. to study whether or not elderly patients with BPPV have a reduction on their falls after the particle repositioning maneuver (PRM). retrospective study including elderly with BPPV who had fall(s) during the last year. All patients were submitted to the PRM according to the affected semicircular canal (SCC). After the abolition of positioning vertigo and nystagmus, the patients were submitted to a 12 month follow-up and were investigated about the number of fall(s). Wilcoxon's test was performed to compare the number of fall(s) before and after 12 months of the PRM. One hundred and twenty one patients were included in the study. One hundred and one patients presented involvement of the posterior SCC, 16 of the lateral and four of the anterior. We noticed a reduction on the number of falls, with statistically significant difference when all the patients were analyzed together (p<0.001), the posterior canal BPPV patients (p<0,001) and the lateral canal VPPB patients (p=0.002). We also found a tendency of statistically significant difference for the anterior canal BPPV patients (p=0.063). BPPV elderly patients had indeed a reduction on the number of falls after the PRM.
BibTeX: @article{Gananca2010, author = {Ganança, Fernando Freitas and Gazzola, Juliana Maria and Ganança, Cristina Freitas and Caovilla, Heloísa Helena and Ganança, Maurício Malavasi and Cruz, Oswaldo Laércio Mendonça}, title = {Elderly falls associated with benign paroxysmal positional vertigo.}, journal = {Brazilian journal of otorhinolaryngology}, year = {2010}, volume = {76}, issue = {1}, pages = {113--120}, keywords = {Accidental Falls, prevention & control, statistics & numerical data; Aged; Aged, 80 and over; Female; Follow-Up Studies; Humans; Male; Physical Therapy Modalities; Posture; Retrospective Studies; Rotation; Semicircular Canals, physiopathology; Vertigo, complications, physiopathology, therapy}, pmid = {20339699} }
Crespi, R., Capparè, P. and Gherlone, E.	Electrical mallet provides essential advantages in maxillary bone condensing. A prospective clinical study. [Abstract] [BibTeX]	2013	Clinical implant dentistry and related research Vol. 15(6), pp. 874-882	article	DOI
Abstract: The aim of this study was to compare the use of hand mallet versus electrical mallet (magnetic mallet, Meta-Ergonomica, Turbigo, Milan, Italy) in osteotome-assisted surgery for condensing bone procedure in edentulous molar and premolar maxillary regions. Patients edentulous in maxillary premolar and molar regions with type 3 or 4 bone were enrolled in this prospective clinical study. The patients were randomly divided in two groups: in the test group, the implant site was prepared with osteotomes pushed by magnetic mallet, while in the control group, the implant site was performed with osteotomes pressed by hand mallet. Intraoral digital radiographic measurements were reported at 6, 12, and 24 months. Thirty-six patients were enrolled in the study. Eighteen patients (21 women and 15 men) were included in the test group and 18 patients in the control group. The mean patient age was 56.1 years (range 41-71 years). Fifty dental implants were placed. In 10 cases, five in control and five in test group, sinus elevation was performed. After 24 months follow-up, a survival rate of 96.0% was reported. In the control group, two patients claimed benign paroxysmal positional vertigo following the use of osteotomes with hand hammer. Marginal bone levels remained stable over time for both groups, and not statistically significant differences were found. After 12 months, the bone height incremented in both groups and, at 24 months, was stable. Statistical analysis reported not statistically significant differences between test and control group. These results demonstrated a stable marginal bone levels over time and a significant increase in bone height between 6 and 12 months in osteotome technique (not sinus elevation). The use of magnetic mallet provided some essential clinical advantages during surgical procedure in comparison with hand mallet.
BibTeX: @article{Crespi2013, author = {Crespi, Roberto and Capparè, Paolo and Gherlone, Enrico}, title = {Electrical mallet provides essential advantages in maxillary bone condensing. A prospective clinical study.}, journal = {Clinical implant dentistry and related research}, year = {2013}, volume = {15}, issue = {6}, pages = {874--882}, doi = {https://doi.org/10.1111/j.1708-8208.2011.00432.x}, keywords = {Adult; Aged; Case-Control Studies; Dental Instruments; Female; Humans; Male; Maxilla, surgery; Middle Aged; Prospective Studies; bone condensing; osteotome; sinus floor elevation; surgery mallet}, pmid = {22235762} }
Korres, S.G., Balatsouras, D.G. and Ferekidis, E.	Electronystagmographic findings in benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2004	The Annals of otology, rhinology, and laryngology Vol. 113(4), pp. 313-318	article	DOI
Abstract: The aim of this study was to investigate the electronystagmographic findings in patients with benign paroxysmal positional vertigo. A retrospective review of the records of 168 patients with this disease during the past 3 years was performed. Epidemiological data and results from the audiological and neuro-otologic workup, including electronystagmography, were recorded. One hundred fifty-one patients had involvement of the posterior canal, 14 of the horizontal canal, and 3 of the anterior canal. Seventy-two patients (42.8%) had abnormal findings on the caloric tests. Thirty-seven of them (22%) had canal paresis and 23 (13.7%) had directional preponderance, whereas in 12 patients (7.1%) both unilateral weakness and directional preponderance were found. Finally, 21 patients (12.5%) had spontaneous nystagmus. It may be thus concluded that electronystagmographic abnormalities are quite common in patients with benign paroxysmal positional vertigo. Their presence may be explained according to several mechanisms, which are further discussed herein.
BibTeX: @article{Korres2004a, author = {Korres, Stavros G and Balatsouras, Dimitrios G and Ferekidis, Eleftherios}, title = {Electronystagmographic findings in benign paroxysmal positional vertigo.}, journal = {The Annals of otology, rhinology, and laryngology}, year = {2004}, volume = {113}, issue = {4}, pages = {313--318}, doi = {https://doi.org/10.1177/000348940411300411}, keywords = {Audiometry, Pure-Tone; Caloric Tests; Electronystagmography; Female; Hearing Loss, diagnosis; Humans; Male; Middle Aged; Posture, physiology; Retrospective Studies; Semicircular Canals, physiopathology; Vertigo, diagnosis, physiopathology}, pmid = {15112976} }
Garrett, A., Heibert, D. and Lithgow, B.	Electrovestibulography: the "DC" potential used to separate Meniere's disease and Benign Paroxysmal Positional Vertigo. [Abstract] [BibTeX]	2007	Conference proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual Conference Vol. 2007, pp. 2381-2384	article	DOI
Abstract: Electrovestibulography (EVestG) is a new diagnostic technique potentially applicable to detecting neurological changes impacting on sensory performance. A complex Morlet wavelet based signal processing technique, a Neural Event Extraction Routine, has been used to extract diagnostically meaningful biomarkers from these EVestG recordings. Separation of Meniere's disease and Benign Paroxysmal Positional Vertigo (BPPV) has been accomplished using a "DC" Biomarker [1]. When using tilt stimuli to evoke a semi circular canal response, otolithic organ responses are also observed. The origin of this "DC" biomarker is likely a multifaceted dipole generated by both semi circular canal and otolithic structures.
BibTeX: @article{Garrett2007, author = {Garrett, Amber and Heibert, Daniel and Lithgow, Brian}, title = {Electrovestibulography: the "DC" potential used to separate Meniere's disease and Benign Paroxysmal Positional Vertigo.}, journal = {Conference proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual Conference}, year = {2007}, volume = {2007}, pages = {2381--2384}, doi = {https://doi.org/10.1109/IEMBS.2007.4352806}, keywords = {Adolescent; Adult; Biomarkers, chemistry; Cochlea, anatomy & histology, pathology; Ear, anatomy & histology, pathology; Ear, Inner, anatomy & histology, pathology; Electrophysiology, instrumentation, methods; Equipment Design; Humans; Meniere Disease, diagnosis, physiopathology; Models, Anatomic; Movement; Neurons, pathology; Time Factors; Vertigo, diagnosis, physiopathology}, pmid = {18002472} }
Asmar, M.H. and Saliba, I.	Endolymphatic Duct Blockage for Refractory Ménière's Disease: Assessment of Endolymphatic Sac Biopsy on Short-Term Surgical Outcomes. [Abstract] [BibTeX]	2016	The journal of international advanced otology Vol. 12(3), pp. 310-315	article	DOI
Abstract: Endolymphatic sac decompression (ESD) for the treatment of Ménière's disease (MD) has had limited success and variable results in the literature. We have devised a novel technique that involves blocking the endolymphatic duct with surgical clips. In a separate effort to study the endolymphatic sac (ELS), we have sectioned the lateral part of the main body of the ELS as biopsies from a subset of patients. We aimed to evaluate the effect of the lateral part sectioning of the ELS on short-term surgical outcomes. This was a single-physician, retrospective study in a tertiary medical center. MD patients underwent endolymphatic duct blockage (EDB) surgery with or without ELS biopsy. The assessed surgical outcomes were the occurrence of benign paroxysmal positional vertigo (BPPV), intraoperative CSF leaks, aural fullness, tinnitus, vertigo spells, and pure tone audiometry. Data were collected at the following visits: preoperatively 1st week, 1st month, and 6th months. A total of 63 patients were included. The outcomes of the biopsy group (EDB+B) (n=27) were compared to those of the EDB group (n=36) at each visit. There was no significant difference in the occurrence of postoperative BPPV, CSF leaks, aural fullness, tinnitus, or vertigo spells. The SDS, the PTA, and bone conduction were not significantly different at any visit, and PTA variations were similar in both groups. Our results suggest that aggressive decompression of the ELS by sectioning the sac does not benefit patients in the early postoperative period. The short-term success of EDB surgery is attributable to the effective obstruction of the endolymphatic duct regardless of pressure in the ELS.
BibTeX: @article{Asmar2016, author = {Asmar, Marc Henri and Saliba, Issam}, title = {Endolymphatic Duct Blockage for Refractory Ménière's Disease: Assessment of Endolymphatic Sac Biopsy on Short-Term Surgical Outcomes.}, journal = {The journal of international advanced otology}, year = {2016}, volume = {12}, issue = {3}, pages = {310--315}, doi = {https://doi.org/10.5152/iao.2016.3069}, keywords = {Adult; Biopsy; Decompression, Surgical; Endolymphatic Duct, surgery; Endolymphatic Sac, pathology; Female; Humans; Male; Meniere Disease, pathology, surgery; Middle Aged; Retrospective Studies; Time Factors; Treatment Outcome}, pmid = {28031156} }
Saliba, I. and Asmar, M.-H.	Endolymphatic duct blockage for refractory Ménière's disease: assessment of intraoperative CSF leak on short-term surgical outcomes. [Abstract] [BibTeX]	2018	Acta oto-laryngologica Vol. 138(10), pp. 886-892	article	DOI
Abstract: Endolymphatic sac decompression has shown limited success for the treatment of Ménière's disease (MD). We have published a novel technique with very promising results for the treatment of refractory MD: the Endolymphatic Duct Blockage (EDB) with two titanium clips. One of the challenges of this technique was an increased incidence of intraoperative Cerebrospinal Fluid (CSF) Leak. To assess the effect of intraoperative CSF Leak on short-term surgical outcomes. Retrospective comparative study in a tertiary care center (61 patients). MD patients who underwent EDB were included. Intraoperative CSF Leaks were documented. Surgical outcomes assessed were the presence of postoperative Benign Paroxysmal Positional Vertigo (BPPV), aural fullness, tinnitus, vertigo spells and pure tone average (PTA), speech discrimination scores (SDS) and bone conduction thresholds (BCT). Data were collected for these visits: preoperative, 1 week, 1 and 6 months postoperatively. Outcomes for the CSF Leak group (CSF +) (n = 22) were compared to remaining patient (CSF-) (n = 39). There was no significant difference in the occurrence of postoperative BPPV, aural fullness, tinnitus and vertigo spells. There was no significant difference in PTA, BCT or SDS between our groups at any visit. Intraoperative CSF Leak may cause a temporary non-significant worsening of hearing in the first-month postoperatively without any difference at 6 months.
BibTeX: @article{Saliba2018, author = {Saliba, Issam and Asmar, Marc-Henri}, title = {Endolymphatic duct blockage for refractory Ménière's disease: assessment of intraoperative CSF leak on short-term surgical outcomes.}, journal = {Acta oto-laryngologica}, year = {2018}, volume = {138}, issue = {10}, pages = {886--892}, doi = {https://doi.org/10.1080/00016489.2018.1481524}, keywords = {CSF; Ménière’s disease; decompression; endolymphatic duct; endolymphatic duct blockage; endolymphatic sac; leak}, pmid = {30016910} }
Manzari, L.	Enlarged vestibular aqueduct (EVA) related with recurrent benign paroxysmal positional vertigo (BPPV). [Abstract] [BibTeX]	2008	Medical hypotheses Vol. 70(1), pp. 61-65	article	DOI
Abstract: The vestibular aqueduct is a bony canal related to the bony labyrinth of the inner ear and represents the non-sensory components of the endolymph-filled, closed, membranous labyrinth. The association of congenital sensorineural hearing loss with a large or enlarged vestibular aqueduct is well known as the large vestibular aqueduct syndrome (LVAS). The enlarged VA (EVA) comprises abnormalities not only in the structure of the inner ear, but also in the physiology of the auditory and vestibular systems. The clinical picture of this clinical entity is variable [Yetiser S, Kertment M, Ozkaptan Y. Vestibular disturbance in patients with Large Vestibular Aqueduct Syndrome (LVAS). Acta Otolaryngol (StochK) 1999;119: 641-646]. Signs and symptoms of the auditory impairment are more commonly described in the literature: hearing loss ranges from mild to profound, arising from fluctuating to stepwise progressive or sudden. Vestibular disturbances, ranging from mild imbalance to episodic vertigo, are rarely described in the literature. Benign paroxysmal positional vertigo (BPPV) is a labyrinthine disorder with a typical behavior: intense crises of rotational vertigo induced by postural changes of the head, with short duration and usually good responsiveness to rehabilitative maneuvers. These maneuvers are effective in about 80% of patients with BPPV. BPPV often recurs. About 1/3 of patients have a recurrence in the first year after treatment, and by five years, about half of all patients have a recurrence. Vestibular aqueduct has been demonstrated by conventional tomography and computed tomography (CT), however, CT scans cannot show the membranous labyrinth itself. On MR images it is not the vestibular aqueduct that is visualized but its contents, the endolymphatic duct and sac, and can show the abnormalities of the fluid spaces related to the membranous labyrinth. It is proposed that recurrent benign paroxysmal positional vertigo (BPPV) is related with volumetric abnormalities of vestibular aqueduct. This verifiable hypothesis tries to define this rapport and explore new diagnostic and therapeutic possibilities.
BibTeX: @article{Manzari2008, author = {Manzari, Leonardo}, title = {Enlarged vestibular aqueduct (EVA) related with recurrent benign paroxysmal positional vertigo (BPPV).}, journal = {Medical hypotheses}, year = {2008}, volume = {70}, issue = {1}, pages = {61--65}, doi = {https://doi.org/10.1016/j.mehy.2007.04.032}, keywords = {Humans; Posture; Tomography, X-Ray Computed; Vestibular Aqueduct, diagnostic imaging, pathology, physiopathology; Vestibular Neuronitis, diagnostic imaging, physiopathology}, pmid = {17590526} }
Song, J.-J., Hong, S.K., Kim, J.S. and Koo, J.-W.	Enlarged vestibular aqueduct may precipitate benign paroxysmal positional vertigo in children. [Abstract] [BibTeX]	2012	Acta oto-laryngologica Vol. 132 Suppl 1, pp. S109-S117	article	DOI
Abstract: Enlarged vestibular aqueduct (EVA) may precipitate secondary benign paroxysmal positional vertigo (BPPV), especially in pediatric populations, as well as paretic dysfunction of the vestibular end organ. EVA is characterized by the early onset of sudden or progressive sensorineural hearing loss with or without vestibular dysfunction. However, vestibular dysfunction in patients with EVA has not been described as frequently as hearing loss, and an association with BPPV has not been previously reported. By reviewing the cochleo-vestibular status of three children and two young adults with EVA who had been diagnosed with BPPV, characteristic features of BPPV in EVA patients were investigated and possible pathogenetic mechanisms are speculated. A retrospective review of medical records was conducted for five patients with EVA who presented with BPPV from January 2004 to July 2009. Clinical courses, characteristics of vertigo and audiovestibular laboratory findings were reviewed. Among 26 patients with radiologically confirmed EVA, 5 (19.2%) exhibited positional nystagmus compatible with BPPV through Dix-Hallpike and head-roll tests. Hearing loss usually accompanied BPPV attacks, and BPPV was recurrent in three patients. Multiple semicircular canals were frequently involved in each episode, and different canals were also involved in recurrent cases. Canalith repositioning procedures were usually successful without difficulty.
BibTeX: @article{Song2012, author = {Song, Jae-Jin and Hong, Sung Kwang and Kim, Ji Soo and Koo, Ja-Won}, title = {Enlarged vestibular aqueduct may precipitate benign paroxysmal positional vertigo in children.}, journal = {Acta oto-laryngologica}, year = {2012}, volume = {132 Suppl 1}, pages = {S109--S117}, doi = {https://doi.org/10.3109/00016489.2012.662714}, keywords = {Adolescent; Adult; Benign Paroxysmal Positional Vertigo; Child; Child, Preschool; Female; Follow-Up Studies; Humans; Male; Nystagmus, Physiologic, physiology; Posture; Prognosis; Retrospective Studies; Vertigo, congenital, diagnosis, physiopathology; Vestibular Aqueduct, pathology, physiopathology; Vestibular Function Tests; Young Adult}, pmid = {22582772} }
von Brevern, M. and Neuhauser, H.	Epidemiological evidence for a link between vertigo and migraine. [Abstract] [BibTeX]	2011	Journal of vestibular research : equilibrium & orientation Vol. 21(6), pp. 299-304	article	DOI
Abstract: Both migraine and dizziness/vertigo rank among the most common complaints in the general population. Worldwide, the lifetime prevalence of migraine is about 14%. Approximately 20% to 30% of the general population are affected by dizziness and vertigo. Given the high prevalence of vertigo and migraine in the general population it is not surprising that many patients suffer from both symptoms. Nonetheless, in the last decade epidemiological arguments have progressively accumulated to strengthen the hypothesis that vertigo is linked to migraine beyond a mere chance concurrence. Several studies with selected patient groups have shown that the prevalence of vertigo is increased in patients with migraine. Vice versa, patients presenting to a dizziness clinic have a history of migraine more often than would be expected by chance. The epidemiological link between vertigo and migraine has recently been confirmed on the population level. The relation between vertigo and migraine is intricate. In vestibular migraine, vertigo is conceptualized as a vestibular symptom caused by migraine. Vestibular migraine is the most common cause for recurrent spontaneous vertigo with a lifetime-prevalence in the general population of about 1%. Other vestibular disorders that display an increased prevalence of migraine are benign paroxysmal positional vertigo and Menière's disease. Furthermore, migraine is associated with motion sickness, rare ataxia disorders and psychiatric syndromes that can also manifest with vertigo and dizziness.
BibTeX: @article{Brevern2011, author = {von Brevern, Michael and Neuhauser, Hannelore}, title = {Epidemiological evidence for a link between vertigo and migraine.}, journal = {Journal of vestibular research : equilibrium & orientation}, year = {2011}, volume = {21}, issue = {6}, pages = {299--304}, doi = {https://doi.org/10.3233/VES-2011-0423}, keywords = {Adolescent; Adult; Aged; Benign Paroxysmal Positional Vertigo; Causality; Cerebellar Ataxia, epidemiology; Comorbidity; Female; Humans; Male; Meniere Disease, epidemiology; Mental Disorders, epidemiology; Middle Aged; Migraine Disorders, complications, diagnosis, epidemiology; Motion Sickness, epidemiology; Prevalence; Vertigo, epidemiology, etiology; Vestibulocochlear Nerve Diseases, complications, epidemiology; Young Adult}, pmid = {22348934} }
Mizukoshi, K., Watanabe, Y., Shojaku, H., Okubo, J. and Watanabe, I.	Epidemiological studies on benign paroxysmal positional vertigo in Japan. [Abstract] [BibTeX]	1988	Acta oto-laryngologica. Supplementum Vol. 447, pp. 67-72	article
Abstract: In 1980, the Research Committee of Peripheral Vestibular Disorders in Japan, which is supported by the Ministry of Health and Welfare, was founded by 24 members, from several districts in Japan. The Committee's first task was to draft the diagnostic criteria for several peripheral vestibular disorders, such as benign paroxysmal positional vertigo (BPPV), and vestibular neuronitis. For the national epidemiological survey, they then collected the data on 101 cases of BPPV out of some 783 vestibular disorder patients. In addition, data on 103 patients of BPPV out of 559 vestibular disorder patients were also collected from the Neuro-otological Clinic of the Toyama Medical and Pharmaceutical University Hospital. From these epidemiological surveys, the incidence of BPPV in Japan was estimated at 10.7 per 100,000 population, while that of BPPV in Toyama was estimated at 17.3 per 100,000 population. The ratio of BPPV was higher in female than male patients in both surveys. The age at the onset of BPPV peaked in the fourth decade in both males and females. Compared with the other epidemiological features of Meniere's disease and sudden deafness with vertigo in the same surveys, it appeared that the characteristic features of BPPV are epidemiologically similar to those of Meniere's disease, but different from those of sudden deafness.
BibTeX: @article{Mizukoshi1988, author = {Mizukoshi, K and Watanabe, Y and Shojaku, H and Okubo, J and Watanabe, I}, title = {Epidemiological studies on benign paroxysmal positional vertigo in Japan.}, journal = {Acta oto-laryngologica. Supplementum}, year = {1988}, volume = {447}, pages = {67--72}, keywords = {Female; Hearing Loss, Sudden, diagnosis; Humans; Japan; Male; Meniere Disease, diagnosis; Nystagmus, Pathologic, epidemiology; Posture; Vertigo, diagnosis, epidemiology}, pmid = {3188895} }
Murdin, L. and Schilder, A.G.M.	Epidemiology of balance symptoms and disorders in the community: a systematic review. [Abstract] [BibTeX]	2015	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 36(3), pp. 387-392	article	DOI
Abstract: Balance disorders presenting with symptoms of dizziness or vertigo may have significant impact on quality of life and are a recognized risk factor for falls. The objective of this review was to systematically synthesize the published literature on the epidemiology of balance symptoms and disorders in the adult community population. A search was carried out across PubMed, Medline, and Cochrane databases to identify suitable studies. Studies were eligible for inclusion if they contained data on the epidemiology of symptoms of balance disorders (dizziness and vertigo) or balance disorders sampled from community-based adult populations. Data were collected on prevalence and incidence of balance symptoms and on specific balance disorders. A validated risk-of-bias assessment was carried out. Twenty eligible studies were identified. The lifetime prevalence estimates of significant dizziness ranged between 17 and 30%, and for vertigo between 3 and 10%. Published point prevalence data exist for Ménière's disease (0.12-0.5%) and for vestibular migraine (0.98%). For benign paroxysmal positional vertigo, 1-year incidence estimates range from 0.06 to 0.6%. There are no community-based studies on the prevalence or incidence of chronic uncompensated peripheral vestibular disorders or vestibular neuritis. Symptoms of dizziness and vertigo are common in the adult population, and data give a coherent picture of community epidemiology. These data can inform rational service planning and much-needed clinical trials in this field. There are insufficient data on specific balance disorders, especially peripheral vestibular disorders such as vestibular neuritis and its long-term sequelae.
BibTeX: @article{Murdin2015, author = {Murdin, Louisa and Schilder, Anne G M}, title = {Epidemiology of balance symptoms and disorders in the community: a systematic review.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2015}, volume = {36}, issue = {3}, pages = {387--392}, doi = {https://doi.org/10.1097/MAO.0000000000000691}, keywords = {Adult; Age Factors; Dizziness, epidemiology; Female; Humans; Incidence; Male; Meniere Disease, epidemiology; Prevalence; Quality of Life; Sex Factors; Vertigo, epidemiology; Vestibular Neuronitis, epidemiology}, pmid = {25548891} }
von Brevern, M., Radtke, A., Lezius, F., Feldmann, M., Ziese, T., Lempert, T. and Neuhauser, H.	Epidemiology of benign paroxysmal positional vertigo: a population based study. [Abstract] [BibTeX]	2007	Journal of neurology, neurosurgery, and psychiatry Vol. 78(7), pp. 710-715	article	DOI
Abstract: To examine the prevalence and incidence, clinical presentation, societal impact and comorbid conditions of benign paroxysmal positional vertigo (BPPV) in the general population. Cross-sectional, nationally representative neurotological survey of the general adult population in Germany with a two stage sampling design: screening of 4869 participants from the German National Telephone Health Interview Survey 2003 (response rate 52%) for moderate or severe dizziness or vertigo, followed by validated neurotological interviews (n = 1003; response rate 87%). Diagnostic criteria for BPPV were at least five attacks of vestibular vertigo lasting <1 min without concomitant neurological symptoms and invariably provoked by typical changes in head position. In a concurrent validation study (n = 61) conducted in two specialised dizziness clinics, BPPV was detected by our telephone interview with a specificity of 92% and a sensitivity of 88% (positive predictive value 88%, negative predictive value 92%). BPPV accounted for 8% of individuals with moderate or severe dizziness/vertigo. The lifetime prevalence of BPPV was 2.4%, the 1 year prevalence was 1.6% and the 1 year incidence was 0.6%. The median duration of an episode was 2 weeks. In 86% of affected individuals, BPPV led to medical consultation, interruption of daily activities or sick leave. In total, only 8% of affected participants received effective treatment. On multivariate analysis, age, migraine, hypertension, hyperlipidaemia and stroke were independently associated with BPPV. BPPV is a common vestibular disorder leading to significant morbidity, psychosocial impact and medical costs.
BibTeX: @article{Brevern2007, author = {von Brevern, M and Radtke, A and Lezius, F and Feldmann, M and Ziese, T and Lempert, T and Neuhauser, H}, title = {Epidemiology of benign paroxysmal positional vertigo: a population based study.}, journal = {Journal of neurology, neurosurgery, and psychiatry}, year = {2007}, volume = {78}, issue = {7}, pages = {710--715}, doi = {https://doi.org/10.1136/jnnp.2006.100420}, keywords = {Adult; Age Factors; Aged; Aged, 80 and over; Comorbidity; Cross-Sectional Studies; Female; Germany, epidemiology; Health Surveys; Humans; Incidence; Male; Middle Aged; Multivariate Analysis; Posture; Prevalence; Risk Factors; Vertigo, epidemiology}, pmid = {17135456} }
Muelleman, T., Shew, M., Subbarayan, R., Shum, A., Sykes, K., Staecker, H. and Lin, J.	Epidemiology of Dizzy Patient Population in a Neurotology Clinic and Predictors of Peripheral Etiology. [Abstract] [BibTeX]	2017	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 38(6), pp. 870-875	article	DOI
Abstract: To compare the proportion of peripheral versus nonperipheral dizziness etiologies among all patients, inclusive of those presenting primarily or as referrals, to rank diagnoses in order of frequency, to determine whether or not age and sex predict diagnosis, and to determine which subgroups tended to undergo formal vestibular testing. Retrospective cohort. Academic neurotology clinic. Age greater than 18 neurotology clinic patients with the chief complaint of dizziness. None. Age, sex, diagnosis, record of vestibular testing. Two thousand seventy-nine patients were assigned 2,468 diagnoses, of which 57.7 and 42.3% were of peripheral and nonperipheral etiologies, respectively. The most common diagnoses were Ménière's (23.0%), vestibular migraine (19.3%), benign paroxysmal positional vertigo (BPPV) (19.1%), and central origin, nonmigraine (16.4%). Peripheral diagnoses are more likely to be found in men than in women (odds ratio [OR] 1.59). Peripheral diagnoses were most likely to be found in the 60 to 69 age group (OR 3.82). There was not a significant difference in rate of vestibular testing between women and men. Among patients with two diagnoses, the most common combinations were vestibular migraine and BPPV then vestibular migraine and Ménière's. A large proportion of patients seen for the chief complaint of dizziness in the neurotology clinic were found not to have a peripheral etiology of their symptoms. These data challenge a prevalent dogma that the most common causes of dizziness are peripheral: BPPV, vestibular neuritis, and Ménière's disease. Age and sex are statistically significant predictors of peripheral etiology of dizziness.
BibTeX: @article{Muelleman2017, author = {Muelleman, Thomas and Shew, Matthew and Subbarayan, Rahul and Shum, Axel and Sykes, Kevin and Staecker, Hinrich and Lin, James}, title = {Epidemiology of Dizzy Patient Population in a Neurotology Clinic and Predictors of Peripheral Etiology.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2017}, volume = {38}, issue = {6}, pages = {870--875}, doi = {https://doi.org/10.1097/MAO.0000000000001429}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo, complications; Dizziness, etiology; Female; Humans; Male; Meniere Disease, complications; Middle Aged; Migraine Disorders, complications; Neurotology, statistics & numerical data; Retrospective Studies; Vestibular Neuronitis, complications}, pmid = {28498271} }
Lempert, T. and Neuhauser, H.	Epidemiology of vertigo, migraine and vestibular migraine. [Abstract] [BibTeX]	2009	Journal of neurology Vol. 256(3), pp. 333-338	article	DOI
Abstract: Both migraine and vertigo are common in the general population with lifetime prevalences of about 16 % for migraine and 7 % for vertigo. Therefore, a concurrence of the two conditions can be expected in about 1.1 % of the general population by chance alone. However, recent epidemiological evidence suggests that the actual comorbidity is higher, namely 3.2 %. This can be explained by the fact that several dizziness and vertigo syndromes occur more frequently in migraineurs than in controls including benign paroxysmal positional vertigo, Meniere's disease, motion sickness, cerebellar disorders and anxiety syndromes which may present with dizziness. In addition, there is increasing recognition of a syndrome called vestibular migraine (VM), which is vertigo directly caused by migraine. VM affects more than 1 % of the general population, about 10 % of patients in dizziness clinics and at least 9 % of patients in migraine clinics.Clinically, VM presents with attacks of spontaneous or positional vertigo lasting seconds to days. Migrainous accompaniments such as headache, phonophobia, photophobia or auras are common but not mandatory. Cochlear symptoms may be associated but are mostly mild and non-progressive. During acute attacks one may find central spontaneous or positional nystagmus and, less commonly, unilateral vestibular hypofunction. In the symptom-free interval, vestibular testing adds little to the diagnosis as findings are mostly minor and non-specific. In the absence of controlled studies, treatment of VM is adopted from the migraine sphere comprising avoidance of triggers, stress management as well as pharmacotherapy for acute attacks and prophylaxis.
BibTeX: @article{Lempert2009a, author = {Lempert, Thomas and Neuhauser, Hannelore}, title = {Epidemiology of vertigo, migraine and vestibular migraine.}, journal = {Journal of neurology}, year = {2009}, volume = {256}, issue = {3}, pages = {333--338}, doi = {https://doi.org/10.1007/s00415-009-0149-2}, keywords = {Cerebellar Diseases, epidemiology; Comorbidity; Diagnosis, Differential; Dizziness, epidemiology; Female; Humans; Male; Meniere Disease, epidemiology; Migraine Disorders, diagnosis, epidemiology, physiopathology; Motion Sickness, epidemiology; Prevalence; Sex Factors; Syndrome; Vertigo, diagnosis, epidemiology, physiopathology}, pmid = {19225823} }
Neuhauser, H.K.	Epidemiology of vertigo. [Abstract] [BibTeX]	2007	Current opinion in neurology Vol. 20(1), pp. 40-46	article	DOI
Abstract: Epidemiological findings on the distribution, determinants and outcome of vertigo can be used for clinical decision making and can help understand the underlying causes of vestibular diseases. This article gives an overview of the epidemiology of the vestibular symptom vertigo and of four specific vestibular disorders: benign paroxysmal positional vertigo, migrainous vertigo, Menière's disease and vestibular neuritis. Based on a neurotologic survey of the general population, 1-year prevalence estimates for vertigo were 4.9%, for migrainous vertigo 0.89% and for benign paroxysmal positional vertigo 1.6%. Diagnostic positional manoeuvres and treatments for benign paroxysmal positional vertigo, however, are still not being done by most doctors. The female preponderance among patients with benign paroxysmal positional vertigo and migrainous vertigo may be linked to migraine but is not fully understood. A recently reported prevalence of Menière's disease of 0.51% is much higher than previous estimates. Follow-up studies have shown benign paroxysmal positional vertigo recurrence rates of 50% at 5 years and a persistence of dizziness related to anxiety in almost a third of patients 1 year after vestibular neuritis. The epidemiology of vertigo and vestibular disorders is still an underdeveloped field. Recent studies have underscored the impact of vertigo at the population level, but its determinants and outcome are not well known yet.
BibTeX: @article{Neuhauser2007, author = {Neuhauser, Hannelore K}, title = {Epidemiology of vertigo.}, journal = {Current opinion in neurology}, year = {2007}, volume = {20}, issue = {1}, pages = {40--46}, doi = {https://doi.org/10.1097/WCO.0b013e328013f432}, keywords = {Humans; Meniere Disease, diagnosis, epidemiology, physiopathology; Migraine Disorders, diagnosis, epidemiology, physiopathology; Prevalence; Risk Factors; Vertigo, diagnosis, epidemiology, physiopathology; Vestibular Nerve, pathology, physiopathology; Vestibular Neuronitis, diagnosis, epidemiology, physiopathology; Vestibule, Labyrinth, pathology, physiopathology}, pmid = {17215687} }
Guerra-Jiménez, G., Arenas Rodríguez, A., Falcón González, J.C., Pérez Plasencia, D. and Ramos Macías, Á.	Epidemiology of vestibular disorders in the otoneurology unit. [Abstract] [BibTeX]	2017	Acta otorrinolaringologica espanola Vol. 68(6), pp. 317-322	article	DOI
Abstract: The set of symptoms relating to disorders of the balance system are common in the general population. However, there are few studies quantifying the frequency of onset of the various vestibular disorders that present in specialist otoneurology units in the Spanish population. The aim of this study is to establish the epidemiology of vestibular disorders, their form of presentation, and the expected care burden in a specialist otoneurology clinic. A retrospective, descriptive, observational study of patients referred to the otoneurology unit of a third level hospital between 1/1/2015 and 31/12/2015. One hundred and seventy-four patients were assessed (121 women and 53 men) with a mean age of 53±17 years. Forty-three individuals per 100,000 inhabitants were assessed over the study period. The patients were referred in the majority from external ENT (36.8%) and primary care (28.7%) clinics. The most frequent reason for consultation was dizziness (40.2%) followed by vertigo (31%). The most frequent diagnoses were benign paroxysmal positional vertigo (28.2%) and vestibular migraine (28.2%) -defined (59%) or probable (41%)-, followed by Ménière's disease (13.8%), vascular disorders (5.7%), chronic subjective dizziness (4.6%) and vestibular neuritis (4%). The availability of precise information on the prevalence and impact of vestibular disorders is important to enable the health services to plan an appropriate response to the expected care demand in the community. Benign paroxysmal positional vertigo and vestibular migraine are the most commonly diagnosed disorders in otoneurology clinics. Systematic terminology is essential for the comparison of results.
BibTeX: @article{Guerra-Jimenez2017, author = {Guerra-Jiménez, Gloria and Arenas Rodríguez, Alejandra and Falcón González, Juan Carlos and Pérez Plasencia, Daniel and Ramos Macías, Ángel}, title = {Epidemiology of vestibular disorders in the otoneurology unit.}, journal = {Acta otorrinolaringologica espanola}, year = {2017}, volume = {68}, issue = {6}, pages = {317--322}, doi = {https://doi.org/10.1016/j.otorri.2017.01.007}, keywords = {Adult; Aged; Comorbidity; Diagnosis-Related Groups; Dizziness, epidemiology; Female; Hospital Units, statistics & numerical data; Humans; Male; Meniere Disease, epidemiology; Middle Aged; Migraine Disorders, epidemiology; Neurology; Otolaryngology; Retrospective Studies; Spain, epidemiology; Tertiary Care Centers, statistics & numerical data; Vestibular Diseases, epidemiology; Dizziness; Epidemiology; Epidemiología; Inestabilidad; Vertigo; Vértigo}, pmid = {28549682} }
Wiener-Vacher, S.R., Quarez, J. and Priol, A.L.	Epidemiology of Vestibular Impairments in a Pediatric Population. [Abstract] [BibTeX]	2018	Seminars in hearing Vol. 39(3), pp. 229-242	article	DOI
Abstract: The purpose of this study was to report the prevalence of vestibular impairment (VI) in children ( = 2,528) referred for complete vestibular testing because of balance disorders (BD) or hearing loss (H). A VI was shown in 51.5% of the children tested (1,304/2,528). For BD (e.g., vertigo, dizziness, instability, delay in posturomotor development), VI was found in 36.5% ( = 379/1,037). The most frequent causes of BD with VI included inner ear malformation (13.5%), delay in posturomotor development (13.4%), hearing loss revealed with vertigo (3.9%), trauma (3.9%), vestibular neuritis (3.3%), meningitis (2.5%), Meniere-like syndrome (1.1%), BPPV posttrauma (1%), labyrinthitis (0.4%), and unknown etiology (19.6%). Normal responses to the complete battery of tests ( = 658, 63.5%) excluded a vestibular origin to BD, leading to other diagnoses: principally migraine (15.6%), ophthalmological disorders (15.1%), neurological disorders (including delay in posturomotor development; 14.4%), orthostatic hypotension, or somatoform dizziness (<1%). Of the children referred for hearing loss ( = 1,491), 68.5% were tested without cochlear implantation (CI; = 1,022). In this group, 54.5% presented with VI ( = 557). This was mostly found in cytomegalovirus infection, inner ear malformation, and genetic syndromes. Profound hearing loss candidates for cochlear implants had complete bilateral vestibular loss in 20% and delay in posturomotor development, and 80% had partial or normal vestibular function and normal posturomotor development. VI was found after CI in 50% on the side of the implant (partial in 41% and complete in 9%). VI is present in 36.5% of children referred to our center for BDs and 54.5% for hearing loss. Vestibular testing permits ruling out peripheral VI and hence seeking other causes for BDs such as migraine and ophthalmological disorders and also helps lower the risk of inducing bilateral complete vestibular loss in CI protocols.
BibTeX: @article{Wiener-Vacher2018, author = {Wiener-Vacher, Sylvette R and Quarez, Juliette and Priol, Audrey Le}, title = {Epidemiology of Vestibular Impairments in a Pediatric Population.}, journal = {Seminars in hearing}, year = {2018}, volume = {39}, issue = {3}, pages = {229--242}, doi = {https://doi.org/10.1055/s-0038-1666815}, keywords = {balance disorders; dizziness; etiologies; hearing loss; pediatric; vertigo}, pmid = {30038452} }
Tungvachirakul, V., Lisnichuk, H. and O'Leary, S.J.	Epidemiology of vestibular vertigo in a neuro-otology clinic population in Thailand. [Abstract] [BibTeX]	2014	The Journal of laryngology and otology Vol. 128 Suppl 2, pp. S31-S38	article	DOI
Abstract: To assess the epidemiology of vestibular vertigo, including the new entity of vestibular migraine, in a neuro-otology clinic population in the biggest public hospital in Thailand. A prospective study involving all patients presenting to the neuro-otology clinic in the Rajavithi Hospital in Bangkok between November 2007 and November 2008. The population studied consisted of adults referred to the neuro-otology clinic. Accepted international criteria and standardised otological and, when necessary, psychiatric assessment were applied to establish each diagnosis. The association between diagnoses and potential triggers was explored. Of the 167 patients assessed, the most prevalent conditions encountered were benign paroxysmal positional vertigo and vestibular migraine. The prevalence of vestibular migraine was 29.3 per cent. No cases of Ménière's disease were encountered. An association was found between vestibular migraine and inadequate sleep, insomnia and changes of head position. This study provides current data on the epidemiology of vestibular vertigo in a Thai neuro-otology out-patient population. The results include data on the prevalence of the new diagnostic entity of vestibular migraine, and on its association with potential triggers.
BibTeX: @article{Tungvachirakul2014, author = {Tungvachirakul, V and Lisnichuk, H and O'Leary, S J}, title = {Epidemiology of vestibular vertigo in a neuro-otology clinic population in Thailand.}, journal = {The Journal of laryngology and otology}, year = {2014}, volume = {128 Suppl 2}, pages = {S31--S38}, doi = {https://doi.org/10.1017/S0022215113003484}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, epidemiology; Female; Humans; Male; Meniere Disease, epidemiology; Middle Aged; Prospective Studies; Thailand, epidemiology; Vertigo, epidemiology, pathology; Vestibular Function Tests; Vestibule, Labyrinth, pathology; Young Adult}, pmid = {24548658} }
Lempert, T. and von Brevern, M.	Episodic vertigo. [Abstract] [BibTeX]	2005	Current opinion in neurology Vol. 18(1), pp. 5-9	article
Abstract: This review focuses on three neuro-otological syndromes, which are all marked by rapid scientific progress on the one hand but under-recognition or undertreatment on the other: benign paroxysmal positional vertigo and its variants, superior semicircular canal dehiscence syndrome, and migrainous vertigo. The efficacy of Epley's maneuver for treatment of benign paroxysmal positional vertigo has been convincingly demonstrated by a meta-analysis of nine randomized controlled trials. Head vibration during Epley's procedure and keeping upright for 48 h after effective treatment do not improve the outcome. Superior canal dehiscence syndrome presents not only with sound and pressure-induced vertigo but also with conductive hearing loss at low frequencies. Migrainous vertigo may present not only with spontaneous attacks but also with positional vertigo or with chronic dizziness and imbalance. Vestibular rehabilitation has been proven to relieve chronic dizziness and visual vertigo. Recent studies have eliminated several white spots on the neuro-otological map. However, many areas are still unexplored, particularly with regard to treatment of specific vestibular syndromes where randomized controlled trials are just at their beginning.
BibTeX: @article{Lempert2005, author = {Lempert, Thomas and von Brevern, Michael}, title = {Episodic vertigo.}, journal = {Current opinion in neurology}, year = {2005}, volume = {18}, issue = {1}, pages = {5--9}, keywords = {Humans; Migraine Disorders, complications, physiopathology; Vertigo, diagnosis, pathology, physiopathology, therapy; Vestibular Diseases, diagnosis, pathology, physiopathology, therapy}, pmid = {15655395} }
Kaski, D. and Bronstein, A.M.	Epley and beyond: an update on treating positional vertigo. [Abstract] [BibTeX]	2014	Practical neurology Vol. 14(4), pp. 210-221	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is the commonest cause of dizziness. It is characterised by brief episodes of vertigo and imbalance with nystagmus. The direction of nystagmus allows the identification of the culprit semicircular canal. As it is readily treatable--and often curable--BPPV should not be missed. Although recurrent episodes of vertigo triggered by movement suggest BPPV, the diagnosis can only be confirmed with the Dix-Hallpike manoeuvre. Here we review the diagnostic manoeuvres required to diagnose BPPV, and the various repositioning manoeuvres for treating different types of BPPV.
BibTeX: @article{Kaski2014, author = {Kaski, Diego and Bronstein, Adolfo M}, title = {Epley and beyond: an update on treating positional vertigo.}, journal = {Practical neurology}, year = {2014}, volume = {14}, issue = {4}, pages = {210--221}, doi = {https://doi.org/10.1136/practneurol-2013-000690}, keywords = {Diagnosis, Differential; Dizziness, diagnosis, therapy; Humans; Movement, physiology; Nystagmus, Pathologic, diagnosis, therapy; Physical Therapists; Vertigo, diagnosis, therapy; EYE MOVEMENTS; NEUROOTOLOGY; VERTIGO; benign paroxysmal positional vertigo}, pmid = {24570475} }
Liu, Y., Wang, W., Zhang, A.-B., Bai, X. and Zhang, S.	Epley and Semont maneuvers for posterior canal benign paroxysmal positional vertigo: A network meta-analysis. [Abstract] [BibTeX]	2016	The Laryngoscope Vol. 126(4), pp. 951-955	article	DOI
Abstract: Using network meta-analysis, we aimed to compare the efficacy and safety of Epley and Semont maneuvers as treatment options for posterior canal benign paroxysmal positional vertigo. Network meta-analysis. Randomized controlled studies with a Jadad score ≥ 3 that used an Epley or Semont maneuver in posterior canal benign paroxysmal positional vertigo patients were analyzed in this project. The following efficacy outcomes included 1-week recovery rate and end of study recovery rate. Recurrence rate was used to assess the safety of each treatment. Of 589 articles, 12 studies that enrolled 999 posterior canal benign paroxysmal positional vertigo patients were selected. The pooled analysis revealed that the Epley maneuver was as efficacious as the Semont maneuver, in both the 1-week recovery rate and end of study recovery rate (odds ratio [OR] = 1.8, 95% confidence interval [CI] = 0.48-7.00; OR = 1.8, 95% CI = 0.47-7.20), and had a similar recurrence rate (OR = 1.00, 95% CI = 0.33-4.4). These two techniques were both better than sham-controlled treatment in the two efficacy indicators. No difference was observed in recurrence rate for treatments. The Epley maneuver was similar to the Semont maneuver in both efficacy and safety for posterior canal benign paroxysmal positional vertigo in short-term effects, and both were superior to the sham-controlled treatment. NA.
BibTeX: @article{Liu2016a, author = {Liu, Yun and Wang, Wei and Zhang, Ao-Bo and Bai, Xue and Zhang, Shuang}, title = {Epley and Semont maneuvers for posterior canal benign paroxysmal positional vertigo: A network meta-analysis.}, journal = {The Laryngoscope}, year = {2016}, volume = {126}, issue = {4}, pages = {951--955}, doi = {https://doi.org/10.1002/lary.25688}, keywords = {Benign Paroxysmal Positional Vertigo, therapy; Humans; Physical Therapy Modalities; Epley; Semont; benign paroxysmal positional vertigo; network meta-analysis; posterior canal}, pmid = {26403977} }
Ozgirgin, O.N. and Tarhan, E.	Epley maneuver and the head autorotation test in benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2008	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 265(11), pp. 1309-1313	article	DOI
Abstract: The head autorotation tests can be affected with the dynamic changes within the semicircular canals caused by benign paroxysmal positional vertigo (BPPV). The vestibular autorotation test is a method of examining the VOR (especially the VOR that develops at higher frequencies like those that occur in the everyday environment). Twenty patients who had been diagnosed as having posterior semicircular canal BPPV were evaluated with head autorotation tests before and after the treatment maneuver. The head autorotation tests were performed just before the use of the Epley maneuver and after the resolution of symptoms and the typical nystagmus pattern. The mean gain values for horizontal rotation tests during the pre-treatment period were 0.823, 0.844, and 0.840 for the frequencies 1, 2, and 3 Hz, respectively. The mean gain values increased by 0.095 (95% confidence interval) with Epley's maneuver. But this difference difference between the pre-treatment and post-treatment values was not statistically significant. All patients were also evaluated with vertical active tests. The differences between the pre-treatment and post-treatment values were not statistically significant in the vertical autorotation group. The phase values were within normal range in the horizontal and vertical rotation tests and remained so after the Epley maneuver. The stimulation of the VOR caused by BPPV did not affect gain and phase values to a statistically significant degree, and the values noted after the resolution of the patient's symptoms improved slightly but without statistical significance.
BibTeX: @article{Ozgirgin2008, author = {Ozgirgin, O Nuri and Tarhan, Erkan}, title = {Epley maneuver and the head autorotation test in benign paroxysmal positional vertigo.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2008}, volume = {265}, issue = {11}, pages = {1309--1313}, doi = {https://doi.org/10.1007/s00405-008-0643-7}, keywords = {Head, physiology; Humans; Movement, physiology; Musculoskeletal Manipulations, methods; Posture; Reflex, Vestibulo-Ocular, physiology; Vertigo, therapy}, pmid = {18365228} }
Khatri, M., Raizada, R.M. and Puttewar, M.P.	Epley's canalith-repositioning manoeuvre for benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2005	Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India Vol. 57(4), pp. 315-319	article	DOI
Abstract: The efficacy of the Epley's canalith-repositioning manoeuvre in the treatment of BPPV was assessed in this prospective study of 62 patients. Patients were selected based on symptoms of positional vertigo and positive Dix-Hallpike's positional test. Patients were divided into two groups; first group comprising 34 patients underwent Epley's manoeuvre alone where as the other group comprising 28 patients underwent Epley's manoeuvre along with mastoid oscillator. At the end of 1 month patients were assessed subjectively by visual analogue scale (VAS) and objectively by Dix-Hallpike's positional test. On VAS, 85.7% patients had complete resolution of symptoms of BPPV in both the groups. Objectively 88.2% did not have positional nysfagmus after 1 month in first group whereas in the second group 86% had complete response at the end of 1 month of therapy. Follow up of 6 months could be done in 38 patients, out of which 7 (18.4%) had recurrence of their symptom of vertigo and positive Dix-Hallpike's positional test, whereas one patient continued to have no relief by Epley's manoeuvre. There was no difference in subjective and objective parameters even when CRP was performed using mastoid vibrator.
BibTeX: @article{Khatri2005, author = {Khatri, M and Raizada, R M and Puttewar, M P}, title = {Epley's canalith-repositioning manoeuvre for benign paroxysmal positional vertigo.}, journal = {Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India}, year = {2005}, volume = {57}, issue = {4}, pages = {315--319}, doi = {https://doi.org/10.1007/BF02907697}, keywords = {Epley's canalith-repositioning manoeuvre Benign paroxysmal positional vertigo}, pmid = {23120204} }
Ganança, C.F., Caovilla, H.H., Gazzola, J.M., Ganança, M.M. and Ganança, F.F.	Epley's maneuver in benign paroxysmal positional vertigo associated with Meniere's disease. [Abstract] [BibTeX]	2007	Brazilian journal of otorhinolaryngology Vol. 73(4), pp. 506-512	article
Abstract: The effects of Epley's maneuver in benign paroxysmal positional vertigo (BPPV) associated with Menière's disease are controversial. To evaluate the progression of positional vertigo and nystagmus after one or more of Epley's maneuvers in BPPV associated with Menière's disease, and the recurrence of BPPV. a retrospective study of 62 patients with BPPV associated with Menière's disease, that underwent Epley's maneuver, and that were monitored during 12 months after elimination of positional nystagmus. One Epley's maneuver was required to eliminate positional nystagmus in 80.7% of the patients, two in 16.1%, and three in 3.2%; after elimination of nystagmus, positional vertigo was suppressed in 71.0% of the patients, improved in 27.4% and remained unaltered in 1.6%. Four weeks after elimination of positional nystagmus, all patients were asymptomatic. Recurrence of BPPV was seen in 19.4% of the cases, with elimination of the positional vertigo and nystagmus by means of the specific maneuver for the involved canal. In BPPV associated with Menière's disease, vertigo and positioning nystagmus were eliminated with one, two or three Epley maneuvers. BPPV recurrence was resolved by using a specific maneuver for the affected canal.
BibTeX: @article{Gananca2007, author = {Ganança, Cristina Freitas and Caovilla, Heloisa Helena and Gazzola, Juliana Maria and Ganança, Maurício Malavasi and Ganança, Fernando Freitas}, title = {Epley's maneuver in benign paroxysmal positional vertigo associated with Meniere's disease.}, journal = {Brazilian journal of otorhinolaryngology}, year = {2007}, volume = {73}, issue = {4}, pages = {506--512}, keywords = {Adult; Aged; Aged, 80 and over; Female; Follow-Up Studies; Head Movements; Humans; Male; Meniere Disease, complications; Middle Aged; Nystagmus, Pathologic, therapy; Physical Therapy Modalities; Retrospective Studies; Treatment Outcome; Vertigo, etiology, therapy}, pmid = {17923921} }
Korn, G.P., Dorigueto, R.S., Ganança, M.M. and Caovilla, H.H.	Epley's maneuver in the same session in benign positional paroxysmal vertigo. [Abstract] [BibTeX]	2007	Brazilian journal of otorhinolaryngology Vol. 73(4), pp. 533-539	article
Abstract: To assess whether more than one Epley's maneuver in the same session, compared to a single one, decreases the number of sessions necessary to suppress positional nystagmus. Epleys maneuver was done in 123 patients with BPPV due to unilateral posterior semicircular canal canalolithiasis. The number of sessions for positional nystagmus suppression was compared in two groups of patients. Group I consisted of 75 patients submitted to a single Epley's maneuver on weekly sessions and group II consisted of 48 patients that were submitted to four Epley's maneuvers during the first session. Group II showed greater nystagmus latency and duration than group I (p<0.05). The number of sessions and standard deviation showed by group I was greater than in group II (p=0.008). We observed a significant association between number of sessions and group (p=0.039) studied. Group II had 21.4% more nystagmus-free patients following only one session (CI95% [7.7% - 35.1%]). Repeated Epley's maneuvers in less sessions rendered more positional nystagmus-free patients when compared to those submitted to more sessions of single maneuvers.
BibTeX: @article{Korn2007, author = {Korn, Gustavo Polacow and Dorigueto, Ricardo S and Ganança, Maurício Malavasi and Caovilla, Heloísa Helena}, title = {Epley's maneuver in the same session in benign positional paroxysmal vertigo.}, journal = {Brazilian journal of otorhinolaryngology}, year = {2007}, volume = {73}, issue = {4}, pages = {533--539}, keywords = {Case-Control Studies; Female; Head Movements; Humans; Male; Middle Aged; Nystagmus, Pathologic, therapy; Physical Therapy Modalities; Prospective Studies; Treatment Outcome; Vertigo, therapy}, pmid = {17923925} }
Wolf, M., Hertanu, T., Novikov, I. and Kronenberg, J.	Epley's manoeuvre for benign paroxysmal positional vertigo: a prospective study. [Abstract] [BibTeX]	1999	Clinical otolaryngology and allied sciences Vol. 24(1), pp. 43-46	article
Abstract: The treatment of benign paroxysmal positional vertigo (BPPV) by the Epley, canalith repositioning, manoeuvre was popularized following clinical reports which demonstrated a significant success rate. Benign paroxysmal positional vertigo is considered a self-limiting disease, yet only few authors have analysed the effect of this manoeuvre in randomized, controlled terms. A prospective 3-year, controlled study of patients with BPPV of long duration (mean = 6 months) verified its benefit: the recovery course differed significantly between a group of 31 patients treated with the manoeuvre and a control group of 10 untreated patients. Symptoms subsided within 72 h in 35% and within a week in 74% of patients after one session of treatment. Only two treated patients (6.5%) did not recover versus a 50% failure rate among untreated patients (P = 0.0005). The rate of recovery was not affected by the duration of symptoms before initiation of treatment, or by the patient's age and gender.
BibTeX: @article{Wolf1999a, author = {Wolf, M and Hertanu, T and Novikov, I and Kronenberg, J}, title = {Epley's manoeuvre for benign paroxysmal positional vertigo: a prospective study.}, journal = {Clinical otolaryngology and allied sciences}, year = {1999}, volume = {24}, issue = {1}, pages = {43--46}, keywords = {Female; Humans; Male; Middle Aged; Posture, physiology; Prospective Studies; Semicircular Canals; Time Factors; Vertigo, epidemiology, prevention & control, rehabilitation}, pmid = {10196647} }
Sundararajan, I., Rangachari, V., Sumathi, V. and Kumar, K.	Epley's manoeuvre versus Epley's manoeuvre plus labyrinthine sedative as management of benign paroxysmal positional vertigo: prospective, randomised study. [Abstract] [BibTeX]	2011	The Journal of laryngology and otology Vol. 125(6), pp. 572-575	article	DOI
Abstract: We report a prospective, randomised study of 51 patients with benign paroxysmal positional vertigo treated with Epley's manoeuvre alone or Epley's manoeuvre plus labyrinthine sedative, at Sundaram Medical Foundation, Chennai, India. To compare the efficacy of Epley's manoeuvre versus Epley's manoeuvre plus labyrinthine sedative in the treatment of benign paroxysmal positional vertigo. Consecutive patients were selected based on history and positive Dix-Hallpike test. Patients were randomised to receive either Epley's manoeuvre alone or Epley's manoeuvre plus labyrinthine sedative for one week. Both groups were followed up for four weeks. Univariate analysis showed that one- and four-week outcomes were influenced by the number of episodes, symptom duration and treatment type. Multivariate logistic regression analysis showed that the one-week outcome was significantly influenced by symptom duration and treatment type, while the four-week outcome was significantly influenced by symptom duration alone. Patients receiving Epley's manoeuvre alone showed better recovery than those receiving both Epley's manoeuvre and labyrinthine sedative. Labyrinthine sedatives do not aid recovery from benign paroxysmal positional vertigo when used in addition to Epley's manoeuvre.
BibTeX: @article{Sundararajan2011, author = {Sundararajan, I and Rangachari, V and Sumathi, V and Kumar, K}, title = {Epley's manoeuvre versus Epley's manoeuvre plus labyrinthine sedative as management of benign paroxysmal positional vertigo: prospective, randomised study.}, journal = {The Journal of laryngology and otology}, year = {2011}, volume = {125}, issue = {6}, pages = {572--575}, doi = {https://doi.org/10.1017/S0022215110002781}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo; Cinnarizine, therapeutic use; Combined Modality Therapy; Female; Histamine H1 Antagonists, therapeutic use; Humans; Male; Middle Aged; Multivariate Analysis; Patient Positioning, methods; Prospective Studies; Regression Analysis; Treatment Outcome; Vertigo, drug therapy, therapy}, pmid = {21269553} }
Mujeeb, M. and Khan, N.	Epley's manoeuvre: treatment of choice for benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2000	The Journal of laryngology and otology Vol. 114(11), pp. 844-847	article
Abstract: Benign paroxysmal positional vertigo (BPPV) is one of the commonest causes of peripheral vestibular disorders. In this prospective study 21 patients with BPPV were treated by Epley's manoeuvre. All patients had an immediate improvement in their symptoms. Recurrence was noted in three patients who required further treatment sessions with resultant improvement in all. However, one patient who originally had suffered from Ménière's disease involving the same ear for more than 14 years developed another recurrence which was treated successfully by further application of Epley's manoeuvre. This study supports the usefulness of Epley's manoeuvre for the treatment of BPPV.
BibTeX: @article{Mujeeb2000, author = {Mujeeb, M and Khan, N}, title = {Epley's manoeuvre: treatment of choice for benign paroxysmal positional vertigo.}, journal = {The Journal of laryngology and otology}, year = {2000}, volume = {114}, issue = {11}, pages = {844--847}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Child; Female; Head Movements; Humans; Male; Middle Aged; Posture; Prospective Studies; Recurrence; Rotation; Sex Distribution; Treatment Outcome; Vertigo, therapy}, pmid = {11144833} }
Halker, R.B., Barrs, D.M., Wellik, K.E., Wingerchuk, D.M. and Demaerschalk, B.M.	Establishing a diagnosis of benign paroxysmal positional vertigo through the dix-hallpike and side-lying maneuvers: a critically appraised topic. [Abstract] [BibTeX]	2008	The neurologist Vol. 14(3), pp. 201-204	article	DOI
Abstract: Many patients consult neurologists because of vertigo. Benign paroxysmal positional vertigo (BBPV) is one of the most common types of vertigo. Although the clinical presentation of this common condition is straightforward, the diagnosis and diagnostic maneuvers can be challenging. How useful is the Dix-Hallpike test in establishing the diagnosis of BPPV? How useful is an alternative positional test, such as the side-lying maneuver, in the diagnosis of BPPV? We addressed the question through development of a structured critically appraised topic. Participants included consultant and resident neurologists, clinical epidemiologists, medical librarian, and clinical content expert in the field of otolaryngology. Participants started with a clinical scenario and structured questions, devised search strategies, located and compiled the best evidence, performed critical appraisals, synthesized the results, summarized the evidence, provided commentary, and declared bottom-line conclusions. A single study comparing the Dix-Hallpike and side-lying tests was identified. For the Dix-Hallpike test, the estimated sensitivity was 79% [95% confidence interval (CI) 65-94], specificity was 75% (33-100), positive likelihood ratio (LR) was 3.17 (95% CI 0.58-17.50), negative LR was 0.28 (95% CI 0.11-0.69). For the side-lying test, the estimated sensitivity was 90% (95% CI 79-100), specificity was 75% (33-100), positive LR was 3.59 (95% CI 0.65-19.67), negative LR was 0.14 (95% CI 0.04-0.46). The study employed very weak methodology, and therefore the results had limited validity. The Dix-Hallpike test is the standard from which the diagnosis of posterior semicircular canal BPPV is made. Hence evaluations of its diagnostic test properties and utility are challenging. For patients unable to move into the Dix-Hallpike test positions, alternative tests such as the side-lying test can be attempted. These modifications, however, are rarely necessary.
BibTeX: @article{Halker2008, author = {Halker, Rashmi B and Barrs, David M and Wellik, Kay E and Wingerchuk, Dean M and Demaerschalk, Bart M}, title = {Establishing a diagnosis of benign paroxysmal positional vertigo through the dix-hallpike and side-lying maneuvers: a critically appraised topic.}, journal = {The neurologist}, year = {2008}, volume = {14}, issue = {3}, pages = {201--204}, doi = {https://doi.org/10.1097/NRL.0b013e31816f2820}, keywords = {Diagnosis, Differential; Evidence-Based Medicine; Humans; Male; Middle Aged; Nausea, diagnosis, etiology, physiopathology; Neurologic Examination, methods; Observer Variation; Postural Balance, physiology; Predictive Value of Tests; Semicircular Canals, physiopathology; Vertigo, diagnosis, etiology, physiopathology; Vestibule, Labyrinth, physiopathology}, pmid = {18469678} }
Yang, H., Gu, H., Sun, W., Li, Y., Wu, H., Burnee, M. and Zhuang, J.	Estradiol deficiency is a risk factor for idiopathic benign paroxysmal positional vertigo in postmenopausal female patients. [Abstract] [BibTeX]	2018	The Laryngoscope Vol. 128(4), pp. 948-953	article	DOI
Abstract: Although it is generally considered that benign paroxysmal positional vertigo (BPPV) is associated with changes in female sex hormone levels, no direct data have been reported until now. The purpose of this article was to provide direct data showing the distinct relationship between female sex hormone fluctuations and BPPV in postmenopausal female patients. Prospective analysis in humans and basic research in animals. Blood samples were analyzed to determine the levels of estradiol, progesterone, follicle-stimulating hormone, and luteinizing hormone in 50- to 80-year-old postmenopausal female patients newly diagnosed with idiopathic BPPV based on history compatible with BPPV and positive provocative maneuvers. Animal models of bilateral ovariectomy and female sex hormone replacement therapy were used to further confirm the relationship between BPPV and female sex hormone levels by determining the expression levels of otoconin 90, the protein suggested as essential in the dislocation of otoconia. Statistically significant differences between the estradiol level of BPPV patients and the control group were found (P < .001). Moreover, in bilateral ovariectomy in rats, 17β-estradiol replacement reversed the decrease of otoconin 90 levels. Our results suggest that estradiol deficiency may be an important risk factor for idiopathic benign paroxysmal positional vertigo in postmenopausal female patients. NA. Laryngoscope, 128:948-953, 2018.
BibTeX: @article{Yang2018b, author = {Yang, Hualan and Gu, Huanhuan and Sun, Wenjing and Li, Yanpeng and Wu, Huijuan and Burnee, Molorerdene and Zhuang, Jianhua}, title = {Estradiol deficiency is a risk factor for idiopathic benign paroxysmal positional vertigo in postmenopausal female patients.}, journal = {The Laryngoscope}, year = {2018}, volume = {128}, issue = {4}, pages = {948--953}, doi = {https://doi.org/10.1002/lary.26628}, keywords = {Aged; Aged, 80 and over; Animals; Benign Paroxysmal Positional Vertigo, blood, etiology; Disease Models, Animal; Estradiol, blood, deficiency; Female; Humans; Middle Aged; Ovariectomy, adverse effects; Postmenopause, blood; Prognosis; Prospective Studies; Rats; Rats, Sprague-Dawley; Risk Factors; Benign paroxysmal positional vertigo; estradiol; hormone replacement therapy; otoconin 90; ovariectomy; postmenopausal}, pmid = {28480516} }
Balatsouras, D.G., Kaberos, A., Assimakopoulos, D., Katotomichelakis, M., Economou, N.C. and Korres, S.G.	Etiology of vertigo in children. [Abstract] [BibTeX]	2007	International journal of pediatric otorhinolaryngology Vol. 71(3), pp. 487-494	article	DOI
Abstract: To detect the most common causes of vertigo in children. Fifty-four children (20 boys and 34 girls) aged 3-16 years, who presented with vertigo attacks during a 3-year period, were studied. A detailed medical history for vestibular symptoms and migraine was obtained from our patients or their parents. All patients underwent otolaryngologic, ophthalmologic and neurologic clinical evaluation. A detailed laboratory examination, including serologic tests for viral infections, was also obtained. Additionally, a complete audiological and neurotologic evaluation was performed. Computed tomography (CT) scans and magnetic resonance imaging (MRI) were obtained in selected cases. Viral infections, benign paroxysmal vertigo of childhood and migraine were the most common causes of vertigo accounting for approximately 65% of our patients. Otitis media, head trauma, benign paroxysmal positional vertigo, Meniere's disease and brain tumor were less common causes of vertigo. A peripheral type of vertigo was found in most cases. Diagnostic approach in vertigo in children should include a detailed history and clinical examination in conjunction with a test battery of audiological and neurotologic tests. When a central cause of vertigo is suspected an MRI or CT scan should be ordered.
BibTeX: @article{Balatsouras2007, author = {Balatsouras, Dimitrios G and Kaberos, Antonis and Assimakopoulos, Dimitrios and Katotomichelakis, Michael and Economou, Nicolas C and Korres, Stavros G}, title = {Etiology of vertigo in children.}, journal = {International journal of pediatric otorhinolaryngology}, year = {2007}, volume = {71}, issue = {3}, pages = {487--494}, doi = {https://doi.org/10.1016/j.ijporl.2006.11.024}, keywords = {Adolescent; Brain Injuries, complications, diagnostic imaging, pathology; Brain Neoplasms, complications, diagnostic imaging, pathology; Child; Child, Preschool; Electronystagmography; Female; Humans; Magnetic Resonance Imaging; Male; Otitis Media, complications; Severity of Illness Index; Tomography, X-Ray Computed; Vertigo, diagnosis, etiology, physiopathology; Virus Diseases, complications, virology}, pmid = {17204337} }
Bunasuwan, P., Bunbanjerdsuk, S. and Nilsuwan, A.	Etiology of vertigo in Thai patients at Thammasat Hospital. [Abstract] [BibTeX]	2011	Journal of the Medical Association of Thailand = Chotmaihet thangphaet Vol. 94 Suppl 7, pp. S102-S108	article
Abstract: The purpose of this research is to study the causes of vertigo in the patients at Otoneurology Clinic, Thammasat Hospital. The data of these patients, collected from the medical records between January 2010 and January 2011, were reviewed and analyzed. From one hundred and forty-nine cases, 49 cases (33%) were men and 100 cases (67%) were women, which yielded the male-to-female ratio of 1:2. The average age of patients was 55 year olds. The most common diagnostic category was peripheral vestibular disorders (80.5%). Other causes were central vestibular disorders (4.7%) and non-vestibular related (4%), whereas the remaining (10.1%) was undiagnosed. The causes of vertigo included benign paroxysmal positional vertigo: BPPV (53%), Meniere's disease (10.1%) and recurrent vestibulopathy (8.1%), while the underlying diseases found were diabetes mellitus (11.4%), hypertension (32.2%) and dyslipidemia (34.2%). In Otoneurology Clinic, Thammasat Hospital, the peripheral vestibular disorders was the main etiology of vertigo, while the three most common causes were BPPV Meniere's disease, and recurrent vestibulopathy respectively.
BibTeX: @article{Bunasuwan2011, author = {Bunasuwan, Parichat and Bunbanjerdsuk, Sacarin and Nilsuwan, Amornwan}, title = {Etiology of vertigo in Thai patients at Thammasat Hospital.}, journal = {Journal of the Medical Association of Thailand = Chotmaihet thangphaet}, year = {2011}, volume = {94 Suppl 7}, pages = {S102--S108}, keywords = {Adult; Aged; Aged, 80 and over; Female; Hospitals, University; Humans; Male; Middle Aged; Retrospective Studies; Thailand; Vertigo, diagnosis, etiology, therapy; Young Adult}, pmid = {22619915} }
Braschi, E., Ross, D. and Korownyk, C.	Evaluating the Epley maneuver. [BibTeX]	2015	Canadian family physician Medecin de famille canadien Vol. 61(10), pp. 878	article
BibTeX: @article{Braschi2015, author = {Braschi, Emélie and Ross, David and Korownyk, Christina}, title = {Evaluating the Epley maneuver.}, journal = {Canadian family physician Medecin de famille canadien}, year = {2015}, volume = {61}, issue = {10}, pages = {878}, keywords = {Benign Paroxysmal Positional Vertigo, therapy; Humans; Physical Therapy Modalities, standards; Randomized Controlled Trials as Topic; Treatment Outcome}, pmid = {26472794} }
Braschi, E., Ross, D. and Korownyk, C.	Evaluating the Epley maneuver. [BibTeX]	2015	Canadian family physician Medecin de famille canadien Vol. 61(9), pp. 779	article
BibTeX: @article{Braschi2015a, author = {Braschi, Emélie and Ross, David and Korownyk, Christina}, title = {Evaluating the Epley maneuver.}, journal = {Canadian family physician Medecin de famille canadien}, year = {2015}, volume = {61}, issue = {9}, pages = {779}, keywords = {Benign Paroxysmal Positional Vertigo, therapy; Humans; Physical Therapy Modalities; Randomized Controlled Trials as Topic; Treatment Outcome}, pmid = {26371102} }
Li, W., Feng, Y., Lu, W., Xie, X., Xiong, Z., Jing, Z., Cai, X. and Huang, L.	Evaluating the morphological changes of intracranial arteries and whole-brain perfusion in undetermined isolated vertigo. [Abstract] [BibTeX]	2016	Journal of the neurological sciences Vol. 370, pp. 70-77	article	DOI
Abstract: To determine the morphological changes of intracranial arteries and whole-brain perfusion in undetermined isolated vertigo (UIV) patients using 320-detector row computed tomography (CT). A total of 150 patients who underwent CT angiography (CTA) and CT perfusion (CTP) imaging were divided into UIV group and benign paroxysmal positional vertigo (BPPV) group. Sixty individuals with sex- and age-matched without vertigo and cerebral diseases served as the control. The morphological changes of intracranial arteries, perfusion parameters and vascular risk factors (VRFs) were analyzed, calculated and compared. In UIV patients, hypertension (HT), hyperlipidemia and number of VRFs≥3 occurred more commonly (P<0.0125, respectively). The incidence of vertebral artery dominance (VAD), vertebral artery stenosis (VAS) and basilar artery curvature (BAC) were significantly higher (P<0.0125, respectively). HT was an independent risk predictor of non-VAD (OR: 5.411, 95%CI: 1.401; 20.900, P=0.014). HT and VAD associated with BAC served as risk predictors (OR: 4.081, 95%CI: 1.056;15.775, P=0.041 and OR: 6.284, 95%CI: 1.848; 21.365, P=0.003, respectively). The absolute difference in relative values of CTP parameters from cerebellum and brainstem were significantly different (P<0.05), and hypoperfusion was found in the territories of the non-VAD side and the BAC cohort (P<0.05, respectively). On the basis of multiple VRFs, morphological changes of vertebrobasilar artery (VBA) and the unilateral hypoperfusion of the cerebellum and brainstem, that acts as a herald for IV occurrence, which should be paid cautious attention to UIV patients.
BibTeX: @article{Li2016, author = {Li, Wenxian and Feng, Youzhen and Lu, Weibiao and Xie, Xie and Xiong, Zhilin and Jing, Zhen and Cai, Xiangran and Huang, Li'an}, title = {Evaluating the morphological changes of intracranial arteries and whole-brain perfusion in undetermined isolated vertigo.}, journal = {Journal of the neurological sciences}, year = {2016}, volume = {370}, pages = {70--77}, doi = {https://doi.org/10.1016/j.jns.2016.09.024}, keywords = {320-detector row computed tomography; Cerebral perfusion; Morphological changes of intracranial arteries; Undetermined isolated vertigo; Vascular risk factors}, pmid = {27772791} }
Deniz, K., Akdeniz, S.S., Koç, A.Ö., Uçkan, S. and Ozluoğlu, L.N.	Evaluation of benign paroxysmal positional vertigo following Le Fort I osteotomy. [Abstract] [BibTeX]	2017	International journal of oral and maxillofacial surgery Vol. 46(3), pp. 309-313	article	DOI
Abstract: The Le Fort I osteotomy is widely used to correct dentofacial deformities. Benign paroxysmal positional vertigo (BPPV) is a common vestibular end organ disorder characterized by short, often recurrent episodes of vertigo. Head trauma is one of the known causes of BPPV. During pterygoid osteotomy, the surgical trauma induced by percussion with the surgical mallet and osteotomes can displace otoliths into the semicircular canal, resulting in BPPV. The aim of this study was to evaluate the potential risk of occurrence of BPPV in individuals undergoing Le Fort I osteotomy. Twenty-three patients were included in this study. The Dix-Hallpike manoeuvre, positional tests using electronystagmography, and vestibular evoked myogenic potential (VEMP) tests were performed 1 week before surgery (T0), 1 week after surgery (T1), and 1 month after surgery (T2). The results were compared statistically. BPPV was observed in three patients. Eleven patients had nystagmus at the T1 evaluation and seven at the T2 evaluation. The difference between the T0 and T1 time points was statistically significant (P=0.001). BPPV is a possible complication of Le Fort I osteotomy. Surgeons should be aware of this complication, and the diagnosis of BPPV should be considered in patients who have undergone Le Fort I osteotomy.
BibTeX: @article{Deniz2017, author = {Deniz, K and Akdeniz, S S and Koç, A Ö and Uçkan, S and Ozluoğlu, L N}, title = {Evaluation of benign paroxysmal positional vertigo following Le Fort I osteotomy.}, journal = {International journal of oral and maxillofacial surgery}, year = {2017}, volume = {46}, issue = {3}, pages = {309--313}, doi = {https://doi.org/10.1016/j.ijom.2016.10.007}, keywords = {Adolescent; Adult; Benign Paroxysmal Positional Vertigo, diagnosis; Craniofacial Abnormalities, surgery; Female; Humans; Male; Osteotomy, Le Fort; Postoperative Complications, diagnosis; Prospective Studies; Treatment Outcome; Turkey; Le Fort I; benign paroxysmal positional vertigo; orthognathic surgery; vertigo}, pmid = {27856148} }
Gökler, O., Koçak, İ., Aydoğan, E., Karanfil, I. and Baş, C.	Evaluation of Benign Paroxysmal Positional Vertigo in American Football Players. [Abstract] [BibTeX]	2018	The journal of international advanced otology Vol. 14(2), pp. 295-298	article	DOI
Abstract: The aim of this investigation was to evaluate the association between posterior channel benign paroxysmal positional vertigo (BPPV) and trauma that is frequently experienced by American football players. Participants were classified into the following two groups: (1) a study group consisting of 63 male participants aged 18-30 years who had been playing American football for more than 2 years and (2) a control group consisting of 49 male participants aged 18-27 years with no history of otologic/vestibular disease or acute/chronic trauma. Trauma, age, total duration of playing American football, and weekly training hours of subjects in the study group were analyzed to determine any relationship with BPPV occurrence. We performed otologic, audiologic, and vestibular assessments of pure sound audiometry, tympanometry, tandem walking test with eyes open and eyes closed, Romberg, head shaking, roll, and Dix-Hallpike tests to all participants. A positive correlation between the total years of American football played and posterior channel BPPV frequency was observed in the study group. In addition, increasing weekly hours of training was shown to further increase the risk of BPPV. A total of 16 out of 63 athletes experienced BPPV, whereas none of the participants in the control group experienced BPPV. All participants completed the Vertigo Symptom Scale, which revealed that vertigo did not cause any significant negative impact on their training routine and activities of daily living. Our results indicate that the weekly training hours and total years of training with American football increase posterior channel BPPV frequency.
BibTeX: @article{Goekler2018, author = {Gökler, Ozan and Koçak, İlker and Aydoğan, Esra and Karanfil, Işıl and Baş, Ceren}, title = {Evaluation of Benign Paroxysmal Positional Vertigo in American Football Players.}, journal = {The journal of international advanced otology}, year = {2018}, volume = {14}, issue = {2}, pages = {295--298}, doi = {https://doi.org/10.5152/iao.2018.4384}, pmid = {30256203} }
Yazıcı, A. and İnanç, Y.	Evaluation of BPPV with vertebral artery values. [Abstract] [BibTeX]	2018	Neuropsychiatric disease and treatment Vol. 14, pp. 1975-1979	article	DOI
Abstract: The aim of this study was to investigate the association between benign paroxysmal positional vertigo (BPPV) and vertebral artery (VA) flow rates and diameters by using Doppler ultrasonography in patients with BPPV. Additionally, we aimed to investigate the abnormalities of VA values obtained by extracranial color-coded duplex sonography in BPPV, which could be accepted as a precursor lesion for posterior cerebral ischemic stroke. Between September 2017 to February 2018, 50 patients diagnosed with BPPV were enrolled in this study. Otorhinolaryngology medical examination and medical history assessment were performed at the otorhinolaryngology clinic. Afterward, neurologic examination and ultrasonography of VAs was undertaken in the neurology clinic of University of Gaziantep Medical Faculty. The types of BPPV found were as follows: right posterior in 27 (54%), right lateral in 4 (8%), left posterior in 16 (32%), and left lateral in 3 (6%), respectively. The most common variables found in the BPPV were smoking (26%), hypertension (26%), and hyperlipidemia (22%). VA flow rates and diameters were found to be affected at the site of BPPV. These findings might suggest that BPPV could be related to an atherosclerotic milieu and may be a precursor clinical condition for future intracranial atherosclerotic diseases.
BibTeX: @article{Yazici2018, author = {Yazıcı, Alper and İnanç, Yusuf}, title = {Evaluation of BPPV with vertebral artery values.}, journal = {Neuropsychiatric disease and treatment}, year = {2018}, volume = {14}, pages = {1975--1979}, doi = {https://doi.org/10.2147/NDT.S169991}, keywords = {Doppler ultrasonography; atherosclerotic disease; benign paroxysmal positional vertigo; vertebral artery}, pmid = {30122930} }
Karataş, A., Yüce, T., Çebi, I.T., Acar Yüceant, G., Hacı, C. and Salviz, M.	Evaluation of Cervical Vestibular-Evoked Myogenic Potential Findings in Benign Paroxysmal Positional Vertigo. [Abstract] [BibTeX]	2016	The journal of international advanced otology Vol. 12(3), pp. 316-320	article	DOI
Abstract: Although there has been a wide consensus on the mechanism of nystagmus and clinical presentation of benign paroxysmal positional vertigo (BPPV), the neuroepithelial pathophysiology of BPPV still remains unclear. In this study, we aimed to clarify the pathophysiology of BPPV by evaluating the cervical vestibular-evoked myogenic potential (cVEMP) findings of patients. Thirty-six BPPV patients and 20 healthy volunteers were included. Bilateral cVEMP tests were performed on all participants. The participants were divided into the following three groups: those with a BPPV-affected ear, those with a BPPV-unaffected ear, and the healthy control group. There were no significant differences regarding the latencies of the first positive (p1) and negative (n1) peaks among the three groups. The mean normalized amplitude asymmetry ratio also did not differ between the BPPV and control groups. However, the normalized amplitudes of the BPPV patients (with both affected and unaffected ears) were significantly lower than those of the healthy control group. We detected that the cVEMP data of the affected and unaffected ears of the BPPV patients was similar and that their normalized amplitudes significantly differed from those of the healthy controls. Eventually, we concluded that even if the symptoms of BPPV were unilateral, the findings suggest that the bilateral involvement of the macular neuroepithelium is important in understanding the pathophysiology of BPPV. This finding supports the conclusion that the pathophysiological process starts with neuroepithelial membrane degeneration and continues with otoconia separation.
BibTeX: @article{Karatas2016, author = {Karataş, Abdullah and Yüce, Turgut and Çebi, Işıl Taylan and Acar Yüceant, Gülşah and Hacı, Cemal and Salviz, Mehti}, title = {Evaluation of Cervical Vestibular-Evoked Myogenic Potential Findings in Benign Paroxysmal Positional Vertigo.}, journal = {The journal of international advanced otology}, year = {2016}, volume = {12}, issue = {3}, pages = {316--320}, doi = {https://doi.org/10.5152/iao.2016.2170}, keywords = {Adult; Benign Paroxysmal Positional Vertigo, physiopathology; Case-Control Studies; Female; Humans; Male; Middle Aged; Nystagmus, Physiologic, physiology; Reaction Time, physiology; Vestibular Evoked Myogenic Potentials, physiology; Young Adult}, pmid = {28031157} }
L'Heureux-Lebeau, B., Godbout, A., Berbiche, D. and Saliba, I.	Evaluation of paraclinical tests in the diagnosis of cervicogenic dizziness. [Abstract] [BibTeX]	2014	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 35(10), pp. 1858-1865	article	DOI
Abstract: To assess the utility of the paraclinical tests in patients presenting with clinical diagnosis of cervicogenic dizziness. Case controlled. Otolaryngology clinic of a tertiary referral hospital center. Twenty-five subjects with cervicogenic dizziness and 25 subjects with benign paroxysmal positional vertigo. Symptoms description, Dizziness Handicap Inventory-short form (DHI), Trait anxiety score, cervical joint position error, the smooth pursuit neck torsion and cervical torsion tests on videonystagmography, and standing balance test (timed 10-meter walk with head turns). The results showed differences in reported symptoms, in mean cervical joint position error (p = 0.001), and cervical torsion test (p = 0.001) between the two groups. There was no between-group difference for DHI scores (p = 0.137), trait anxiety scores (p = 0.240), and walking test: time (p = 0.797), steps (p = 0.963). The Youden index is 0.60 for the predictive value of the cervical joint position error, and the smooth pursuit and the cervical torsion tests. This study showed differences in sensorimotor disturbances between the two groups, particularly in the control of head and eye movements and cervical proprioception. Patients with cervicogenic dizziness were more likely to (1) have a sensation of drunkenness and lightheadedness, (2) have pain induced during the physical examination of the upper cervical vertebrae, (3) have an elevated joint position error of 4.5 degrees during the cervical relocation test, and (4) exhibit more than 2 degrees per second nystagmus during the cervical rotation test. The walking test was not able to differentiate the two groups.
BibTeX: @article{LHeureux-Lebeau2014, author = {L'Heureux-Lebeau, Bénédicte and Godbout, Alain and Berbiche, Djamal and Saliba, Issam}, title = {Evaluation of paraclinical tests in the diagnosis of cervicogenic dizziness.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2014}, volume = {35}, issue = {10}, pages = {1858--1865}, doi = {https://doi.org/10.1097/MAO.0000000000000506}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, diagnosis; Diagnosis, Differential; Dizziness, diagnosis, etiology, physiopathology; Eye Movements, physiology; Female; Humans; Male; Middle Aged; Neck Pain, complications, diagnosis; Nystagmus, Pathologic, etiology; Postural Balance, physiology; Proprioception, physiology; Sensitivity and Specificity; Vestibular Function Tests, methods; Young Adult}, pmid = {25058834} }
Socher, D.D., Socher, J.A. and Azzi, V.J.B.	Evaluation of quality of life pre- and post-vestibular rehabilitation in patients with benign paroxysmal positional vertigo associated with Meniere's disease. [Abstract] [BibTeX]	2012	International archives of otorhinolaryngology Vol. 16(4), pp. 430-436	article	DOI
Abstract: Vertigo is a symptom that impacts the patients' quality of life and may force them to cease performing activities of daily living. Here, we discuss benign paroxysmal positional vertigo (BPPV) and Meniere's disease (MD), which show exacerbated symptoms when they appear in association. Vestibular rehabilitation (VR) is an effective treatment in reducing vertigo, especially in conjunction with other therapies. To evaluate the quality of life of patients with BPPV and MD before and after VR. We conducted a descriptive observational qualitative and quantitative case study with 12 patients aged 35 to 86 years. All patients diagnosed with BPPV and MD received treatment in the ENT clinic. The Brazilian DHI questionnaire, which assesses the quality of life with a focus on physical, emotional, and functional aspects, was used for data collection, and was completed by patients before the first session and after the fifth session of VR. Data were tested using the Shapiro-Wilk normality test, followed by Wilcoxon, Friedman, and Spearman correlation tests (p < 0.05). There were significant improvements in scores for all aspects, with median changes ranging from 12 to 0 in the physical, 6 to 1 in the emotional, and 11 to 1 in the functional aspect. There were no correlations between the scores and sample characteristics. VR was an effective method for the treatment of patients with BPPV and MD; it improves quality of life and shows the maximal influence on physical aspect scores, regardless of age or gender.
BibTeX: @article{Socher2012, author = {Socher, Dayra Dill and Socher, Jan Alessandro and Azzi, Viviane Jacintha Bolfe}, title = {Evaluation of quality of life pre- and post-vestibular rehabilitation in patients with benign paroxysmal positional vertigo associated with Meniere's disease.}, journal = {International archives of otorhinolaryngology}, year = {2012}, volume = {16}, issue = {4}, pages = {430--436}, doi = {https://doi.org/10.7162/S1809-97772012000400002}, keywords = {meniere disease; quality of life; rehabilitation; vertigo}, pmid = {25991970} }
Sugita-Kitajima, A., Azuma, M., Hattori, K. and Koizuka, I.	Evaluation of the otolith function using sinusoidal off-vertical axis rotation in patients with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2007	Neuroscience letters Vol. 422(1), pp. 81-86	article	DOI
Abstract: The vestibulo-ocular reflex (VOR) was studied via sinusoidal off-vertical axis rotation (OVAR) to evaluate the otolith function in patients with benign paroxysmal positional vertigo (BPPV). Subjects were sinusoidally rotated with eyes open in complete darkness at frequencies of 0.4 and 0.8 Hz with a maximum angular velocity of 60 degrees s(-1) in earth-vertical axis rotation (EVAR) and OVAR. Twenty-three controls and 24 BPPV patients were investigated. Results showed that VOR gain during OVAR at 0.8 Hz in a 30 degrees nose-up position in BPPV patients was significantly less than the gain during EVAR, whereas the gain was not significantly different between EVAR and OVAR in the controls in each condition. In addition, to examine each type of BPPV, we also investigated whether there were any differences between the patients who suffered from dizziness and those who did not. VOR gain in OVAR of BPPV patients who were suffering from dizziness was significantly less than that of BPPV patients without dizziness. Not only cupulolithiasis or canalolithiasis, but also otolith dysfunction was considered to be the possible origin of BPPV. Because sinusoidal OVAR produced minimal nausea compared to constant velocity OVAR, the stimulation of 0.8 Hz nose-up in sinusoidal OVAR may be used to evaluate otolith function without discomfort for patients.
BibTeX: @article{Sugita-Kitajima2007, author = {Sugita-Kitajima, Akemi and Azuma, Miki and Hattori, Kosuke and Koizuka, Izumi}, title = {Evaluation of the otolith function using sinusoidal off-vertical axis rotation in patients with benign paroxysmal positional vertigo.}, journal = {Neuroscience letters}, year = {2007}, volume = {422}, issue = {1}, pages = {81--86}, doi = {https://doi.org/10.1016/j.neulet.2007.06.007}, keywords = {Adult; Dizziness, physiopathology; Female; Humans; Male; Otolithic Membrane, physiopathology; Physical Stimulation; Reflex, Vestibulo-Ocular, physiology; Rotation; Vertigo, physiopathology}, pmid = {17597299} }
Pierchała, K., Lachowska, M., Wysocki, J., Morawski, K. and Niemczyk, K.	Evaluation of the Sensory Organization Test to differentiate non-fallers from single- and multi-fallers. [Abstract] [BibTeX]	2018	Advances in clinical and experimental medicine : official organ Wroclaw Medical University	article	DOI
Abstract: Among the elderly, instability leading to falls (and consequences of them) is one of the most important problems. The etiology of falls is usually complex, but balance, posture and gait problems are considered to be the most important risk factors. The objective of this study was to assess the usefulness of the Sensory Organization Test (SOT) in differentiating multi-fallers from single-fallers. The studied group included 92 patients aged >60 years with balance disorders and falls in their history. The patients were divided into 2 groups: multi-fallers and single-fallers. The control group (non-fallers) included 21 individuals. The SOT was performed on the 1st day (SOT1) and on the last day (SOT2) of rehabilitation. Mean equilibrium score (ES) of 1-3 and 4-6 sensory conditions and composite score (CS) of the SOT1 and SOT2 were analyzed. The falls were analyzed as a total number of falls while performing SOT and a number of falls in all 3 repetitions of both conditions 5 and 6 separately. In SOT conditions 1-4 there were no falls observed. The importance of SOT to differentiate fallers from non-fallers and single-fallers from multi-fallers is ambiguous. The SOT may or may not indicate the differences between the groups - it does not fully explain those differences. It shows only postural dysfunction without indicating any localization in particular part of vestibular organ. The basic diagnostic evaluation in the elderly with a proneness to falls should include clinical examination and the Dix-Hallpike maneuver, supplemented with a videonystagmography (VNG), which would assess the structure of damage in vestibular organ. Posturography is of less validity in the differentiation of fallers from non-fallers.
BibTeX: @article{Pierchala2018, author = {Pierchała, Katarzyna and Lachowska, Magdalena and Wysocki, Jarosław and Morawski, Krzysztof and Niemczyk, Kazimierz}, title = {Evaluation of the Sensory Organization Test to differentiate non-fallers from single- and multi-fallers.}, journal = {Advances in clinical and experimental medicine : official organ Wroclaw Medical University}, year = {2018}, doi = {https://doi.org/10.17219/acem/76374}, keywords = {benign paroxysmal positional vertigo (BPPV); dizziness; gait; inner ear; posture}, pmid = {30058785} }
Xu, H., Liang, F.-y., Chen, L., Song, X.-c., Tong, M.C.F., Thong, J.F., Zhang, Q.-q. and Sun, Y.	Evaluation of the utricular and saccular function using oVEMPs and cVEMPs in BPPV patients. [Abstract] [BibTeX]	2016	Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale Vol. 45, pp. 12	article	DOI
Abstract: It is well-known that ocular vestibular evoked myogenic potentials (oVEMPs) predominantly reflect utricular function whilst cervical vestibular evoked myogenic potentials (cVEMPs) reflect saccular function. To date, there are no published reports on the systemic evaluation of utricular and saccular function in benign paroxysmal positional vertigo (BPPV), nor are there any reports on the differences in VEMPs between patients with recurrent and non-recurrent BPPV. The aim of this study was to evaluate the difference in cervical and ocular (c/o)VEMPs between patients with BPPV and normal controls, as well as between patients with recurrent and non-recurrent BPPV. Thirty patients with posterior canal BPPV and 30 healthy subjects (as normal controls) were prospectively enrolled. cVEMP and oVEMP testing using 500 Hz tone-burst stimuli were performed on all. VEMP tests were repeated 3 times on each subject to ensure reliability and reproducibility of responses. VEMPs were defined as present or absent. Abnormal VEMP was defined by lack of VEMP response. In the control group, abnormal cVEMPs responses were detected in 6.67% and abnormal oVEMPs responses were detected in 3.34%. In BPPV patients (10 with recurrent BPPV, 20 with non-recurrent BPPV), abnormal cVEMPs responses were detected in 30% and abnormal oVEMPs responses were detected in 56.7%. More patients with BPPV showed abnormal responses in c/oVEMPs as compared to the control group (p < 0.05). oVEMPs was more often abnormal as compared to cVEMPs in BPPV patients (p < 0.05). There was no statistical difference between abnormal cVEMP responses in non-recurrent BPPV patients (25%) and recurrent BPPV patients (40%) (p > 0.05). Differences in abnormal oVEMP responses (non-recurrent BPPV, 40%; recurrent BPPV, 90%) were significant (p < 0.05). An increased occurrence of abnormal c/oVEMP recordings appeared in BPPV patients, possibly as a result of degeneration of the otolith macula. oVEMPs were more often abnormal in BPPV patients as compared to cVEMPs, suggesting that utricular dysfunction may be more common than saccular dysfunction. Furthermore, oVEMP abnormalities in the recurrent BPPV group were significantly higher than those in the non-recurrent BPPV group. Assessment of c/oVEMPs in BPPV patients may therefore be of prognostic value in predicting likelihood of BPPV recurrence.
BibTeX: @article{Xu2016a, author = {Xu, Hui and Liang, Fa-ya and Chen, Liang and Song, Xi-cheng and Tong, Michael Chi Fai and Thong, Jiun Fong and Zhang, Qing-quan and Sun, Yan}, title = {Evaluation of the utricular and saccular function using oVEMPs and cVEMPs in BPPV patients.}, journal = {Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale}, year = {2016}, volume = {45}, pages = {12}, doi = {https://doi.org/10.1186/s40463-016-0125-7}, keywords = {Adult; Benign Paroxysmal Positional Vertigo, diagnosis, physiopathology; Female; Follow-Up Studies; Humans; Male; Middle Aged; Prospective Studies; Reproducibility of Results; Saccule and Utricle, physiopathology; Severity of Illness Index; Time Factors; Vestibular Evoked Myogenic Potentials, physiology}, pmid = {26857819} }
Iida, M., Igarashi, M., Naitoh, A., Ishida, K., Endo, K., Nomura, K. and Sakai, M.	Evaluation of the vertical semicircular canal function by the pendular rotation test: a study on patients with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	1997	ORL; journal for oto-rhino-laryngology and its related specialties Vol. 59(5), pp. 269-271	article	DOI
Abstract: The pendular rotation test (non-damped) in a head-tilted position, 60 degrees backward and then rotated 45 degrees either to the right or left, was performed in 6 patients with benign paroxysmal positional vertigo. The stimulus mode was amplitude = 360 degrees, frequency = 0.1 Hz, and the maximal speed = 114 degrees/s. By this test procedure, it was possible to evaluate the excitability of vertical semicircular canals. Using an infra-red CCD camera and a personal computer system, the evoked nystagmus was analysed. A statistically significant difference (p < 0.05) in the maximal slow-phase eye velocity of vertical nystagmus was found between those from the anterior semicircular canal and those from the posterior semicircular canal. The excitability of the posterior semicircular canal in the affected ear was found to be lower than that of the anterior semicircular canal.
BibTeX: @article{Iida1997, author = {Iida, M and Igarashi, M and Naitoh, A and Ishida, K and Endo, K and Nomura, K and Sakai, M}, title = {Evaluation of the vertical semicircular canal function by the pendular rotation test: a study on patients with benign paroxysmal positional vertigo.}, journal = {ORL; journal for oto-rhino-laryngology and its related specialties}, year = {1997}, volume = {59}, issue = {5}, pages = {269--271}, doi = {https://doi.org/10.1159/000276951}, keywords = {Adult; Aged; Female; Head; Humans; Male; Middle Aged; Movement; Nystagmus, Pathologic, diagnosis, physiopathology; Semicircular Canals, physiopathology; Vertigo, diagnosis, physiopathology; Non-programmatic}, pmid = {9279865} }
Zhang, D., Zhang, S., Zhang, H., Xu, Y., Fu, S., Yu, M. and Ji, P.	Evaluation of vertebrobasilar artery changes in patients with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2013	Neuroreport Vol. 24(13), pp. 741-745	article	DOI
Abstract: The aim of this study was to investigate vertebrobasilar artery (VBA) lesions in elderly patients with benign paroxysmal positional vertigo (BPPV) by magnetic resonance angiography. VBA lesions in patients older than 65 years of age with BPPV were prospectively investigated by magnetic resonance angiography. Vascular risk factors, blood vessel changes, and vertigo severity were recorded. Age-matched individuals without BPPV were included in the control group. Of 126 patients screened for this study, 104 were included. Relevant comorbidities included diabetes (12 patients), hypertension (23 patients), and dyslipidemia (20 patients). Findings included left or right vertebral artery (VA) stenosis or occlusion (22 patients, 21.2%), VA tortuosity (25 patients, 24.0%), VA dominance (20 patients, 19.2%), basilar artery (BA) stenosis or occlusion (nine patients, 8.6%), and BA tortuosity (12 patients, 11.5%). These abnormal vessels differed between BPPV patients and the control group (all P<0.05). The severity of Vertigo did not differ between the abnormal VA and abnormal BA groups (P>0.05), but did differ between the normal group and the abnormal VA or BA group (P<0.05). Vertigo severity correlated with VA stenosis or occlusion, VA dominance, and unilateral or bilateral VA tortuosity. VBA tortuosity and VA dominance were common in BPPV patients and may contribute toward BPPV.
BibTeX: @article{Zhang2013, author = {Zhang, Daopei and Zhang, Shuling and Zhang, Hongtao and Xu, Yuming and Fu, Shengqi and Yu, Meng and Ji, Peng}, title = {Evaluation of vertebrobasilar artery changes in patients with benign paroxysmal positional vertigo.}, journal = {Neuroreport}, year = {2013}, volume = {24}, issue = {13}, pages = {741--745}, doi = {https://doi.org/10.1097/WNR.0b013e328364b948}, keywords = {Aged; Aged, 80 and over; Basilar Artery, pathology, physiopathology; Comorbidity; Female; Humans; Image Processing, Computer-Assisted; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Male; Middle Aged; Prospective Studies; Vertebral Artery, pathology, physiopathology; Vertebrobasilar Insufficiency, complications, diagnosis, pathology, physiopathology; Vertigo, diagnosis, etiology, pathology}, pmid = {23903461} }
Iida, M., Naitoh, A., Aihara, H., Takahashi, H., Hitouji, K. and Nomura, K.	Evaluation of vertical semicircular canal function by the caloric test--a study on patients with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	1998	The Tokai journal of experimental and clinical medicine Vol. 23(5), pp. 231-234	article
Abstract: The morbidity of benign paroxysmal positional vertigo (BPPV) was investigated from the functional standpoint by analyzing nystagmus elicited by the caloric test. As a result of an investigation of the three (horizontal, vertical and torsional) components of the nystagmus elicited by the caloric stimulus (cold water), the vertical nystagmus differed in direction between the left and the right ear in 3 out of the 4 BPPV cases. The vertical nystagmus elicited by the caloric stimulus reflected the functions of the anterior and posterior semicircular canals, and investigation of the difference in function between the anterior and posterior semicircular canal from the direction of the vertical nystagmus appeared to be feasible.
BibTeX: @article{Iida1998, author = {Iida, M and Naitoh, A and Aihara, H and Takahashi, H and Hitouji, K and Nomura, K}, title = {Evaluation of vertical semicircular canal function by the caloric test--a study on patients with benign paroxysmal positional vertigo.}, journal = {The Tokai journal of experimental and clinical medicine}, year = {1998}, volume = {23}, issue = {5}, pages = {231--234}, keywords = {Adult; Aged; Caloric Tests, methods; Evaluation Studies as Topic; Female; Humans; Male; Middle Aged; Nystagmus, Physiologic; Semicircular Canals, physiopathology; Vertigo, physiopathology}, pmid = {10418726} }
Eryaman, E., Oz, I.D., Ozker, B.Y., Erbek, S. and Erbek, S.S.	Evaluation of vestibular evoked myogenic potentials during benign paroxysmal positional vertigo attacks; neuroepithelial degeneration? [Abstract] [BibTeX]	2012	B-ENT Vol. 8(4), pp. 247-250	article
Abstract: Recent studies show that benign paroxysmal positional vertigo (BPPV) may also affect the macula of the saccule. We investigated vestibular evoked myogenic potential (VEMP) results in patients with BPPV. The study group included 31 patients (31 ears) diagnosed with posterior canal BPPV and the control group included 23 healthy volunteers (46 ears) with no neurotologic symptoms. After VEMP recordings were performed, mean latency values for p13 of the study and control groups were compared. VEMP responses were elicited in all controls (46 ears). In the study group, responses were normal in 19, delayed in 5, and absent in 7 ears. There was a significant difference between abnormal VEMP rates for patients versus controls (p < 0.001). Although VEMP responses were elicited in all non-affected ears of patients, there was a delayed response in 6 (19%) non-affected ears. This was statistically significant when compared with controls (p = 0.002). There was no correlation between abnormal VEMPs and the number of canalith reposition maneuvers required (p = 0.392). Our findings suggest the prolongation of mean latency values for p13 of VEMP in patients with BPPV might signify neuronal degeneration in the macula of the saccule, and the absence of VEMP waves might represent the extent of damage. Also, high latency values for p13 in non-affected ears of patients might indicate bilateral neural degeneration in BPPV.
BibTeX: @article{Eryaman2012, author = {Eryaman, E and Oz, I D and Ozker, B Y and Erbek, S and Erbek, S S}, title = {Evaluation of vestibular evoked myogenic potentials during benign paroxysmal positional vertigo attacks; neuroepithelial degeneration?}, journal = {B-ENT}, year = {2012}, volume = {8}, issue = {4}, pages = {247--250}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo; Female; Humans; Male; Middle Aged; Neuroepithelial Cells, pathology; Reaction Time; Saccule and Utricle, pathology; Vertigo, physiopathology; Vestibular Evoked Myogenic Potentials}, pmid = {23409551} }
Karanjai, S. and Saha, A.K.	Evaluation of vestibular exercises in the management of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2010	Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India Vol. 62(2), pp. 202-207	article	DOI
Abstract: (1) To evaluate the role of vestibular exercises in the management of benign paroxysmal positional vertigo (BPPV). (2) To compare the three vestibular exercises (Semont's manoeuvre, Epley's manoeuvre or Brandt-Daroff exercises) in the treatment of BPPV. Prospective randomised study Fourty-eight patients diagnosed as BPPV in the study period November 2005-2006 were included in the study. They were randomly assigned to one of three groups, and the corresponding manoeuvre was done on them. Follow-up were at 2 weeks and 3 months. Thirty-five of the 48 patients (72.91%) reported relief of symptoms at 2 weeks and no recurrence of symptoms at 3 months. Result was best for the group which was subjected to the Epley manoeuvre (87.5%). Performance of any of the three manoeuvres can be expected to give good results in the management of BPPV. The Epley manoeuvre appears to be better than the other two in terms of relief of symptoms and prevention of recurrence.
BibTeX: @article{Karanjai2010, author = {Karanjai, Subhadeep and Saha, Asok K}, title = {Evaluation of vestibular exercises in the management of benign paroxysmal positional vertigo.}, journal = {Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India}, year = {2010}, volume = {62}, issue = {2}, pages = {202--207}, doi = {https://doi.org/10.1007/s12070-010-0036-2}, keywords = {BPPV; Brandt-Daroff exercises; Particle repositioning manoeuvre; Semont’s manoeuvre; Vertigo}, pmid = {23120716} }
Uneri, A. and Turkdogan, D.	Evaluation of vestibular functions in children with vertigo attacks. [Abstract] [BibTeX]	2003	Archives of disease in childhood Vol. 88(6), pp. 510-511	article
Abstract: To examine vestibular system functions in children with episodic vertigo attacks. Thirty four children (20 males) aged 4-18 years with paroxysmal dizziness and/or vertigo attacks were evaluated. A medical history for vestibular symptoms and migraine was taken. Vestibular and auditory functions were assessed. Chronic headache attacks consistent with migraine were reported in 12 children and motion sickness was reported in 30. Family history in first degree relatives was positive for migraine in 29 children and for episodic vertigo in 22. Electronystagmography and videonystagmography showed two types of nystagmus: spontaneous vestibular nystagmus (41%) and benign paroxysmal positional nystagmus (BPPN) (59%). The first type of nystagmus was assessed as a sign of vestibulopathy and the patients with BPPN were diagnosed as having benign paroxysmal positional vertigo (BPPV). Audiometric examination in four cases revealed bilateral sensory neural hearing loss in low frequencies. Pure tone averages in 30 cases were within normal ranges; however low frequencies in 28 of them were approximately 10 dB lower than high frequencies. Unilateral caloric responses diminished in eight children. Peripheral vestibular problems in childhood present in a wide spectrum, which varies from a short episode of dizziness to a typical vestibular attack with fluctuating sensory neural hearing loss or episodes of BPPV. A considerable number of these vestibular problems might be related to the migraine syndrome.
BibTeX: @article{Uneri2003, author = {Uneri, A and Turkdogan, D}, title = {Evaluation of vestibular functions in children with vertigo attacks.}, journal = {Archives of disease in childhood}, year = {2003}, volume = {88}, issue = {6}, pages = {510--511}, keywords = {Adolescent; Child; Child, Preschool; Dizziness, etiology; Female; Follow-Up Studies; Humans; Male; Migraine Disorders, complications, genetics; Nystagmus, Pathologic, complications; Vertigo, etiology; Vestibular Diseases, complications}, pmid = {12765917} }
Gacek, R.R.	Evidence for a viral neuropathy in recurrent vertigo. [Abstract] [BibTeX]	2008	ORL; journal for oto-rhino-laryngology and its related specialties Vol. 70(1), pp. 6-14; discussion 14-5	article	DOI
Abstract: The concept that reactivation of latent neurotropic viruses (i.e. Herpesviridae group) in the vestibular ganglion is responsible for recurrent vestibulopathies is presented. A similar histopathologic degeneration of vestibular ganglion cells in vestibular neuronitis (VN), Ménière's disease and benign paroxysmal positional vertigo is presented to support this concept. The clinical response (relief of vertigo) to the administration of antiviral medication in these syndromes provides practical evidence of a viral neuropathy in patients with recurrent vertigo. Relief of vertigo after this treatment was 90% in VN, Ménière's disease and VN. The relief of positional vertigo (benign paroxysmal positional vertigo) was 66%.
BibTeX: @article{Gacek2008, author = {Gacek, Richard R}, title = {Evidence for a viral neuropathy in recurrent vertigo.}, journal = {ORL; journal for oto-rhino-laryngology and its related specialties}, year = {2008}, volume = {70}, issue = {1}, pages = {6--14; discussion 14-5}, doi = {https://doi.org/10.1159/000111042}, keywords = {Adult; Aged; Biopsy, Needle; Evidence-Based Medicine; Female; Humans; Immunohistochemistry; Male; Middle Aged; Prognosis; Recurrence; Risk Assessment; Sensitivity and Specificity; Severity of Illness Index; Vertigo, physiopathology, virology; Vestibular Function Tests; Vestibular Nerve, physiopathology, virology; Vestibular Neuronitis, pathology, virology}, pmid = {18235200} }
Lloyd, M., Mackintosh, A., Grant, C., McManus, F., Kelly, A.-M., Karunajeewa, H. and Tang, C.Y.	Evidence-based management of patients with vertigo, dizziness, and imbalance at an Australian metropolitan health service: an observational study of clinical practice. [Abstract] [BibTeX]	2018	Physiotherapy theory and practice, pp. 1-8	article	DOI
Abstract: To determine whether patients presenting to the emergency department (ED) with possible benign paroxysmal positional vertigo (BPPV) are managed in accordance with best practice guidelines, and whether physiotherapists are involved in their care. Retrospective observational study. Ninety-six consecutive patients presenting to one of three EDs with vertigo, dizziness or imbalance symptoms documented at triage. Individuals with a clear non-vestibular cause of symptoms were excluded. Proportional adherence to clinical practice guidelines by medical and physiotherapy clinicians, primary diagnosis, incidence of falls, admission to hospital, and referral to a physiotherapy service. Adherence to clinical practice guidelines by both professions was low, with only 25 (26%, 95% CI: 18-36%) and 3 (14%, 95% CI: 4-36%) patients assessed by a medical clinician or physiotherapist, respectively, receiving the gold-standard Dix-Hallpike test. Sixty-four (67%) individuals were given a diagnosis of undifferentiated dizziness. Of the 26 (27%) patients with a primary BPPV diagnosis, only three (12%) were treated with a canalith-repositioning technique, and four (15%) reviewed by a physiotherapist. Adherence to best-practice guidelines for the management of BPPV in individuals presenting to the ED is low, and physiotherapists are seldom involved in their management.
BibTeX: @article{Lloyd2018, author = {Lloyd, Melanie and Mackintosh, Alexandra and Grant, Catherine and McManus, Fiona and Kelly, Anne-Maree and Karunajeewa, Harin and Tang, Clarice Y}, title = {Evidence-based management of patients with vertigo, dizziness, and imbalance at an Australian metropolitan health service: an observational study of clinical practice.}, journal = {Physiotherapy theory and practice}, year = {2018}, pages = {1--8}, doi = {https://doi.org/10.1080/09593985.2018.1511020}, keywords = {Benign paroxysmal positional vertigo; Dizziness; Emergency Department; Physiotherapy}, pmid = {30332324} }
Wahlgren, A. and Palombaro, K.	Evidence-based physical therapy for BPPV using the International Classification of Functioning, Disability and Health model: a case report. [Abstract] [BibTeX]	2012	Journal of geriatric physical therapy (2001) Vol. 35(4), pp. 200-205	article	DOI
Abstract: The model provided by the World Health Organization's International Classification of Functioning, Disability, and Health (ICF) was created to describe, classify, and measure function in both health care practice and research. This model has not been applied to management of many physical therapy cases, limiting its implementation conceptually into practice as a whole. The purpose of this case report is to illustrate the use of the ICF model in the evidence-based management of posterior canal benign paroxysmal positional vertigo. One patient with acute posterior canal canalithiasis benign paroxysmal positional vertigo was treated using the evidence-based clinical practice guideline for the diagnosis as well as the ICF framework. Repositioning maneuvers and education were provided to ameliorate the relevant body structure and function impairments, activity limitations, and contextual factors related to the patient's overall functioning and disability. The patient demonstrated complete abolishment of her symptoms, both objectively and subjectively after 3 sessions over 4 weeks of care. The physical therapy community has adopted the framework of the ICF because this model has been found to be effective in illustrating the impact of a patient's functional impairments in terms of activity limitations as well as the role that personal and environmental factors play in the patient's overall functioning and disability. When using the ICF in tandem with evidence-based care, patient outcomes have the capability to improve at an even greater rate; however, further research should be completed to discover this potential effect with appropriately designed clinical trials.
BibTeX: @article{Wahlgren2012, author = {Wahlgren, Amy and Palombaro, Kerstin}, title = {Evidence-based physical therapy for BPPV using the International Classification of Functioning, Disability and Health model: a case report.}, journal = {Journal of geriatric physical therapy (2001)}, year = {2012}, volume = {35}, issue = {4}, pages = {200--205}, doi = {https://doi.org/10.1519/JPT.0b013e318247a243}, keywords = {Aged; Benign Paroxysmal Positional Vertigo; Evidence-Based Medicine; Humans; Physical Therapy Modalities; Vertigo, rehabilitation}, pmid = {22411081} }
Nguyen-Huynh, A.T.	Evidence-based practice: management of vertigo. [Abstract] [BibTeX]	2012	Otolaryngologic clinics of North America Vol. 45(5), pp. 925-940	article	DOI
Abstract: The article focuses on the evidence basis for the management of benign paroxysmal positional vertigo, the most common diagnosis of vertigo in both primary care and subspecialty settings. An overview is presented, along with evidence-based clinical assessment, diagnosis, and management. Summaries of differential diagnosis of vertigo and outcomes are presented.
BibTeX: @article{Nguyen-Huynh2012, author = {Nguyen-Huynh, Anh T}, title = {Evidence-based practice: management of vertigo.}, journal = {Otolaryngologic clinics of North America}, year = {2012}, volume = {45}, issue = {5}, pages = {925--940}, doi = {https://doi.org/10.1016/j.otc.2012.06.001}, keywords = {Benign Paroxysmal Positional Vertigo; Denervation, methods; Diagnosis, Differential; Disease Management; Evidence-Based Practice; Humans; Patient Positioning, methods; Remission, Spontaneous; Semicircular Canals, innervation, pathology, surgery; Therapeutic Occlusion, methods; Treatment Outcome; Vertigo, diagnosis, physiopathology, therapy; Vestibular Function Tests, methods}, pmid = {22980676} }
Troost, B.T. and Patton, J.M.	Exercise therapy for positional vertigo. [Abstract] [BibTeX]	1992	Neurology Vol. 42(8), pp. 1441-1444	article
Abstract: We present a common cause of vertigo, benign positional paroxysmal vertigo (BPPV), and its history, diagnosis, and therapy. BPPV is suggested by history, readily diagnosed by office examination, and cured by appropriate exercise therapy. Since the condition is so common and often unrecognized, physicians are encouraged to consider BPPV as a possible cause of treatable dizziness.
BibTeX: @article{Troost1992, author = {Troost, B T and Patton, J M}, title = {Exercise therapy for positional vertigo.}, journal = {Neurology}, year = {1992}, volume = {42}, issue = {8}, pages = {1441--1444}, keywords = {Exercise Therapy; Humans; Physical Examination; Posture; Vertigo, diagnosis, etiology, therapy}, pmid = {1641134} }
Norré, M.E. and Beckers, A.	Exercise treatment for paroxysmal positional vertigo: comparison of two types of exercises. [Abstract] [BibTeX]	1987	Archives of oto-rhino-laryngology Vol. 244(5), pp. 291-294	article
Abstract: The use of exercises can be an excellent method for treating benign paroxysmal positional vertigo (BPPV). We compared the results obtained by a progressive training method, vestibular habituation training (VHT), with a brisk exercise method. While VHT can be applied in all kinds of "provoked" (positional) vertigo of peripheral origin, the brisk method can be used only in typical BPPV, provided the vertigo is unilaterally provoked. A series of patients with such typical "unilateral" cases were treated by the brisk method and were compared with a second series of identical cases treated by the VHT technique. The results after 1 week seemed to be different: with the brisk method 52% of the patients were free of vertigo, while only 32% with VHT were vertigo free. This difference is not statistically significant. However, those cases treated by VHT and still having vertigo after 1 week had a striking reduction in the severity of their vertigo, as estimated by the score-system used. In contrast, the scores were unchanged for those cases not responding to the brisk method. Continuation of treatment of these latter cases using VHT exercises showed that the final result after 6 weeks was equal for both groups.
BibTeX: @article{Norre1987a, author = {Norré, M E and Beckers, A}, title = {Exercise treatment for paroxysmal positional vertigo: comparison of two types of exercises.}, journal = {Archives of oto-rhino-laryngology}, year = {1987}, volume = {244}, issue = {5}, pages = {291--294}, keywords = {Exercise Therapy, methods; Habituation, Psychophysiologic; Humans; Movement; Posture; Vertigo, therapy; Vestibule, Labyrinth, physiology}, pmid = {3501947} }
Campos-Barreiro, S. and López-Fidalgo, J.	Experimental designs for a benign paroxysmal positional vertigo model. [Abstract] [BibTeX]	2013	Theoretical biology & medical modelling Vol. 10, pp. 21	article	DOI
Abstract: The pathology of the Benign Paroxysmal Positional Vertigo (BPPV) is detected by a clinician through maneuvers consisting of a series of consecutive head turns that trigger the symptoms of vertigo in patient. A statistical model based on a new maneuver has been developed in order to calculate the volume of endolymph displaced after the maneuver. A simplification of the Navier-Stokes problem from the fluids theory has been used to construct the model. In addition, the same cubic splines that are commonly used in kinematic control of robots were used to obtain an appropriate description of the different maneuvers. Then experimental designs were computed to obtain an optimal estimate of the model. D-optimal and c-optimal designs of experiments have been calculated. These experiments consist of a series of specific head turns of duration Δt and angle α that should be performed by the clinician on the patient. The experimental designs obtained indicate the duration and angle of the maneuver to be performed as well as the corresponding proportion of replicates. Thus, in the D-optimal design for 100 experiments, the maneuver consisting of a positive 30° pitch from the upright position, followed by a positive 30° roll, both with a duration of one and a half seconds is repeated 47 times. Then the maneuver with 60° /6° pitch/roll during half a second is repeated 16 times and the maneuver 90° /90° pitch/roll during half a second is repeated 37 times. Other designs with significant differences are computed and compared. A biomechanical model was derived to provide a quantitative basis for the detection of BPPV. The robustness study for the D-optimal design, with respect to the choice of the nominal values of the parameters, shows high efficiencies for small variations and provides a guide to the researcher. Furthermore, c-optimal designs give valuable assistance to check how efficient the D-optimal design is for the estimation of each of the parameters. The experimental designs provided in this paper allow the physician to validate the model. The authors of the paper have held consultations with an ENT consultant in order to align the outline more closely to practical scenarios.
BibTeX: @article{Campos-Barreiro2013, author = {Campos-Barreiro, Santiago and López-Fidalgo, Jesús}, title = {Experimental designs for a benign paroxysmal positional vertigo model.}, journal = {Theoretical biology & medical modelling}, year = {2013}, volume = {10}, pages = {21}, doi = {https://doi.org/10.1186/1742-4682-10-21}, keywords = {Benign Paroxysmal Positional Vertigo; Humans; Models, Theoretical; Vertigo, physiopathology}, pmid = {23509996} }
Yatomi, M., Ogawa, Y., Suzuki, M., Otsuka, K., Inagaki, T., Konomi, U. and Tsukahara, K.	Experimental model of benign paroxysmal positional vertigo with biphasic nystagmus using isolated semicircular canals. [Abstract] [BibTeX]	2017	Acta oto-laryngologica Vol. 137(1), pp. 53-57	article	DOI
Abstract: The co-existence of cupulolithiasis and canalolithiasis might be a possible mechanism for the spontaneous inversion of positional nystagmus. To investigate the mechanism of spontaneous inversion of nystagmus direction without a positional change in experimental models of co-existing cupulolithiasis and canalolithiasis. Co-existing canalolithiasis and cupulolithiasis models were prepared using the bullfrog posterior semicircular canal (PSC). Ten bullfrogs were used. The ampullary nerve discharges were recorded as compound action potentials (CAPs). First, an otoconial mass was placed on the cupula to produce cupulolithiasis. Subsequently, another otoconial mass was introduced into the canal lumen to produce canalolithiasis. Decremental time constants for cupulolithiasis and incremental time constants for canalolithiasis were determined. At first the CAPs increased and continued for a long time when the cupulolithiasis was generated. Subsequently the CAPs were suppressed by creating canalolithiasis. Finally, the CAPs increased again after the motion of otoconia inside the canal lumen stopped. The decremental time constant for cupulolithiasis was significantly longer than the incremental time constant for canalolithiasis.
BibTeX: @article{Yatomi2017, author = {Yatomi, Masanori and Ogawa, Yasuo and Suzuki, Mamoru and Otsuka, Koji and Inagaki, Taro and Konomi, Ujimoto and Tsukahara, Kiyoaki}, title = {Experimental model of benign paroxysmal positional vertigo with biphasic nystagmus using isolated semicircular canals.}, journal = {Acta oto-laryngologica}, year = {2017}, volume = {137}, issue = {1}, pages = {53--57}, doi = {https://doi.org/10.1080/00016489.2016.1217560}, keywords = {Animals; Benign Paroxysmal Positional Vertigo; Disease Models, Animal; In Vitro Techniques; Nystagmus, Physiologic; Rana catesbeiana; BPPV; Horizontal canal; benign paroxysmal positional vertigo; lateral canal; positional nystagmus}, pmid = {27553764} }
Naguib, M.B.	Experimental selective posterior semicircular canal laser deafferentation. [Abstract] [BibTeX]	2005	The Journal of laryngology and otology Vol. 119(5), pp. 381-384	article	DOI
Abstract: In this experimental study, we attempted to perform selective deafferentation of the posterior semicircular canal ampulla of guinea pigs using carbon dioxide laser beam. The results of this study document the efficacy of this procedure in achieving deafferentation of the posterior semicircular canal safely with regards to the other semicircular canals, the otolithic organ and the organ of hearing. Moreover, the procedure is performed with relative ease compared with other procedures previously described for selective deafferentation of the posterior semicircular canal. The clinical application of such a procedure for the treatment of intractable benign paroxysmal positional vertigo in humans is suggested.
BibTeX: @article{Naguib2005, author = {Naguib, Maged B}, title = {Experimental selective posterior semicircular canal laser deafferentation.}, journal = {The Journal of laryngology and otology}, year = {2005}, volume = {119}, issue = {5}, pages = {381--384}, doi = {https://doi.org/10.1258/0022215053945895}, keywords = {Animals; Carbon Dioxide; Guinea Pigs; Laser Therapy, methods; Male; Otologic Surgical Procedures, methods; Semicircular Canals, pathology, surgery; Treatment Outcome; Vertigo, pathology, surgery}, pmid = {15949103} }
Furuya, M., Suzuki, M. and Sato, H.	Experimental study of speed-dependent positional nystagmus in benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2003	Acta oto-laryngologica Vol. 123(6), pp. 709-712	article
Abstract: One of the clinical characteristics of benign paroxysmal positional vertigo (BPPV) is that the more quickly the head position changes, the more severe the vertigo. This suggests that the velocity of the head change is critical in determining the occurrence and severity of vertigo. The aim of this study was to examine factors determining the symptoms of BPPV using models of canalolithiasis and cupulolithiasis. Canalolithiasis and cupulolithiasis models were prepared using the bullfrog posterior semicircular canal (PSC). The ampullary nerve discharges were compared between quick and slow positional changes to examine factors determining the symptoms of BPPV. In the canalolithiasis model, the acceleration of the otoconia was greater for the quick positional change. This resulted in a greater discharge with a longer duration. With the slow positional change, the discharges were smaller and shorter. In the cupulolithiasis model, the discharges were sustained and their magnitude did not differ between the quick and slow positional changes. The canalolithiasis model influenced the magnitude of discharge of the PSC depending on the speed of the positional change. Canalolithiasis is the more likely mechanism of BPPV, which is characterized by various degrees of vertigo upon kinetic positional change.
BibTeX: @article{Furuya2003, author = {Furuya, Masayoshi and Suzuki, Mamoru and Sato, Harushiro}, title = {Experimental study of speed-dependent positional nystagmus in benign paroxysmal positional vertigo.}, journal = {Acta oto-laryngologica}, year = {2003}, volume = {123}, issue = {6}, pages = {709--712}, keywords = {Animals; Ear, Inner, innervation, physiopathology; Head Movements, physiology; Labyrinth Diseases, physiopathology; Lithiasis, physiopathology; Models, Animal; Nystagmus, Physiologic, physiology; Rana catesbeiana; Vertigo, physiopathology; Vestibulocochlear Nerve, physiology, physiopathology}, pmid = {12953769} }
Otsuka, K., Negishi, M., Suzuki, M., Inagaki, T., Yatomi, M., Konomi, U., Kondo, T. and Ogawa, Y.	Experimental study on the aetiology of benign paroxysmal positional vertigo due to canalolithiasis: comparison between normal and vestibular dysfunction models. [Abstract] [BibTeX]	2014	The Journal of laryngology and otology Vol. 128(1), pp. 68-72	article	DOI
Abstract: Using American bullfrog models under normal conditions and under vestibular dysfunction, we investigated whether mechanical vibration applied to the ear could induce otoconial dislodgement. Vibration was applied to the labyrinth of the bullfrog using a surgical drill. The time required for the otoconia to dislodge from the utricular macula was measured. Vestibular dysfunction models were created and the dislodgement time was compared with the normal models. The morphology of the utricular macula was also investigated. In the normal models, the average time for otoconial dislodgement to occur was 7 min and 36 s; in the vestibular dysfunction models, it was 2 min and 11 s. Pathological investigation revealed that the sensory hairs of the utricle were reduced in number and that the sensory cells became atrophic in the vestibular dysfunction models. The otoconia of the utricle were dislodged into the semicircular canal after applying vibration. The time to dislodgement was significantly shorter in the vestibular dysfunction models than in the normal models; the utricular macula sustained significant morphological damage.
BibTeX: @article{Otsuka2014, author = {Otsuka, K and Negishi, M and Suzuki, M and Inagaki, T and Yatomi, M and Konomi, U and Kondo, T and Ogawa, Y}, title = {Experimental study on the aetiology of benign paroxysmal positional vertigo due to canalolithiasis: comparison between normal and vestibular dysfunction models.}, journal = {The Journal of laryngology and otology}, year = {2014}, volume = {128}, issue = {1}, pages = {68--72}, doi = {https://doi.org/10.1017/S0022215113003381}, keywords = {Animals; Benign Paroxysmal Positional Vertigo; Disease Models, Animal; Ear, Inner, pathology; Hair Cells, Auditory, Inner, pathology; Otolithic Membrane, physiopathology; Rana catesbeiana; Saccule and Utricle, pathology; Vertigo, pathology, physiopathology; Vibration, adverse effects}, pmid = {24423787} }
Burton, M.J., Eby, T.L. and Rosenfeld, R.M.	Extracts from the Cochrane Library: modifications of the Epley (canalith repositioning) maneuver for posterior canal benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2012	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 147(3), pp. 407-411	article	DOI
Abstract: The "Cochrane Corner" is a quarterly section in the Journal that highlights systematic reviews relevant to otolaryngology-head and neck surgery, with invited commentary to aid clinical decision making. This installment features a Cochrane review "Modifications of the Epley (Canalith Repositioning) Manoeuvre for Posterior Canal Benign Paroxysmal Positional Vertigo (BPPV)" that finds no evidence of benefit for mastoid oscillation applied during the Epley maneuver nor any clinically important benefit for post-Epley postural restrictions in comparison with the Epley maneuver alone.
BibTeX: @article{Burton2012, author = {Burton, Martin J and Eby, Thomas L and Rosenfeld, Richard M}, title = {Extracts from the Cochrane Library: modifications of the Epley (canalith repositioning) maneuver for posterior canal benign paroxysmal positional vertigo.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2012}, volume = {147}, issue = {3}, pages = {407--411}, doi = {https://doi.org/10.1177/0194599812457134}, pmid = {22886077} }
Shirabe, S.	Eye movement induced by lateral tilt and its clinical significance. [Abstract] [BibTeX]	1991	Acta oto-laryngologica. Supplementum Vol. 481, pp. 51-54	article
Abstract: We have studied ocular reflexes caused by tilting stimulations in test subjects placed in an upright sitting position on a chair apparatus which tilts continuously. In healthy persons, a weak nystagmus can be observed of minor amplitude and showing a small number of beats. The actual incidence of nystagmus in the younger group was minimal, but it tended to increase with age. This occurrence is considered to be due to age-related degeneration of the otolithic organ. Patients with vertigo and/or dizziness clearly develop nystagmus. These responses are classified as follows: type I is of fixed direction: type II is of changed direction; and type III is a combination of the first and second types. Among the peripheral vestibular disorders, particularly involving patients with benign paroxysmal positional vertigo, a nystagmus of changed direction was found. This type was rarely seen in patients with other vestibular disorders, but was a common occurrence in healthy individuals who readily experienced motion sickness. These observations have led us to conclude that patients with benign paroxysmal positional vertigo have definite reactions which are similar to those of individuals with motion sickness, and that this depends on the susceptibility of the otolithic organs.
BibTeX: @article{Shirabe1991, author = {Shirabe, S}, title = {Eye movement induced by lateral tilt and its clinical significance.}, journal = {Acta oto-laryngologica. Supplementum}, year = {1991}, volume = {481}, pages = {51--54}, keywords = {Adult; Aging, physiology; Eye Movements, physiology; Humans; Middle Aged; Motion Sickness, physiopathology; Otolithic Membrane, physiopathology; Posture; Vertigo, physiopathology}, pmid = {1927457} }
Shirabe, S., Soda, T., Kawano, M. and Shiraishi, K.	Eye movements induced by lateral tilt and testing of otolithic function. [Abstract] [BibTeX]	1986	Archives of oto-rhino-laryngology Vol. 243(3), pp. 153-157	article
Abstract: In the last few years, we have studied ocular reflexes caused by tilting stimulations in test subjects placed in an upright sitting position on a chair apparatus which tilts continuously. In healthy persons, a weak nystagmus can be observed, and involves a nystagmus of minor amplitude and showing a small number of beats. The actual incidence of nystagmus in the younger group was minimal, but it tended to increase with age. This occurrence is considered to be due to age-related degeneration of the otolithic organ. Patients with vertigo and/or dizziness clearly develop nystagmus. These responses are classified as follows: type I is of fixed direction; type II is of changed direction; and type III is a combination of the first and second types. Among the peripheral vestibular disorders, particularly involving those patients with benign paroxysmal positional vertigo, a nystagmus of changed direction was found. This type was rarely seen in patients with other vestibular disorders, but was a common occurrence in healthy individuals who readily experienced motion sickness. These observations have led us to conclude that patients with benign paroxysmal positional vertigo have definite reactions which are similar to those of individuals with motion sickness, and that such depends on the susceptibility of the otolithic organs.
BibTeX: @article{Shirabe1986, author = {Shirabe, S and Soda, T and Kawano, M and Shiraishi, K}, title = {Eye movements induced by lateral tilt and testing of otolithic function.}, journal = {Archives of oto-rhino-laryngology}, year = {1986}, volume = {243}, issue = {3}, pages = {153--157}, keywords = {Adult; Humans; Meniere Disease, physiopathology; Middle Aged; Motion Sickness, physiopathology; Nystagmus, Physiologic; Otolithic Membrane, physiopathology; Posture; Saccule and Utricle, physiopathology; Vertigo, physiopathology; Vestibule, Labyrinth, physiopathology}, pmid = {3489457} }
Yuan, J., Dai, J., Li, W.A. and Hu, W.	Factors Associated with Benign Paroxysmal Positional Vertigo: A Chinese Case-Control Study. [Abstract] [BibTeX]	2017	Medical science monitor : international medical journal of experimental and clinical research Vol. 23, pp. 3885-3889	article
Abstract: BACKGROUND Benign paroxysmal positional vertigo (BPPV) is one of the most common and most successfully treated vestibular disorders. However, there is a lack of predictive factors for BPPV in clinical practice. We aimed to explore several possible predictive factors for BPPV in the Chinese population. MATERIAL AND METHODS We enrolled 240 patients with BPPV from Beijing Chaoyang Hospital between July 2013 and July 2016. Biochemical and hematological markers were obtained along with the history of cardiovascular and cerebrovascular diseases. RESULTS Serum uric acid (SUA) [279.0±84.7 vs. 331.0±82.7], hemoglobin A1C (HbA1c) [5.75±1.17 vs. 6.61±1.00], albumin [38.1±3.71 vs. 40.9±4.1], and creatinine [68.4±19.3 vs. 81.5±24.1] were significantly lower in patients with BPPV compared with controls (P<0.05). Multiple logistic regression analysis showed that lower levels of HbA1c and albumin were independently associated with BPPV (P<0.05), with odds ratio (OR) 0.680 (95% CI 0.551-0.839) and 0.338 (95% CI 0.190-0.603), respectively. However, the level of SUA was not independently related with BPPV [OR=0.999 (95% CI 0.991-1.006), P=0.713]. There were no significant differences between the parameters of systolic blood pressure, diastolic blood pressure, blood routine examination, lipid profiles, homocysteine, pre-albumin, and blood urea nitrogen in patients with BPPV vs. controls (P>0.05). CONCLUSIONS Lower levels of HbA1c and albumin were independently associated with BPPV. Although the level of SUA was lower in BPPV patients, SUA was not an independent risk factor for BPPV.
BibTeX: @article{Yuan2017, author = {Yuan, Junliang and Dai, Jinsheng and Li, William A and Hu, Wenli}, title = {Factors Associated with Benign Paroxysmal Positional Vertigo: A Chinese Case-Control Study.}, journal = {Medical science monitor : international medical journal of experimental and clinical research}, year = {2017}, volume = {23}, pages = {3885--3889}, keywords = {Aged; Benign Paroxysmal Positional Vertigo, blood, physiopathology; Blood Cell Count; Blood Urea Nitrogen; Case-Control Studies; China; Creatinine, blood; Female; Hemoglobin A, metabolism; Humans; Male; Middle Aged; Nystagmus, Physiologic, physiology; Odds Ratio; Risk Factors; Serum Albumin, metabolism; Uric Acid, blood}, pmid = {28800356} }
Uneri, A.	Falling sensation in patients who undergo the Epley maneuver: a retrospective study. [Abstract] [BibTeX]	2005	Ear, nose, & throat journal Vol. 84(2), pp. 82, 84-82, 85	article
Abstract: The author conducted a retrospective study to determine the prevalence of a falling sensation in patients who underwent the Epley canalith repositioning maneuver for the treatment of benign paroxysmal positional vertigo. The author studied a total of 436 maneuvers performed on 412 patients and observed 58 episodes (13%) of a strong falling sensation, some very severe. In almost every case, the sensation occurred when the patient was moved to the final (sitting) position; in 1 case, the sensation occurred nearly 30 minutes later. The author recommends that physicians who perform the Epley maneuver warn patients of the risk of a falling sensation, take steps to prevent its consequences, and monitor their patients for at least 30 minutes after the completion of the procedure.
BibTeX: @article{Uneri2005, author = {Uneri, Alev}, title = {Falling sensation in patients who undergo the Epley maneuver: a retrospective study.}, journal = {Ear, nose, & throat journal}, year = {2005}, volume = {84}, issue = {2}, pages = {82, 84--82, 85}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Nystagmus, Physiologic; Physical Therapy Modalities, adverse effects; Posture; Retrospective Studies; Semicircular Canals, physiopathology; Sensation Disorders, etiology; Time Factors; Vertigo, etiology, therapy}, pmid = {15794543} }
Crossland, G., De, R. and Axon, P.	Far advanced otosclerosis and intractable benign paroxysmal positional vertigo treated with combined cochlear implantation and posterior semicircular canal occlusion. [Abstract] [BibTeX]	2004	The Journal of laryngology and otology Vol. 118(4), pp. 302-304	article	DOI
Abstract: This paper presents a combined procedure for the management of intractable benign paroxysmal positional vertigo (BPPV) and profound hearing loss in a patient with far advanced otosclerosis. The procedure comprised of a posterior semicircular canal occlusion and cochlear implantation as one combined procedure in the same ear. The combined approach added little to the operative morbidity and proved effective in this patient's management. A search of the literature reveals this to be a unique case.
BibTeX: @article{Crossland2004, author = {Crossland, G and De, Ranit and Axon, P}, title = {Far advanced otosclerosis and intractable benign paroxysmal positional vertigo treated with combined cochlear implantation and posterior semicircular canal occlusion.}, journal = {The Journal of laryngology and otology}, year = {2004}, volume = {118}, issue = {4}, pages = {302--304}, doi = {https://doi.org/10.1258/002221504323012076}, keywords = {Cochlear Implantation, methods; Hearing Loss, Sensorineural, surgery; Humans; Male; Middle Aged; Otosclerosis, surgery; Semicircular Canals, surgery; Vertigo, surgery}, pmid = {15117471} }
Pollak, L. and Stryjer, R.	Fatigue during an episode of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2015	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 272(9), pp. 2129-2133	article	DOI
Abstract: Fatigue is characterized by weariness unrelated to exertion levels. It has been reported in chronic neurological diseases such as multiple sclerosis, Parkinson disease and stroke. Patients with benign paroxysmal positional vertigo (BPPV) often complain about fatigue during a vertigo attack. No attention has been paid to this symptom in the literature so far. We were interested to evaluate the frequency and factors influencing fatigue in BPPV. Patients treated for idiopathic BPPV during the years 2011-2012 were prospectively evaluated for the presence of fatigue. During the first visit, patients were asked to complete two questionnaires based on their experience during the last week: the Fatigue severity scale and the Hospital anxiety and depression scale. Patients' demographic data and BPPV characteristics were registered. Among 172 patients treated for BPPV, 40 (23.2 %) reported fatigue. The mean fatigue score was 4.73 ± 1.98 indicating moderate fatigue. No correlation was found between fatigue and anxiety or fatigue and depression. Fatigue scores were inversely related to age (r = -0.36, p = 0.020) and were not dependent on the type of BPPV, its recurrence, background diseases, gender, duration of vertigo or the presence of autonomic symptoms. Moderate fatigue is quite common during an attack of BPPV. It seems to be a genuine symptom of the entity that might worsen patients' distress. For severe or persistent fatigue treatment with fatigue relieving drugs such as amantadine, methylphenidate or modafinil could be tried in the future.
BibTeX: @article{Pollak2015, author = {Pollak, Lea and Stryjer, Rafael}, title = {Fatigue during an episode of benign paroxysmal positional vertigo.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2015}, volume = {272}, issue = {9}, pages = {2129--2133}, doi = {https://doi.org/10.1007/s00405-014-3041-3}, keywords = {Adult; Aged; Anxiety, etiology; Benign Paroxysmal Positional Vertigo, psychology; Depression, etiology; Fatigue, etiology; Female; Humans; Male; Middle Aged; Prospective Studies; Recurrence; Surveys and Questionnaires}, pmid = {24728232} }
Martellucci, S., Pagliuca, G., de Vincentiis, M., Greco, A., De Virgilio, A., Nobili Benedetti, F.M., Gallipoli, C., Rosato, C., Clemenzi, V. and Gallo, A.	Features of Residual Dizziness after Canalith Repositioning Procedures for Benign Paroxysmal Positional Vertigo. [Abstract] [BibTeX]	2016	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 154(4), pp. 693-701	article	DOI
Abstract: To assess factors related to residual dizziness (RD) in patients who underwent successful canalith repositioning procedures (CRPs) for benign paroxysmal positional vertigo (BPPV). Prospective cohort study. Academic center. Ninety-seven consecutive patients with BPPV of the posterior semicircular canal were initially enrolled. Diagnosis was assessed according to clinical history and bedside evaluation. All patients were treated with CRPs until nystagmus disappeared. Three days after the successful treatment, presence of RD was investigated. If RD was present, patients were monitored every 3 days until the symptoms disappeared. Subjects who required ≥4 CRPs or who failed to meet the follow-up visit were excluded. The Dizziness Handicap Inventory (DHI) was obtained from patients at the time of diagnosis and at every subsequent visit. At the end of selection, 86 patients were included; 33 (38.36%) reported RD after successful treatment. A significant difference in the incidence of RD was observed in consideration of the age of the subjects (P = .0003) and the DHI score at the time of diagnosis (P < .001). A logistic regression analysis showed that the probability of RD occurrence increased with the increase of the emotional subdomain score of the DHI questionnaire. RD is a common self-limited disorder, more frequent in the elderly, which may occur after the physical treatment for BPPV. The DHI score at the time of BPPV diagnosis represents a useful tool to quantify the impact of this vestibular disorder on the quality of life and to estimate the risk of RD after CRPs.
BibTeX: @article{Martellucci2016, author = {Martellucci, Salvatore and Pagliuca, Giulio and de Vincentiis, Marco and Greco, Antonio and De Virgilio, Armando and Nobili Benedetti, Ferdinando Maria and Gallipoli, Camilla and Rosato, Chiara and Clemenzi, Veronica and Gallo, Andrea}, title = {Features of Residual Dizziness after Canalith Repositioning Procedures for Benign Paroxysmal Positional Vertigo.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2016}, volume = {154}, issue = {4}, pages = {693--701}, doi = {https://doi.org/10.1177/0194599815627624}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis, physiopathology, therapy; Female; Humans; Male; Middle Aged; Physical Therapy Modalities; Prospective Studies; Surveys and Questionnaires; Treatment Outcome; BPPV; DHI; anxiety; benign paroxysmal positional vertigo; canalith repositioning procedures; elderly; imbalance; repositioning maneuver; residual dizziness; vertigo}, pmid = {26861236} }
Hawthorne, M. and el-Naggar, M.	Fenestration and occlusion of posterior semicircular canal for patients with intractable benign paroxysmal positional vertigo. [Abstract] [BibTeX]	1994	The Journal of laryngology and otology Vol. 108(11), pp. 935-939	article
Abstract: A series of 15 patients with intractable benign paroxysmal positional vertigo (BPPV) who had fenestration and occlusion of the posterior semicircular canal (FOP) surgery commencing in December 1990 are reported. Follow-up was from 14 to 40 months. All patients reported a cure of their positional vertigo. No patient regretted having the surgery. All patients had a negative Dix-Hallpike test post-operatively and the test remained negative for the duration of follow-up. Eight patients had a mild high frequency sensorineural hearing (SNHL) loss post-operatively which had almost recovered six months later. No patient reported any change in their hearing following surgery. Of the 10 patients who did not have pre-operative tinnitus, six developed tinnitus but it was not considered significant by them. All patients developed mild unsteadiness following surgery which gradually improved with mobilization and physiotherapy if necessary. The operation preserves hearing, is technically straightforward, well-tolerated and effective.
BibTeX: @article{Hawthorne1994, author = {Hawthorne, M and el-Naggar, M}, title = {Fenestration and occlusion of posterior semicircular canal for patients with intractable benign paroxysmal positional vertigo.}, journal = {The Journal of laryngology and otology}, year = {1994}, volume = {108}, issue = {11}, pages = {935--939}, keywords = {Adult; Female; Fenestration, Labyrinth; Follow-Up Studies; Hearing Loss, Sensorineural, etiology; Humans; Male; Mastoid, surgery; Middle Aged; Postoperative Complications; Semicircular Canals, surgery; Vertigo, surgery}, pmid = {7829944} }
Ahn, S.H., Shin, J.E. and Kim, C.-H.	Final diagnosis of patients with clinically suspected vestibular neuritis showing normal caloric response. [Abstract] [BibTeX]	2017	Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia Vol. 41, pp. 107-110	article	DOI
Abstract: Vestibular neuritis is one of the most common peripheral causes of acute vestibular syndrome, of which the diagnosis is generally based on a comprehensive interpretation of clinical and laboratory findings following reasonable exclusion of other disorders. This study aimed to investigate the final diagnosis of patients admitted to hospital under the clinical impression of vestibular neuritis who showed no unilateral caloric paresis. Forty-five patients who visited the emergency department with isolated acute spontaneous vertigo were included. Among them, six patients (13%) developed definitive spontaneous vertigo lasting longer than 20min again after discharge from hospital, accompanied by hearing loss, which was audiometrically documented, leading to a final diagnosis of definite Ménière's disease. Nine patients (20%) revisited our clinic with recurrent episodic vertigo without any documented hearing loss or auditory symptoms such as hearing loss, tinnitus or ear fullness, which led to a final diagnosis of possible Ménière's disease. In four patients (9%), initial spontaneous vertigo and nystagmus changed to positional vertigo and nystagmus on the second hospital day. In 26 patients (58%), neither another episode of vertigo nor auditory symptoms developed during follow-up period (7-92months), a condition to which the authors gave an arbitrary diagnosis of "mild unilateral vestibular deficit". In conclusion, patients admitted to hospital under clinical impression of vestibular neuritis may have various final diagnoses, and "mild unilateral vestibular deficit" was the most common final diagnosis among patients who did not meet the diagnostic criteria of vestibular neuritis.
BibTeX: @article{Ahn2017, author = {Ahn, Sung Hwan and Shin, Jung Eun and Kim, Chang-Hee}, title = {Final diagnosis of patients with clinically suspected vestibular neuritis showing normal caloric response.}, journal = {Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia}, year = {2017}, volume = {41}, pages = {107--110}, doi = {https://doi.org/10.1016/j.jocn.2017.02.064}, keywords = {Adult; Aged; Caloric Tests; Diagnosis, Differential; Female; Humans; Male; Meniere Disease, diagnosis; Middle Aged; Nystagmus, Physiologic; Vertigo, diagnosis; Vestibular Neuronitis, diagnosis; Benign paroxysmal positional vertigo; Caloric test; Ménière’s disease; Vertigo; Vestibular neuritis}, pmid = {28416082} }
Tan, J., Yu, D., Feng, Y., Song, Q., You, J., Shi, H. and Yin, S.	First-referral presentations of patients with benign paroxysmal positional vertigo who were negative on positional testing and who lacked nystagmus. [Abstract] [BibTeX]	2015	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 272(11), pp. 3247-3251	article	DOI
Abstract: The aim of the present study was to explore the demographic, clinical, and pathogenetic features; and treatment outcomes of patients with benign paroxysmal positional vertigo (BPPV) who were negative upon positional testing at their first referral. A total of 133 patients presented with histories of BPPV but were negative, in our hands, upon positional testing. Patients were told to cease taking vestibular suppressant medication (if any) and were to return for re-examination when positional vertigo symptoms recurred. If BPPV was diagnosed, the appropriate repositioning maneuver was applied and patients were re-examined weekly until the characteristic nystagmus and vertigo disappeared. Follow-up was performed 1 week, 4 weeks, 3 months, 6 months, and 1 year after diagnosis. The 133 patients were compared with a group of 250 patients with typical BPPV. Sixty-five of the 133 patients (termed the n-BPPV group) were subsequently identified with typical BPPV. Such diagnoses were made within 10 days of the first referral in 37 (56.9%) cases. Patients of the n-BPPV group had a longer duration of the last episode of vertigo than did others (39.7 ± 38.4 vs. 26.1 ± 36.7 days, p < 0.001), and a higher proportion used vestibular suppressant medication prior to first referral (75.4 vs. 54.8%, p = 0.003). The n-BPPV and typical BPPV patients responded similarly to treatment and exhibited similar recurrence rates. BPPV patients who were negative upon positional testing at first referral were quite common, accounting for 26% of all typical BPPV patients. No significant difference in either treatment outcome or recurrence rate was evident between n-BPPV and typical BPPV positions. Positional vertigo and nystagmus are not always present as BPPV progresses.
BibTeX: @article{Tan2015, author = {Tan, Jun and Yu, Dongzhen and Feng, Yanmei and Song, Qiang and You, Jin and Shi, Haibo and Yin, Shankai}, title = {First-referral presentations of patients with benign paroxysmal positional vertigo who were negative on positional testing and who lacked nystagmus.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2015}, volume = {272}, issue = {11}, pages = {3247--3251}, doi = {https://doi.org/10.1007/s00405-014-3399-2}, keywords = {Benign Paroxysmal Positional Vertigo, complications, diagnosis, physiopathology; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nystagmus, Pathologic, diagnosis, etiology, physiopathology; Patient Positioning; Recurrence; Referral and Consultation; Retrospective Studies; Time Factors; Treatment Outcome; Vestibule, Labyrinth, physiopathology; Benign paroxysmal positional vertigo; Nystagmus; Positional testing; Recurrence; Treatment}, pmid = {25416308} }
Obrist, D. and Hegemann, S.	Fluid-particle dynamics in canalithiasis. [Abstract] [BibTeX]	2008	Journal of the Royal Society, Interface Vol. 5(27), pp. 1215-1229	article	DOI
Abstract: The semicircular canals (SCCs; located in the inner ear) are the primary sensors for angular motion. Angular head movements induce a fluid flow in the SCCs. This flow is detected by afferent hair cells inside the SCCs. Canalithiasis is a condition where small particles disturb this flow, which leads to benign paroxysmal positional vertigo (top-shelf vertigo). The present work investigates the interaction between the fluid flow and the particles on the basis of an idealized analytical model. Numerical solutions of the full model and a thorough analytical study of the linearized model reveal the principal mechanisms of canalithiasis. We propose a set of dimensionless numbers to characterize canalithiasis and derive explicit expressions connecting these dimensionless numbers directly to the typical clinical symptoms.
BibTeX: @article{Obrist2008, author = {Obrist, Dominik and Hegemann, Stefan}, title = {Fluid-particle dynamics in canalithiasis.}, journal = {Journal of the Royal Society, Interface}, year = {2008}, volume = {5}, issue = {27}, pages = {1215--1229}, doi = {https://doi.org/10.1098/rsif.2008.0047}, keywords = {Computer Simulation; Humans; Labyrinth Diseases, pathology; Lithiasis, pathology; Models, Biological; Particle Size; Semicircular Canals, anatomy & histology, pathology; Vertigo, pathology}, pmid = {18319210} }
Seccia, V., Fortunato, S., Cristofani-Mencacci, L., Dallan, I., Casani, A.P., Latorre, M., Paggiaro, P., Bartoli, M.L., Sellari-Franceschini, S. and Baldini, C.	Focus on audiologic impairment in eosinophilic granulomatosis with polyangiitis. [Abstract] [BibTeX]	2016	The Laryngoscope Vol. 126(12), pp. 2792-2797	article	DOI
Abstract: To evaluate the clinical features of audiologic impairment and its relationship with the nasal, vestibular, and rheumatologic profile in a cohort of patients with eosinophilic granulomatosis with polyangiitis (EGPA), formerly named Churg-Strauss syndrome. Prospective cross-sectional study. Thirty-nine patients with EGPA, considered controlled according to the Birmingham Vasculitis Activity Score and the Vasculitis Damage Index, underwent a complete audiologic evalutaion with otomicroscopy, impedance audiometry, speech audiometry, and auditory brainstem responses; rhinologic evaluation was made by means of fiberoptic endoscopy and nasal cytology; the clinical evaluation was completed with analysis of the facial function and, in patients with referred vertigo, with videonystagmography (VNG). Data were compared to the rheumatologic profile (eosinophil count, antineutrophil cytoplasmic antibodies status). Thirty-four of 39 patients fulfilled the inclusion criteria. Of those, 18 (52, 8%) were affected by variable degrees of hearing loss (sensorineural hearing loss [SNHL]) in four cases (11, 8%), mixed sensorineural and conductive hearing loss in two (5, 9%), presbycusis in six (17, 6%), and otitis media with effusion (OME) in six (17, 6%). Vestibular impairment was represented by benign paroxysmal positional vertigo and unspecific dizziness in three (8, 8%) and four cases (11, 8%), respectively, all with normal VNG. Ear involvement was statistically related to the EGPA vasculitic pattern and independent from the nasal impairment, cytology, and duration of nasal symptoms. No facial palsy was registered. In our experience, the largest in the existing literature, the otological involvement in EGPA is common and may occur variably as SNHL or OME. Otological involvement occurs early in the course of the disease process, but is nonspecific in making the diagnosis of EGPA. Its recognition is therefore fundamental. 4. Laryngoscope, 126:2792-2797, 2016.
BibTeX: @article{Seccia2016, author = {Seccia, Veronica and Fortunato, Susanna and Cristofani-Mencacci, Lodovica and Dallan, Iacopo and Casani, Augusto P and Latorre, Manuela and Paggiaro, Pierluigi and Bartoli, Maria Laura and Sellari-Franceschini, Stefano and Baldini, Chiara}, title = {Focus on audiologic impairment in eosinophilic granulomatosis with polyangiitis.}, journal = {The Laryngoscope}, year = {2016}, volume = {126}, issue = {12}, pages = {2792--2797}, doi = {https://doi.org/10.1002/lary.25964}, keywords = {Adult; Aged; Churg-Strauss Syndrome, complications, pathology; Cross-Sectional Studies; Female; Hearing Loss, diagnosis, etiology; Hearing Tests; Humans; Male; Middle Aged; Otitis Media with Effusion, etiology; Prospective Studies; Turbinates, pathology; Churg-Strauss syndrome; Eosinophilic granulomatosis with polyangiitis; chronic otitis media with effusion; sensorineural hearing loss; vasculitis}, pmid = {27075698} }
Youngs, R. and Fisher, E.	Focus on epistaxis. [BibTeX]	2015	The Journal of laryngology and otology Vol. 129(5), pp. 409	article	DOI
BibTeX: @article{Youngs2015, author = {Youngs, Robin and Fisher, Edward}, title = {Focus on epistaxis.}, journal = {The Journal of laryngology and otology}, year = {2015}, volume = {129}, issue = {5}, pages = {409}, doi = {https://doi.org/10.1017/S0022215115001061}, keywords = {Benign Paroxysmal Positional Vertigo; Epistaxis; Humans; Otolaryngology}, pmid = {25994380} }
Walker, J.L., Robinson-Bostom, L. and Landow, S.	Four Diseases, Two Associations, One Patient: A Case of Frontal Fibrosing Alopecia, Lichen Planus Pigmentosus, Acne Rosacea, and Morbihan Disease. [Abstract] [BibTeX]	2016	Skinmed Vol. 14(3), pp. 225-228	article
Abstract: A 77-year-old woman born in the Dominican Republic presented with fullness of the glabella and medial eyebrows for 1 year followed by alopecia of the lateral eyebrows and frontal hairline. She stated that although she had a high hairline at baseline, it had receded in the past year. She had also noted central scalp hair thinning that started 6 years earlier. She denied all styling practices that used traction or chemical processes, although she admitted to hair dye and blow dryer use. She reported "acne" in the central face for decades and darkening of the skin on the lateral face for several years. Her medical history included hypertension, hyperlipidemia, hypothyroidism, benign paroxysmal positional vertigo, and treated breast ductal hyperplasia. Her medications were metoprolol, amlodipine, aspirin, levothyroxine, omeprazole, pravastatin, and meclizine; she denied starting any new medications within the past 2 years. Her family history was notable for androgenic pattern alopecia in a brother and a high hairline in her father. Review of systems was negative except for knee arthralgias and seasonal allergic rhinitis.
BibTeX: @article{Walker2016, author = {Walker, Joanna L and Robinson-Bostom, Leslie and Landow, Shoshana}, title = {Four Diseases, Two Associations, One Patient: A Case of Frontal Fibrosing Alopecia, Lichen Planus Pigmentosus, Acne Rosacea, and Morbihan Disease.}, journal = {Skinmed}, year = {2016}, volume = {14}, issue = {3}, pages = {225--228}, keywords = {Aged; Alopecia, complications, pathology; Eyebrows; Female; Fibrosis; Humans; Hyperpigmentation, complications, pathology; Lichen Planus, complications, pathology; Rosacea, complications, pathology; Skin}, pmid = {27502265} }
Power, L., Murray, K., Drummond, K.J., Trost, N. and Szmulewicz, D.J.	Fourth ventricle ependymoma mimicking benign paroxysmal positional vertigo. [BibTeX]	2018	Neurology Vol. 91(7), pp. 327-328	article	DOI
BibTeX: @article{Power2018a, author = {Power, Laura and Murray, Kate and Drummond, Katherine J and Trost, Nicholas and Szmulewicz, David J}, title = {Fourth ventricle ependymoma mimicking benign paroxysmal positional vertigo.}, journal = {Neurology}, year = {2018}, volume = {91}, issue = {7}, pages = {327--328}, doi = {https://doi.org/10.1212/WNL.0000000000005992}, pmid = {30104227} }
Nakada, T., Teranishi, M., Ueda, Y. and Sone, M.	Fracture probability assessed using FRAX, javax.xml.bind.JAXBElement@35870603, in elderly women with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2018	Auris, nasus, larynx Vol. 45(6), pp. 1173-1177	article	DOI
Abstract: Patients with benign paroxysmal positional vertigo (BPPV) can have vitamin D deficiency, which is a cause of abnormal bone turnover. Several studies have established a relationship between osteoporosis and BPPV. The World Health Organization Fracture Risk Assessment Tool, widely known as FRAX (http://www.shef.ac.uk/FRAX), is a computer-based algorithm for assessing fracture risk. No direct comparison has been made between the FRAX scores of patients with BPPV and controls. The purpose of this study was to determine whether women with BPPV are at high risk of fracture as assessed using FRAX. The study involved 40 postmenopausal women diagnosed with BPPV between July 2015 and April 2016, and 40 postmenopausal women as controls. The 10-year major osteoporotic and hip fracture risks were calculated using FRAX and were compared between BPPV patients and controls using Welch's t test and a general linear model. The 10-year major osteoporotic fracture risk was 20.4%±12.1% for BPPV patients (aged 72.4±8.6years) and 14.3%±6.5% for controls (aged 71.2±6.3years). The 10-year hip fracture risk was 9.0%±9.8% for BPPV patients and 5.0%±3.9% for controls. The BPPV group had significantly higher 10-year major risks of osteoporotic fracture (p=0.0069) and hip fracture (p=0.0202) compared with controls. Similarly, after adjustment for age, the BPPV group had significantly higher 10-year risks of major osteoporotic fracture (p=0.0007) and hip fracture (p=0.0092) compared with controls. Fracture risk calculated using FRAX was significantly higher in the BPPV group than in controls. Women with BPPV may need early intervention to prevent future fractures.
BibTeX: @article{Nakada2018, author = {Nakada, Takafumi and Teranishi, Masaaki and Ueda, Yukio and Sone, Michihiko}, title = {Fracture probability assessed using FRAX, javax.xml.bind.JAXBElement@35870603, in elderly women with benign paroxysmal positional vertigo.}, journal = {Auris, nasus, larynx}, year = {2018}, volume = {45}, issue = {6}, pages = {1173--1177}, doi = {https://doi.org/10.1016/j.anl.2018.05.002}, keywords = {Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, epidemiology; Case-Control Studies; Female; Fractures, Bone, epidemiology; Hip Fractures, epidemiology; Humans; Linear Models; Osteoporotic Fractures, epidemiology; Postmenopause; Risk Assessment; Vitamin D Deficiency, epidemiology; Benign paroxysmal positional vertigo; FRAX; Fracture; Postmenopausal women}, pmid = {29784241} }
Parnes, L.S. and McClure, J.A.	Free-floating endolymph particles: a new operative finding during posterior semicircular canal occlusion. [Abstract] [BibTeX]	1992	The Laryngoscope Vol. 102(9), pp. 988-992	article	DOI
Abstract: Most clinicians accept cupulolithiasis as the pathophysiological mechanism underlying benign paroxysmal positional vertigo (BPPV.) According to this theory, a cupular deposit induces a gravitational effect on the posterior canal crista. Posterior semicircular canal occlusion is a new operative procedure for treating incapacitating BPPV. It is postulated that canal occlusion abolishes endolymph movement within the canal, effectively fixing the cupula and rendering it unresponsive to both angular and linear acceleration (gravity). During two recent canal occlusions, abundant "free-floating particles" were identified within the posterior canal endolymph. When changing the position of the canal in the earth vertical plane, these free-floating particles would move under the influence of gravity. The hydrodynamic drag of the particles would induce endolymph movement with cupular displacement leading to the typical response. This finding supports an alternate explanation to cupulolithiasis as the pathophysiological mechanism underlying BPPV.
BibTeX: @article{Parnes1992, author = {Parnes, L S and McClure, J A}, title = {Free-floating endolymph particles: a new operative finding during posterior semicircular canal occlusion.}, journal = {The Laryngoscope}, year = {1992}, volume = {102}, issue = {9}, pages = {988--992}, doi = {https://doi.org/10.1288/00005537-199209000-00006}, keywords = {Aged; Aged, 80 and over; Cochlear Duct, pathology, surgery; Endolymph; Female; Humans; Semicircular Canals, pathology, surgery; Vertigo, pathology, surgery}, pmid = {1518363} }
Parnes, L.S. and McClure, J.A.	Free-floating endolymph particles: A new operative finding during posterior semicircular canal occlusion. 1992. [BibTeX]	2015	The Laryngoscope Vol. 125(5), pp. 1033	article	DOI
BibTeX: @article{Parnes2015, author = {Parnes, Lorne S and McClure, Joseph A}, title = {Free-floating endolymph particles: A new operative finding during posterior semicircular canal occlusion. 1992.}, journal = {The Laryngoscope}, year = {2015}, volume = {125}, issue = {5}, pages = {1033}, doi = {https://doi.org/10.1002/lary.25220}, keywords = {Benign Paroxysmal Positional Vertigo, history, pathology, surgery; Endolymph; History, 20th Century; Humans; Otologic Surgical Procedures, history, methods; Semicircular Canals, pathology, surgery}, pmid = {25917654} }
Yoneda, S. and Tokumasu, K.	Frequency analysis of body sway in the upright posture. Statistical study in cases of peripheral vestibular disease. [Abstract] [BibTeX]	1986	Acta oto-laryngologica Vol. 102(1-2), pp. 87-92	article
Abstract: The frequency component of shift in the centre of gravity while standing upright was investigated in 14 normal subjects and 30 patients with peripheral vestibular disease. Relative changes in the square root value of the power in each small frequency band of 0.1 and 0.2 Hz in frequencies of less than 2 Hz were evaluated statistically for four groups, viz. a group of normal subjects, and patients with Ménière's disease, benign paroxysmal positional vertigo, and vestibular neuritis. The influence of visual control in each group and the difference between each pathological group and the normal subjects were examined statistically. The combination of a minor change in each small frequency band is considered to be utilizable to establish a differential diagnosis for the three groups of peripheral vestibular disease and versus the normal group.
BibTeX: @article{Yoneda1986, author = {Yoneda, S and Tokumasu, K}, title = {Frequency analysis of body sway in the upright posture. Statistical study in cases of peripheral vestibular disease.}, journal = {Acta oto-laryngologica}, year = {1986}, volume = {102}, issue = {1-2}, pages = {87--92}, keywords = {Adult; Aged; Humans; Labyrinth Diseases, diagnosis; Meniere Disease, diagnosis; Middle Aged; Movement; Neuritis, diagnosis; Postural Balance; Posture; Vertigo, diagnosis; Vestibular Nerve; Vestibule, Labyrinth; Vestibulocochlear Nerve Diseases, diagnosis; Vision, Ocular, physiology}, pmid = {3488637} }
Cohen, H.S., Stewart, M.G., Brissett, A.E., Olson, K.L., Takashima, M. and Sangi-Haghpeykar, H.	Frequency of sinus disease in normal subjects and patients with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2010	ORL; journal for oto-rhino-laryngology and its related specialties Vol. 72(1), pp. 63-67	article	DOI
Abstract: To determine if patients with benign paroxysmal positional vertigo (BPPV) have a higher frequency of rhinosinusitis than people with normal vestibular function. The subjects were 52 patients with BPPV and 46 normal people. Every subject had a sinus CT scan, a blood draw for IgE and a rhinologic examination by an otolaryngologist. The frequency of rhinosinusitis based on physician diagnosis was 49% and based on CT scan findings 59%. This difference approached significance (p = 0.08). The observed frequency of rhinosinusitis was higher than predicted by survey data about the southern US region. The data trended toward higher prevalence of rhinosinusitis (by physician diagnosis) in the BPPV patients versus controls (58 vs. 39%, p = 0.06). BPPV patients have a higher frequency of sinus disease compared to people with normal vestibular systems, perhaps due to age differences, but physiologic factors may also be involved. The higher frequency of rhinosinusitis in this geographical area than reported rates based on survey data raises concerns about the usefulness of questionnaire data for estimating population prevalence.
BibTeX: @article{Cohen2010a, author = {Cohen, H S and Stewart, M G and Brissett, A E and Olson, K L and Takashima, M and Sangi-Haghpeykar, H}, title = {Frequency of sinus disease in normal subjects and patients with benign paroxysmal positional vertigo.}, journal = {ORL; journal for oto-rhino-laryngology and its related specialties}, year = {2010}, volume = {72}, issue = {1}, pages = {63--67}, doi = {https://doi.org/10.1159/000296304}, keywords = {Case-Control Studies; Chi-Square Distribution; Female; Humans; Immunoglobulin E, blood; Male; Middle Aged; Paranasal Sinus Diseases, complications, diagnostic imaging, epidemiology; Risk Factors; Texas, epidemiology; Tomography, X-Ray Computed; Vertigo, complications, epidemiology, physiopathology}, pmid = {20424495} }
Suzuki, M., Kadir, A., Hayashi, N. and Takamoto, M.	Functional model of benign paroxysmal positional vertigo using an isolated frog semicircular canal. [Abstract] [BibTeX]	1996	Journal of vestibular research : equilibrium & orientation Vol. 6(2), pp. 121-125	article
Abstract: Bull frogs posterior semicircular canals (psc) wee used to simulate the condition of benign paroxysmal positional vertigo (BPPV). The psc was isolated in frog Ringer's solution, and the saccular otoconia were used as a responsible material to stimulate the cupula. When the otoconia were placed on the cupular surface to mimic the condition of cupulolithiasis, the psc ampullary nerve action potentials instantaneously changed according to the direction of the gravity produced by otoconia. When the otoconia were dropped into the canal to mimic the condition of moving otoconia in the canal, the action potentials changed together with the otoconial flow after a latent period. Both cupulolithiasis and moving otoconia are possibly valid mechanisms of BPPV, since they effectively stimulate the cupula. However, moving otoconia with a latent period would better explain clinical features of BPPV.
BibTeX: @article{Suzuki1996, author = {Suzuki, M and Kadir, A and Hayashi, N and Takamoto, M}, title = {Functional model of benign paroxysmal positional vertigo using an isolated frog semicircular canal.}, journal = {Journal of vestibular research : equilibrium & orientation}, year = {1996}, volume = {6}, issue = {2}, pages = {121--125}, keywords = {Action Potentials; Animals; In Vitro Techniques; Male; Models, Neurological; Nervous System, physiopathology; Otolithic Membrane, physiopathology; Posture; Rana catesbeiana; Semicircular Canals, innervation, physiopathology; Vertigo, etiology, physiopathology}, pmid = {8925114} }
Parnes, L.S. and Robichaud, J.	Further observations during the particle repositioning maneuver for benign paroxysmal positional vertigo. [BibTeX]	1997	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 116(2), pp. 238-243	article	DOI
BibTeX: @article{Parnes1997, author = {Parnes, L S and Robichaud, J}, title = {Further observations during the particle repositioning maneuver for benign paroxysmal positional vertigo.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {1997}, volume = {116}, issue = {2}, pages = {238--243}, doi = {https://doi.org/10.1016/S0194-59989770333-4}, keywords = {Adult; Aged; Ambulatory Care; Endolymph, physiology; Female; Head, physiology; Humans; Labyrinthitis, complications, diagnosis, physiopathology; Middle Aged; Movement; Nystagmus, Pathologic, diagnosis, physiopathology; Posture; Semicircular Canals, physiopathology; Vertigo, diagnosis, etiology, therapy}, pmid = {9051072} }
Gacek, R.R.	Further observations on posterior ampullary nerve transection for positional vertigo. [Abstract] [BibTeX]	1978	The Annals of otology, rhinology, and laryngology Vol. 87(3 Pt 1), pp. 300-305	article	DOI
Abstract: An evaluation was made on ten patients with benign paroxysmal positional vertigo (BPPV) in whom transection of the posterior ampullary nerve was performed by the middle ear approach under local anesthesia. The undermost ear in the provocative test position was selected for surgery. All ten patients were relieved of positional vertigo by the procedure. Of the five patients who were relieved of BPPV by posterior ampullary nerve transection prior to 1974, the long-term follow-up on four revealed continued relief of vertigo. Five additional patients treated by this surgical procedure since 1975 have also experienced relief from BPPV, but a moderate sensorineural hearing loss occurred in one patient. Two additional patients with BPPV were explored surgically but the singular canal could not be located. Persistence of the vertigo in these two patients strengthens the conclusion that the posterior semicircular canal sense organ is largely responsible for BPPV.
BibTeX: @article{Gacek1978, author = {Gacek, R R}, title = {Further observations on posterior ampullary nerve transection for positional vertigo.}, journal = {The Annals of otology, rhinology, and laryngology}, year = {1978}, volume = {87}, issue = {3 Pt 1}, pages = {300--305}, doi = {https://doi.org/10.1177/000348947808700301}, keywords = {Adult; Ear, Inner, surgery; Evaluation Studies as Topic; Female; Follow-Up Studies; Humans; Male; Middle Aged; Vertigo, surgery}, pmid = {655566} }
Ichijo, H. and Akita, M.	Gender difference and laterality of sleep position. [Abstract] [BibTeX]	2018	Auris, nasus, larynx Vol. 45(3), pp. 592-597	article	DOI
Abstract: A higher incidence in women (approximately 7:3) and a predominant involvement of the right ear (approximately 7:5) are interesting features of BPPV (benign paroxysmal positional vertigo). It is speculated that these features are related to sleep position. The first aim of this study was to compare the frequency of position shifts during sleep between men and women. The second aim was to elucidate any differences in sleep position between men and women. The third aim was to clarify the laterality of sleep position. We retrospectively selected the data of 30 males (mean, 53.1 years) and 22 females (mean, 50.6 years) diagnosed as mild or moderate obstructive sleep apnea. A position sensor was attached to the patient's anterior chest. Supine position was defined as less than 45° tilt, and lateral position was defined as more than 45° tilt. A single overnight laboratory polysomnography provided the number of position shifts, total sleep time, sleep time spent in the supine position (S), sleep time spent in the right-side-down lateral position (R), and sleep time spent in the left-side-down lateral position (L). The mean value and standard deviation of the number of position shifts per hour was 2.4±1.3 in males, and 2.3±1.1 in females. There was no significant difference between males and females. Twelve cases (40%) were lateral type (SR+L) in males. Ten cases (45%) were lateral type, and 12 (55%) were supine type in females. There was no significant difference between males and females. Seventeen cases (56.6%) were right-dominant type (R-L>0), and 13 (43.3%) were left-dominant type (R-L<0) in males. Thirteen cases (59%) were right-dominant type, and 9 (41%) were left-dominant type in females. Body position and the number of position shifts during sleep differ substantially between individuals. There is no gender difference in the frequency of position shifts. Although the supine type is more common than the lateral type, there is no gender difference in sleep position. Therefore, the reason of higher incidence in women is not related to sleep. The right-dominant type occurs more than the left-dominant type in both genders. It is possible that this behavior is the reason for the predominant involvement of the right ear in BPPV.
BibTeX: @article{Ichijo2018, author = {Ichijo, Hiroaki and Akita, Miwaoki}, title = {Gender difference and laterality of sleep position.}, journal = {Auris, nasus, larynx}, year = {2018}, volume = {45}, issue = {3}, pages = {592--597}, doi = {https://doi.org/10.1016/j.anl.2017.08.004}, keywords = {Benign Paroxysmal Positional Vertigo, physiopathology; Female; Humans; Male; Middle Aged; Polysomnography; Posture; Retrospective Studies; Sex Factors; Sleep; Sleep Apnea, Obstructive; Supine Position; Benign paroxysmal positional vertigo; Lateral position; Micro-otoconia accumulation theory; Polysomnography; Position sensor; Sleep time; Supine position}, pmid = {28863980} }
Ogun, O.A., Janky, K.L., Cohn, E.S., Büki, B. and Lundberg, Y.W.	Gender-based comorbidity in benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2014	PloS one Vol. 9(9), pp. e105546	article	DOI
Abstract: It has been noted that benign paroxysmal positional vertigo (BPPV) may be associated with certain disorders and medical procedures. However, most studies to date were done in Europe, and epidemiological data on the United States (US) population are scarce. Gender-based information is even rarer. Furthermore, it is difficult to assess the relative prevalence of each type of association based solely on literature data, because different comorbidities were reported by various groups from different countries using different patient populations and possibly different inclusion/exclusion criteria. In this study, we surveyed and analyzed a large adult BPPV population (n = 1,360 surveyed, 227 completed, most of which were recurrent BPPV cases) from Omaha, NE, US, and its vicinity, all diagnosed at Boys Town National Research Hospital (BTNRH) over the past decade using established and consistent diagnostic criteria. In addition, we performed a retrospective analysis of patients' diagnostic records (n = 1,377, with 1,360 adults and 17 children). The following comorbidities were found to be significantly more prevalent in the BPPV population when compared to the age- and gender-matched general population: ear/hearing problems, head injury, thyroid problems, allergies, high cholesterol, headaches, and numbness/paralysis. There were gender differences in the comorbidities. In addition, familial predisposition was fairly common among the participants. Thus, the data confirm some previously reported comorbidities, identify new ones (hearing loss, thyroid problems, high cholesterol, and numbness/paralysis), and suggest possible predisposing and triggering factors and events for BPPV.
BibTeX: @article{Ogun2014, author = {Ogun, Oluwaseye Ayoola and Janky, Kristen L and Cohn, Edward S and Büki, Bela and Lundberg, Yunxia Wang}, title = {Gender-based comorbidity in benign paroxysmal positional vertigo.}, journal = {PloS one}, year = {2014}, volume = {9}, issue = {9}, pages = {e105546}, doi = {https://doi.org/10.1371/journal.pone.0105546}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, epidemiology, genetics; Comorbidity; Female; Genetic Predisposition to Disease; Headache, epidemiology; Hearing Loss, epidemiology; Humans; Male; Middle Aged; Nebraska, epidemiology; Recurrence; Retrospective Studies; Sex Factors; Young Adult}, pmid = {25187992} }
Møller, M.N., Kirkeby, S., Vikeså, J., Nielsen, F.C. and Cayé-Thomasen, P.	Gene expression in the human endolymphatic sac: the solute carrier molecules in endolymphatic fluid homeostasis. [Abstract] [BibTeX]	2015	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 36(5), pp. 915-922	article	DOI
Abstract: The purpose of the present study is to explore, demonstrate, and describe the expression of genes related to the solute carrier (SLC) molecules of ion transporters in the human endolymphatic sac. cDNA microarrays and immunohistochemistry were used for analyses of fresh human endolymphatic sac tissue samples. Twelve tissue samples of the human endolymphatic sac were obtained during translabyrinthine surgery for vestibular schwannoma. Microarray technology was used to investigate tissue sample expression of solute carrier family genes, using adjacent dura mater as control. Immunohistochemistry was used for verification of translation of selected genes, as well as localization of the specific protein within the sac. An extensive representation of the SLC family genes were upregulated in the human endolymphatic sac, including SLC26a4 Pendrin, SLC4a1 sodium-bicarbonate transporter, SLC9a2 sodium-hydrogen transporter, SLC12a3 thiazide-sensitive Na-Cl transporter, and SLC34a2 sodium-phosphate transporter. Several important ion transporters of the SLC family are expressed in the human endolymphatic sac, including Pendrin, the thiazide-sensitive Na-Cl transporter, and the Na-phosphate transporter SLC34a2. The data provide a new knowledge base considering the ion-dependent metabolic mechanisms maintaining inner ear homeostasis. More specifically, the results indicate a strong similarity with the ion transportation occurring in the kidney collecting ducts. In addition, the findings prompt a revision of the theories behind contemporary pharmacological treatment of Ménière's disease and may broaden the understanding of the pathogenesis of BPPV.
BibTeX: @article{Moeller2015, author = {Møller, Martin Nue and Kirkeby, Svend and Vikeså, Jonas and Nielsen, Finn Cilius and Cayé-Thomasen, Per}, title = {Gene expression in the human endolymphatic sac: the solute carrier molecules in endolymphatic fluid homeostasis.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2015}, volume = {36}, issue = {5}, pages = {915--922}, doi = {https://doi.org/10.1097/MAO.0000000000000669}, keywords = {Adult; Body Fluids, metabolism; Endolymphatic Sac, metabolism; Female; Gene Expression; Homeostasis, physiology; Humans; Immunohistochemistry; Male; Membrane Transport Proteins, metabolism; Middle Aged; Oligonucleotide Array Sequence Analysis}, pmid = {25486439} }
Mira, E.	General view of vestibular disorders. [Abstract] [BibTeX]	1995	Acta oto-laryngologica. Supplementum Vol. 519, pp. 13-16	article
Abstract: The role of the labyrinthine receptors is to transduce the forces associated with head acceleration into a biological signal. Vestibular centres in the brain use this signal, in cooperation with visual and somatosensory signals, to detect the motion of the head and its position relative to gravity vector and to produce motor reflexes to maintain equilibrium and accurate vision during head movements. The evaluation of vestibular function is the mainstay of the general otoneurological examination and relies upon testing for static and dynamic imbalance in the vestibular system, positional testing, eye movement testing and testing for visual-vestibular interaction. The more recent aspects of two conditions, benign paroxysmal positional vertigo and ocular tilt reaction, are discussed. Their pathophysiological mechanisms are reinterpreted and re-evaluated on the basis of present knowledge of vestibulo-oculomotor function.
BibTeX: @article{Mira1995, author = {Mira, E}, title = {General view of vestibular disorders.}, journal = {Acta oto-laryngologica. Supplementum}, year = {1995}, volume = {519}, pages = {13--16}, keywords = {Eye, physiopathology; Eye Movements; Head, physiopathology; Humans; Models, Biological; Neurologic Examination; Posture; Vertigo, physiopathology; Vestibular Diseases, diagnosis, physiopathology; Vestibule, Labyrinth, physiopathology}, pmid = {7610848} }
Oh, A.K.	Genetics of vestibulopathy and migraine. [Abstract] [BibTeX]	2013	Current opinion in otolaryngology & head and neck surgery Vol. 21(5), pp. 469-472	article	DOI
Abstract: Our understanding of the genetics of vestibular loss lags far behind advances in the genetics of hearing loss, in large part because a basic awareness of hearing is a universal human experience, in those without congenital deafness, whereas public awareness of vestibular function is virtually nonexistent. This review highlights the challenges brought on by this disparity and recent advances in genetics, which provide hope for improved diagnosis and treatment of vestibular loss. Linkage analysis has resulted in mapping of genetic loci for familial vestibulopathies with normal hearing and migraine. Targeted gene therapy provides hope for those with permanent vestibular loss. Recent discoveries emphasize the need for better ascertainment of vestibular loss in general clinical practice.
BibTeX: @article{Oh2013, author = {Oh, Andrew K}, title = {Genetics of vestibulopathy and migraine.}, journal = {Current opinion in otolaryngology & head and neck surgery}, year = {2013}, volume = {21}, issue = {5}, pages = {469--472}, doi = {https://doi.org/10.1097/MOO.0b013e32836464d5}, keywords = {Benign Paroxysmal Positional Vertigo; Genetic Linkage; Hearing Loss, genetics; Humans; Migraine Disorders, etiology, genetics; Molecular Targeted Therapy; Vertigo, complications, genetics, therapy}, pmid = {23892793} }
Furman, J.M., Raz, Y. and Whitney, S.L.	Geriatric vestibulopathy assessment and management. [Abstract] [BibTeX]	2010	Current opinion in otolaryngology & head and neck surgery Vol. 18(5), pp. 386-391	article	DOI
Abstract: This review discusses the demographics of dizziness in the older person, the evaluation of the older dizzy patient and how the treatment of dizziness in older patients differs from that in younger individuals. Seven percent of all visits to primary care physicians for patients older than 65 years of age are for dizziness, and dizziness is the most common complaint for patients older than 75 years. In a German study, the 12-month prevalence of vertigo in the general population was 5% with an incidence of 1.4% in adults overall. For individuals aged 60-69 the 12-month prevalence was found to be 7.2% and in individuals 70 years of age or older 8.9%. Data from the United States National Health and Nutrition Examination Surveys indicated that the prevalence of vestibular dysfunction for individuals in the seventh decade of life, eighth decade of life, and older was 49.4, 68.7, and 84.8 percent, respectively. Only subtle age effects are seen on caloric and rotational testing whereas vestibular evoked myogenic potentials (VEMPs) change somewhat with age. Particle repositioning for benign paroxysmal positional vertigo combined with vestibular rehabilitation is more effective than only performing the repositioning maneuver. Tai Chi appears to be an effective intervention for older adults at risk for falling. When caring for an older dizzy patient always assess medication use, perform a Dix-Hallpike maneuver, obtain orthostatic vital signs, discuss fall risk precautions, and consider referral for vestibular rehabilitation.
BibTeX: @article{Furman2010, author = {Furman, Joseph M and Raz, Yael and Whitney, Susan L}, title = {Geriatric vestibulopathy assessment and management.}, journal = {Current opinion in otolaryngology & head and neck surgery}, year = {2010}, volume = {18}, issue = {5}, pages = {386--391}, doi = {https://doi.org/10.1097/MOO.0b013e32833ce5a6}, keywords = {Age Factors; Aged; Aged, 80 and over; Dizziness, etiology; Female; Humans; Male; Middle Aged; Vertigo, etiology; Vestibular Diseases, complications, diagnosis, therapy; Vestibule, Labyrinth, anatomy & histology, physiology, physiopathology}, pmid = {20613528} }
Amor-Dorado, J.C., Llorca, J., Costa-Ribas, C., Garcia-Porrua, C. and Gonzalez-Gay, M.A.	Giant cell arteritis: a new association with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2004	The Laryngoscope Vol. 114(8), pp. 1420-1425	article	DOI
Abstract: To assess the incidence and characteristics of both benign paroxysmal positional vertigo (BPPV) and positional nystagmus in a series of patients with giant cell arteritis (GCA). Patients diagnosed with GCA between June 1999 and May 2001 at the single hospital for a defined population were examined prospectively. Patients included in this study fulfilled the 1990 American College of Rheumatology classification criteria for GCA. Otologic and oculographic studies were performed. Type, frequency, and outcome of positional oculographic findings was assessed. Patients were required to have been examined within 1 week after the onset of corticosteroid therapy. Data found in GCA patients were compared with those observed in an age, sex, and ethnically matched control population. Further studies in patients and controls were performed 3 and 6 months later. Forty-four patients and 44 matched controls were included in this study. Nine (20.5%) GCA patients fulfilled diagnostic criteria of BPPV compared with only 1 (2.3%) of the controls (P =.007). In seven of these nine GCA patients, BPPV was related to the posterior and two to the horizontal semicircular canals, respectively. Horizontal nystagmus was found in seven GCA patients who developed nystagmus in the head hanging position test compared with none in the controls (P =.006). The present study shows a higher frequency of BPPV in GCA than in matched controls. Because most clinical manifestations in GCA are caused by ischemic complications, our results suggest an ischemic etiology as responsible for BPPV in these elderly patients. According to these results, GCA may constitute a new association with BPPV.
BibTeX: @article{Amor-Dorado2004, author = {Amor-Dorado, Juan C and Llorca, Javier and Costa-Ribas, Carmen and Garcia-Porrua, Carlos and Gonzalez-Gay, Miguel A}, title = {Giant cell arteritis: a new association with benign paroxysmal positional vertigo.}, journal = {The Laryngoscope}, year = {2004}, volume = {114}, issue = {8}, pages = {1420--1425}, doi = {https://doi.org/10.1097/00005537-200408000-00020}, keywords = {Giant Cell Arteritis, complications, drug therapy, physiopathology; Glucocorticoids, therapeutic use; Humans; Middle Aged; Nystagmus, Pathologic; Prednisone, therapeutic use; Semicircular Canals, physiopathology; Vertigo, complications, physiopathology; Vestibular Function Tests}, pmid = {15280720} }
Czesnik, D. and Liebetanz, D.	Granddaughter's somersault treats cupulolithiasis of the horizontal semicircular canal. [Abstract] [BibTeX]	2013	American journal of otolaryngology Vol. 34(1), pp. 72-74	article	DOI
Abstract: We report on a 61-year-old woman with cupulolithiasis of the right horizontal semicircular canal, which is usually difficult to treat. The patient reported that several years ago, similar symptoms relieved completely after having performed several somersaults together with her granddaughter. This time, repetitive somersaults were again effective to treat her benign paroxysmal positional vertigo. Acceleration during a somersault may induce an intracanalicular force strong enough to detach otoconia debris from the cupula. Rolling may then promote their reentrance into the utricle. This case suggests that repetitive somersaults may be an alternative treatment of cupulolithiasis of the horizontal semicircular canal.
BibTeX: @article{Czesnik2013, author = {Czesnik, Dirk and Liebetanz, David}, title = {Granddaughter's somersault treats cupulolithiasis of the horizontal semicircular canal.}, journal = {American journal of otolaryngology}, year = {2013}, volume = {34}, issue = {1}, pages = {72--74}, doi = {https://doi.org/10.1016/j.amjoto.2012.07.002}, keywords = {Benign Paroxysmal Positional Vertigo; Calculi, complications, physiopathology, therapy; Exercise Therapy, methods; Female; Follow-Up Studies; Humans; Middle Aged; Posture, physiology; Semicircular Canals, physiopathology; Vertigo, etiology, physiopathology}, pmid = {22999308} }
Kirschen, M.P. and Friedlander, J.A.	Grounded for an ethical dilemma: disequilibrium in a commercial airline pilot. [Abstract] [BibTeX]	2012	Continuum (Minneapolis, Minn.) Vol. 18(5 Neuro-otology), pp. 1158-1162	article	DOI
Abstract: This article presents the case of a 41-year-old airline pilot with benign paroxysmal positional vertigo who requests that his diagnosis not be disclosed to his commercial airline employer or his aviation medical examiner because it may result in the suspension of medical certification. The legal and ethical requirements for physicians reporting impaired pilots are discussed as well as practical recommendations for handling such situations. The argument is made that a physician's obligation to honor patient confidentiality should not take precedence over his or her duty to protect the safety and well-being of the airplane passengers and the general public. If the patient chooses not to self-report, a physician has an ethical obligation to report the patient's medical condition to the Federal Aviation Administration.
BibTeX: @article{Kirschen2012, author = {Kirschen, Matthew P and Friedlander, Joel A}, title = {Grounded for an ethical dilemma: disequilibrium in a commercial airline pilot.}, journal = {Continuum (Minneapolis, Minn.)}, year = {2012}, volume = {18}, issue = {5 Neuro-otology}, pages = {1158--1162}, doi = {https://doi.org/10.1212/01.CON.0000421624.64148.5a}, keywords = {Adult; Aerospace Medicine, ethics, legislation & jurisprudence; Benign Paroxysmal Positional Vertigo; Certification, ethics, legislation & jurisprudence; Duty to Warn, ethics, legislation & jurisprudence; Ethics, Medical; Humans; Male; Neurotology, ethics, legislation & jurisprudence; Occupational Medicine, ethics, legislation & jurisprudence; Truth Disclosure, ethics; Vertigo}, pmid = {23042065} }
Shenoy, A.M.	Guidelines in practice: therapies for benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2012	Continuum (Minneapolis, Minn.) Vol. 18(5 Neuro-otology), pp. 1172-1176	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo. This article describes the presentation and physical examination of a patient with BPPV. The case is then used to explore various features of the diagnosis, examination, and management of BPPV, with a focus on the 2008 AAN practice parameter on therapies for BPPV.
BibTeX: @article{Shenoy2012, author = {Shenoy, Anant M}, title = {Guidelines in practice: therapies for benign paroxysmal positional vertigo.}, journal = {Continuum (Minneapolis, Minn.)}, year = {2012}, volume = {18}, issue = {5 Neuro-otology}, pages = {1172--1176}, doi = {https://doi.org/10.1212/01.CON.0000421627.43063.79}, keywords = {Benign Paroxysmal Positional Vertigo; Female; Humans; Middle Aged; Physical Examination, methods; Practice Guidelines as Topic; Vertigo, diagnosis, therapy}, pmid = {23042068} }
Baloh, R.W.	Harold Schuknecht and pathology of the ear. [Abstract] [BibTeX]	2001	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 22(1), pp. 113-122	article
Abstract: Like Joseph Toynbee and Karl Wittmaack before him, Harold Schuknecht understood that studying pathology was the key to advancing the scientific basis of neurotology. His work elucidated the pathophysiology of the most common neurotologic disorders, including benign paroxysmal positional vertigo, Meniere's disease, and viral neurolabyrinthitis. Schuknecht was a tireless crusader against medical and surgical treatments that he considered to have little scientific foundation. His textbook Pathology of the Ear remains the definitive work in the field.
BibTeX: @article{Baloh2001, author = {Baloh, R W}, title = {Harold Schuknecht and pathology of the ear.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2001}, volume = {22}, issue = {1}, pages = {113--122}, keywords = {Ear, pathology, physiopathology; History, 20th Century; Humans; Meniere Disease, diagnosis, history, physiopathology; Otolaryngology, history; Semicircular Canals, pathology; United States; Vertigo, diagnosis, history, physiopathology}, pmid = {11314705} }
Chiarella, G., Russo, D., Monzani, F., Petrolo, C., Fattori, B., Pasqualetti, G., Cassandro, E. and Costante, G.	HASHIMOTO THYROIDITIS AND VESTIBULAR DYSFUNCTION. [Abstract] [BibTeX]	2017	Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists Vol. 23(7), pp. 863-868	article	DOI
Abstract: The aim of this review was to analyze the existing literature concerning the relationship between Hashimoto thyroiditis (HT) and vestibular dysfunction. We used electronic databases (PubMed, EMBASE, Cochrane Library) to search and collect all published articles about the association between HT and vestibular disorders. Several observational and retrospective studies have postulated a relationship between thyroid autoimmunity and vestibular disorders. In most cases, an appropriate control group was lacking, and the impact of thyroid functional status could not precisely be established. In recent years, two well-designed prospective studies have provided convincing evidence that the association is not random. One article reported that patients with Ménière disease (MD) had a significantly higher prevalence of positive anti-thyroid autoantibody as compared to healthy controls. Moreover, more than half of MD patients had either positive anti-thyroid or non-organ-specific autoantibody titers, compared to less than 30% of both patients with unilateral vestibular paresis without cochlear involvement and healthy controls. Another study found that patients with benign paroxysmal positional vertigo (BPPV) had significantly higher serum thyroid-stimulating hormone and antithyroid autoantibody levels than healthy controls. Additionally, almost one-fifth of euthyroid patients with HT had signs of BPPV. The published results indicate that patients with MD or BPPV are potential candidates to also develop HT. Thus, in HT patients, the presence of even slight symptoms or signs potentially related to vestibular lesions should be carefully investigated. AITD = autoimmune thyroid disease; BPPV = benign paroxysmal positional vertigo; EH = endolymphatic hydrops; HT = Hashimoto thyroiditis; L-T = L-thyroxine; MD = Ménière disease; PS = Pendred syndrome; Tg = thyroglobulin; TPO = thyroid peroxidase; TSH = thyroid-stimulating hormone.
BibTeX: @article{Chiarella2017, author = {Chiarella, Giuseppe and Russo, Diego and Monzani, Fabio and Petrolo, Claudio and Fattori, Bruno and Pasqualetti, Giuseppe and Cassandro, Ettore and Costante, Giuseppe}, title = {HASHIMOTO THYROIDITIS AND VESTIBULAR DYSFUNCTION.}, journal = {Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists}, year = {2017}, volume = {23}, issue = {7}, pages = {863--868}, doi = {https://doi.org/10.4158/EP161635.RA}, keywords = {Autoantibodies, immunology; Autoimmune Diseases, complications, immunology; Benign Paroxysmal Positional Vertigo, complications, immunology; Hashimoto Disease, complications, immunology; Humans; Meniere Disease, complications, immunology; Vestibular Diseases, complications, immunology}, pmid = {28534686} }
Faldon, M.E. and Bronstein, A.M.	Head accelerations during particle repositioning manoeuvres. [Abstract] [BibTeX]	2008	Audiology & neuro-otology Vol. 13(6), pp. 345-356	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) due to canalithiasis can be treated with particle repositioning manoeuvres, which aim to evacuate trapped particles from the semicircular canals (SCC). The movement of particles within the SCC is affected by gravity as well as by the accelerations of the head during the manoeuvres. Moreover, as experienced by the particles, gravity is indistinguishable from an upward acceleration of the SCC in free space. We used a set of three orthogonal linear accelerometers to measure the net three-dimensional linear acceleration vector acting on the head during the Hallpike manoeuvre and Epley and Semont particle repositioning manoeuvres (which are used to treat posterior canal BPPV). The projection of the net acceleration vector onto the SCC planes showed that both the Epley and Semont manoeuvres approximated to stepwise, 360 degrees , backward rotations in the plane of the targeted posterior canal. Angular velocity measurements however showed that the rotational component during the central stages of these two manoeuvres is opposite in direction. A simple model of head rotations during particle repositioning manoeuvres was created which showed good agreement to the linear acceleration measurements. Analysis of modelled and measured data identified that speed of movement during the Semont manoeuvre should be critical to its clinical success.
BibTeX: @article{Faldon2008, author = {Faldon, M E and Bronstein, A M}, title = {Head accelerations during particle repositioning manoeuvres.}, journal = {Audiology & neuro-otology}, year = {2008}, volume = {13}, issue = {6}, pages = {345--356}, doi = {https://doi.org/10.1159/000136153}, keywords = {Acceleration; Gravity Sensing, physiology; Head Movements, physiology; Humans; Lithiasis, diagnosis, physiopathology, rehabilitation; Models, Biological; Posture; Rotation; Semicircular Canals, physiopathology; Vertigo, diagnosis, physiopathology, rehabilitation}, pmid = {18525198} }
Norré, M.E.	Head extension effect in static posturography. [Abstract] [BibTeX]	1995	The Annals of otology, rhinology, and laryngology Vol. 104(7), pp. 570-573	article	DOI
Abstract: The effect of head extension on the standing position has been studied by analysis of recordings made by static posturography type III (SPGIII), a set of six test of posturography for sensory interaction. The head extension effect in posturography was evaluated by comparing the results of testing with head extension on a stable platform and on foam rubber to testing with a normal head position. In normal subjects head extension increased the postural sway, but there was no more effect on foam rubber than on the stable platform. For patients with peripheral vestibular disorders the head extension effect on the measured postural sway was evaluated by the difference from the normal condition. This difference could be positive, zero, or negative on the stable platform as well as on foam rubber. In both patients and normal subjects, foam rubber had no more effect than the stable platform. The several types of results could be seen in each category of peripheral vestibular disorders. Only minor nuances could be observed: positive differences were more pronounced in benign paroxysmal positional vertigo, whereas negative ones were more obvious in unilateral vestibular deficits. These findings, moreover, deny that head extension in SPGIII should be considered a condition revealing vestibular dysfunction, as has been supposed. As head extension has an influence on the neck proprioceptor as well as on the position of the otoliths, its effect is ambiguous, which makes the interpretation rather difficult. A neck proprioceptive as well as an otolithic explanation appears to have some clinical support.
BibTeX: @article{Norre1995a, author = {Norré, M E}, title = {Head extension effect in static posturography.}, journal = {The Annals of otology, rhinology, and laryngology}, year = {1995}, volume = {104}, issue = {7}, pages = {570--573}, doi = {https://doi.org/10.1177/000348949510400712}, keywords = {Head; Humans; Posture; Vestibular Diseases, physiopathology}, pmid = {7598371} }
Kaplan, D.M., Slovik, Y., Joshua, B.Z., Puterman, M. and Kraus, M.	Head shaking during Dix-Hallpike exam increases the diagnostic yield of posterior semicircular canal BPPV. [Abstract] [BibTeX]	2013	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 34(8), pp. 1444-1447	article	DOI
Abstract: To examine whether shaking the head during the DH exam (HSDH) may improve diagnosis of posterior semicircular canal benign paroxysmal positional vertigo (pBPPV) in patients with a negative Dix-Hallpike (DH) examination. A prospective cohort clinical study on consecutive patients with dizziness, who were seen by 2 experienced neurotologists. Patients underwent a complete neurotology examination, including positioning testing with roll test and DH. Patients with a negative DH underwent a HSDH. Patients with a positive DH (Group 1) or only with a positive HSDH (Group 2) underwent a particle reposition maneuver (PRM), which was a modification of the Epley maneuver. Variables including sex, age, the duration of symptoms until diagnosis, and the number of visits required until cure were examined in each group. A tertiary dizziness clinic and in 2 private clinics. All patients diagnosed with pBPPV. DH test after head shaking and comparison of variables between the 2 study groups. Sixty nine patients were diagnosed with pBPPV (Group 1). Twelve additional patients were negative on DH but were found positive on HSDH (Group 2), improving the diagnostic yield by 14.8%. There was no statistical relation between the 2 groups and the variables examined; however, there was a trend for longer duration of symptoms (44.3 versus 64 d) and less visits until cure (1.5 versus 1.7 visits) in Group 2. Patients with a negative DH should undergo a HSDH. Patients only diagnosed as pBPPV by a positive HSDH may represent a subgroup with a milder form of disease.
BibTeX: @article{Kaplan2013, author = {Kaplan, Daniel M and Slovik, Youval and Joshua, Be Zion and Puterman, Marc and Kraus, Mordechai}, title = {Head shaking during Dix-Hallpike exam increases the diagnostic yield of posterior semicircular canal BPPV.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2013}, volume = {34}, issue = {8}, pages = {1444--1447}, doi = {https://doi.org/10.1097/MAO.0b013e3182953120}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo; Dizziness, diagnosis, physiopathology; Female; Humans; Male; Middle Aged; Patient Positioning; Physical Examination, methods; Semicircular Canals, physiopathology; Vertigo, diagnosis, physiopathology}, pmid = {23928522} }
Guidetti, G., Monzani, D. and Civiero, N.	Head shaking nystagmus in the follow-up of patients with vestibular diseases. [Abstract] [BibTeX]	2002	Clinical otolaryngology and allied sciences Vol. 27(2), pp. 124-128	article
Abstract: We examined 420 patients with vestibular diseases of different origin; 273 with peripheral vestibular disease and 147 with both peripheral and central vestibular disease. Recurrent vestibulopathy like Menière's disease, or benign paroxysmal positional vertigo, were not included. Patients were evaluated initially and 6 months after pharmacological and/or rehabilitation therapy. At the initial assessment, the head-shaking test was specific for the side of the lesion in both groups, even if spontaneous nystagmus was no longer present. Thus, head-shaking nystagmus is a physical sign that can be easily evoked and gives useful information about the presence of vestibulo-ocular reflex asymmetry. At the follow-up at 6 months, many changes in the head-shaking nystagmus were noted: in some cases it appeared, in some others it changed direction and more often it disappeared. There is actually no acceptable explanation for the disappearance of the head-shaking nystagmus, despite some evidence that vestibular compensation could play a role. It is definitely proved that sensitivity of the head-shaking test is really poor, especially in the course of time and, therefore, it should not be used alone in the follow-up of patients with vestibular disease.
BibTeX: @article{Guidetti2002, author = {Guidetti, G and Monzani, D and Civiero, N}, title = {Head shaking nystagmus in the follow-up of patients with vestibular diseases.}, journal = {Clinical otolaryngology and allied sciences}, year = {2002}, volume = {27}, issue = {2}, pages = {124--128}, keywords = {Adult; Aged; Aged, 80 and over; Evaluation Studies as Topic; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nystagmus, Physiologic; Sensitivity and Specificity; Vestibular Diseases, diagnosis, physiopathology; Vestibular Function Tests, methods}, pmid = {11994119} }
Fitzgerald, D.C.	Head trauma: hearing loss and dizziness. [Abstract] [BibTeX]	1996	The Journal of trauma Vol. 40(3), pp. 488-496	article
Abstract: Because the physicians who care for patients with head trauma may be family practitioners or internists, this article provides these physicians some knowledge of the causes and pathophysiology of such trauma with respect to neurologic sequelae to aid in their decisions to seek consultation with neurologists and otoneurologists in diagnosis and management. This article reviews the literature concerning differential diagnosis, appropriate evaluation, and possible treatments of patients who exhibit hearing loss and dizziness after head trauma, whiplash injuries, or both. I also relate those findings to my extensive experience with such neurologic problems. The findings are grouped according to injuries that cause dizziness, including trauma to the brain stem - eighth nerve complex, the semicircular canals (labyrinthine concussion), benign paroxysmal positional vertigo, Meniere's syndrome -- vestibular symptoms, perilymphatic fistula -- vestibular symptoms, and cervical vertigo; and those that cause hearing loss, including trauma to the brain, eighth nerve, middle ear, cochlear concussion, Meniere's syndrome, and perilymphatic fistula.
BibTeX: @article{Fitzgerald1996, author = {Fitzgerald, D C}, title = {Head trauma: hearing loss and dizziness.}, journal = {The Journal of trauma}, year = {1996}, volume = {40}, issue = {3}, pages = {488--496}, keywords = {Craniocerebral Trauma, complications; Diagnosis, Differential; Dizziness, diagnosis, etiology, therapy; Hearing Disorders, diagnosis, etiology, therapy; Humans; Referral and Consultation}, pmid = {8601878} }
Pollak, L. and Pollak, E.	Headache during a cluster of benign paroxysmal positional vertigo attacks. [Abstract] [BibTeX]	2014	The Annals of otology, rhinology, and laryngology Vol. 123(12), pp. 875-880	article	DOI
Abstract: In view of patients' recurrent complaints, we were interested in investigating the frequency and headache characteristics in patients during a benign paroxysmal positional vertigo (BPPV) cluster. Patients with BPPV treated at an outpatient dizziness clinic were interviewed about the presence of headache; its quality, localization, severity, time course, and aggravating and alleviating factors; and headache-related disability during their present vertigo cluster. Among 152 patients with BPPV, 53 (34.8%) reported headache associated with vertigo. According to The International Classification of Headache Disorders, 8 (15%) patients could be classified as migraine without aura (1.1), 14 (26%) were classified as infrequent episodic tension-type headache associated with pericranial tenderness (2.1.1), 23 (43%) were classified as infrequent episodic tension-type headache without pericranial tenderness (2.1.2), 6 (11%) had cervicogenic headache (11.2.1), and in 2 (4%) patients, the headache could not be specified (14.2). Fifty-two age-matched BPPV patients without headache did not differ in history of headaches, BPPV history, or background diseases. The distribution of canal involvement and number of treatment maneuvers was also similar in both groups. Headache is frequent in BPPV. The most common is tension-type headache, followed by migraine and cervicogenic headache. Head pain seems to be an independently associated epiphenomenon of BPPV that can worsen patients' distress.
BibTeX: @article{Pollak2014, author = {Pollak, Lea and Pollak, Eitan}, title = {Headache during a cluster of benign paroxysmal positional vertigo attacks.}, journal = {The Annals of otology, rhinology, and laryngology}, year = {2014}, volume = {123}, issue = {12}, pages = {875--880}, doi = {https://doi.org/10.1177/0003489414539921}, keywords = {Benign Paroxysmal Positional Vertigo, complications; Female; Headache, classification, complications, diagnosis; Humans; Male; Middle Aged; Recurrence; Time Factors; BPPV; headache}, pmid = {25015924} }
Bronstein, A.M., Kaski, D., Cutfield, N., Buckwell, D., Banga, R., Ray, J., Chavda, S. and Irving, R.	Head-Jolting Nystagmus: Occlusion of the Horizontal Semicircular Canal Induced by Vigorous Head Shaking. [Abstract] [BibTeX]	2015	JAMA otolaryngology-- head & neck surgery Vol. 141(8), pp. 757-760	article	DOI
Abstract: We report a new syndrome, which we are calling head-jolting nystagmus, that expands the differential diagnosis of head movement-induced paroxysmal vertigo. Two male patients (65 and 58 years old) described rotational vertigo after violent and brief (1- to 2-second) oscillations of the head (head jolting) that triggered intense horizontal nystagmus lasting 45 seconds. Accelerations of the head required to induce these episodes could only be achieved by the patients themselves. In case 1, the episodes gradually disappeared over a 6-year period. In case 2, magnetic resonance imaging (3-T) suggested a filling defect within the left horizontal semicircular canal. He underwent surgical canal plugging in March 2013 that resolved the symptoms. We attribute head-jolting nystagmus to dislodged material within the horizontal semicircular canal and provide a mechanistic model to explain its origin.
BibTeX: @article{Bronstein2015, author = {Bronstein, Adolfo M and Kaski, Diego and Cutfield, Nick and Buckwell, David and Banga, Rupan and Ray, Jaydip and Chavda, Swarupsinh and Irving, Richard}, title = {Head-Jolting Nystagmus: Occlusion of the Horizontal Semicircular Canal Induced by Vigorous Head Shaking.}, journal = {JAMA otolaryngology-- head & neck surgery}, year = {2015}, volume = {141}, issue = {8}, pages = {757--760}, doi = {https://doi.org/10.1001/jamaoto.2015.0711}, keywords = {Aged; Benign Paroxysmal Positional Vertigo, diagnosis, etiology; Head Movements; Humans; Male; Middle Aged; Nystagmus, Pathologic, diagnosis, etiology; Semicircular Canals; Syndrome}, pmid = {25996844} }
Welgampola, M.S., Croxson, G.R., McGarvie, L.A. and Halmagyi, G.M.	Head-shaking nystagmus and vertigo cured by lateral semicircular canal occlusion. [BibTeX]	2016	Journal of neurology Vol. 263(3), pp. 588-590	article	DOI
BibTeX: @article{Welgampola2016, author = {Welgampola, Miriam S and Croxson, Glen R and McGarvie, Leigh A and Halmagyi, G Michael}, title = {Head-shaking nystagmus and vertigo cured by lateral semicircular canal occlusion.}, journal = {Journal of neurology}, year = {2016}, volume = {263}, issue = {3}, pages = {588--590}, doi = {https://doi.org/10.1007/s00415-016-8027-1}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis; Head Movements; Humans; Male; Nystagmus, Pathologic, diagnosis; Semicircular Canals}, pmid = {26810724} }
Inukai, K., Koizuka, I. and Takahashi, S.	Head-tilting stabilometry in patients with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2008	Auris, nasus, larynx Vol. 35(1), pp. 31-35	article	DOI
Abstract: One of the pathologic conditions underlying benign paroxysmal positional vertigo (BPPV) is degeneration of the otolith organs. In this study, we examined changes in the parameters of stabilometry under an upright condition and head-tilt conditions in patients with BPPV. We performed stabilometry on 21 patients with right BPPV, on 21 patients with left BPPV and on 21 controls. First, the subject stood barefoot in an upright position with both feet together on the platform with eyes closed. Next, tilting of the head about 30 degrees to the left was added. Then, tilting about 30 degrees to the right was performed. In right BPPV patients, the total length of velocity vectors in the right or left direction on right or left head-tilt were significantly smaller than those in an upright position. The enveloped area and total length of velocity vectors in the right or left direction were significantly larger than those in controls. In left BPPV patients, there were no parameters that showed any significant difference. In this study, lesions of right BPPV patients were coincidentally more severe than those in left BPPV patients, and velocity vectors with head-tilts were significantly smaller than in an upright position. Using the total length of the velocity vectors, head-tilting stabilometry has the potential to become a reliable otolith function examination method.
BibTeX: @article{Inukai2008, author = {Inukai, Kenya and Koizuka, Izumi and Takahashi, Sugata}, title = {Head-tilting stabilometry in patients with benign paroxysmal positional vertigo.}, journal = {Auris, nasus, larynx}, year = {2008}, volume = {35}, issue = {1}, pages = {31--35}, doi = {https://doi.org/10.1016/j.anl.2007.06.007}, keywords = {Adult; Aged; Aged, 80 and over; Electrodiagnosis; Electronystagmography; Female; Hair Cells, Vestibular, physiology; Head Movements, physiology; Humans; Male; Middle Aged; Otolithic Membrane, innervation, physiopathology; Postural Balance, physiology; Reference Values; Reflex, Vestibulo-Ocular, physiology; Saccule and Utricle, innervation, physiopathology; Signal Processing, Computer-Assisted; Vertigo, etiology, physiopathology; Vestibular Function Tests; Vestibulocochlear Nerve Diseases, diagnosis, physiopathology}, pmid = {17826929} }
Guerra-Jiménez, G., Domènech-Vadillo, E., Álvarez-Morujo de Sande, M.G., González-Aguado, R., Galera-Ruiz, H., Morales Angulo, C., Martín-Mateos, A.J., Figuerola-Massana, E., Ramos-Macías, Á. and Domínguez-Durán, E.	Healing criteria: How should an episode of benign paroxistic positional vertigo of posterior semicircular canal's resolution be defined? Prospective observational study. [Abstract] [BibTeX]	2018	Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery	article	DOI
Abstract: To compare the outcome of the Epley maneuver (EM) in benign paroxysmal positional vertigo of the posterior canal (CSP-BPPV) depending on the definition used for recovery. Multicenter observational prospective study. Otoneurology Units of 5 tertiary reference hospitals. All patients presenting with unilateral CSP-BPPV assisted for 1-year period. Spontaneous nystagmus, positive McClure-Pagnini maneuver, positive bilateral Dix-Hallpike maneuver (DHM), positive DHM for vertigo but negative for nystagmus and atypical nystagmus. Response to EM was measured after 7 days in 3 different outcomes: disappearance of nystagmus during the DHM in the follow-up visit, disappearance of vertigo during the DHM and general status (GS) during daily life activities. 264 patients were recruited (68 male/166 female, mean age 62 years). After the EM, nystagmus disappeared in 67% of them, vertigo in 54% and 36% were asymptomatic in their daily life. These outcomes were strongly correlated, but they were not concordant in a clinically significant group of cases; only the 26% of patients met all of them. The healing process follows the next sequence: negativization of positional nystagmus, then disappearance of positional vertigo and, finally, the improvement of GS during daily life activities. Nowadays, healing criteria for the resolution of an PSC-BPPV episode have not been specifically defined yet. Provided that other otoneurological disorders have been ruled out, the next resolution criterion is proposed: absence of nystagmus and specifically during control DHM and disappearance of symptoms during daily life activities.
BibTeX: @article{Guerra-Jimenez2018, author = {Guerra-Jiménez, G and Domènech-Vadillo, E and Álvarez-Morujo de Sande, M G and González-Aguado, R and Galera-Ruiz, H and Morales Angulo, C and Martín-Mateos, A J and Figuerola-Massana, E and Ramos-Macías, Á and Domínguez-Durán, E}, title = {Healing criteria: How should an episode of benign paroxistic positional vertigo of posterior semicircular canal's resolution be defined? Prospective observational study.}, journal = {Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery}, year = {2018}, doi = {https://doi.org/10.1111/coa.13173}, keywords = {BPPV; Epley maneuver; Nystagmus; positional nystagmus; positional vertigo}, pmid = {29905001} }
Grill, E., Strupp, M., Müller, M. and Jahn, K.	Health services utilization of patients with vertigo in primary care: a retrospective cohort study. [Abstract] [BibTeX]	2014	Journal of neurology Vol. 261(8), pp. 1492-1498	article	DOI
Abstract: Vertigo and dizziness count among the most frequent symptoms in outpatient practices. Although most vestibular disorders are manageable, they are often under- and misdiagnosed in primary care. This may result in prolonged absence from work, increased resource use and, potentially, in chronification. Reliable information on health services utilization of patients with vertigo in primary care is scarce. Retrospective cohort study in patients referred to a tertiary care balance clinic. Included patients had a confirmed diagnosis of benign paroxysmal positional vertigo (BPPV), Menière's disease (MD), vestibular paroxysmia (VP), bilateral vestibulopathy (BVP), vestibular migraine (VM), or psychogenic vertigo (PSY). All previous diagnostic and therapeutic measures prior to the first visit to the clinic were recorded. 2,374 patients were included (19.7 % BPPV, 12.7 % MD, 5.8 % VP, 7.2 % BVP, 14.1 % VM, 40.6 % PSY), 61.3 % with more than two consultations. Most frequent diagnostic measures were magnetic resonance imaging (MRI, 76.2 %, 71 % in BPPV) and electrocardiography (53.5 %). Most frequent therapies were medication (61.0 %) and physical therapy (41.3 %). 37.3 % had received homoeopathic medication (39 % in BPPV), and 25.9 % were treated with betahistine (20 % in BPPV). Patients had undergone on average 3.2 (median 3.0, maximum 6) diagnostic measures, had received 1.8 (median 2.0, maximum 8) therapies and 1.8 (median 1.0, maximum 17) different drugs. Diagnostic subgroups differed significantly regarding number of diagnostic measures, therapies and drugs. The results emphasize the need for establishing systematic training to improve oto-neurological skills in primary care services not specialized on the treatment of dizzy patients.
BibTeX: @article{Grill2014, author = {Grill, Eva and Strupp, Michael and Müller, Martin and Jahn, Klaus}, title = {Health services utilization of patients with vertigo in primary care: a retrospective cohort study.}, journal = {Journal of neurology}, year = {2014}, volume = {261}, issue = {8}, pages = {1492--1498}, doi = {https://doi.org/10.1007/s00415-014-7367-y}, keywords = {Adolescent; Adult; Cohort Studies; Female; Health Services, statistics & numerical data; Humans; Male; Middle Aged; Neuroimaging; Primary Health Care, methods; Vertigo, diagnosis, therapy; Young Adult}, pmid = {24817192} }
Petri, M., Chirilă, M., Bolboacă, S.D. and Cosgarea, M.	Health-related quality of life and disability in patients with acute unilateral peripheral vestibular disorders. [Abstract] [BibTeX]	2017	Brazilian journal of otorhinolaryngology Vol. 83(6), pp. 611-618	article	DOI
Abstract: Health-related quality of life is used to denote that portion of the quality of life that is influenced by the person's health. To compare the health-related quality of life of individuals with vestibular disorders of peripheral origin by analyzing functional, emotional and physical disabilities before and after vestibular treatment. A prospective, non randomized case-controlled study was conduced in the ENT Department, between January 2015 and December 2015. All patients were submitted to customize a 36 item of health survey on quality of life, short form 36 health survey questionnaire (SF-36) and the Dizziness Handicap Inventory for assessing the disability. Individuals were diagnosed with acute unilateral vestibular peripheral disorders classified in 5 groups: vestibular neuritis, Ménière Disease, Benign Paroxysmal Positional Vertigo, cochlear-vestibular dysfunction (other than Ménière Disease), or other type of acute peripheral vertigo (as vestibular migraine). There was a statistical significant difference for each parameter of Dizziness Handicap Inventory score (the emotional, functional and physical) between the baseline and one month both in men and women, but with any statistical significant difference between 7 days and 14 days. It was found a statistical significant difference for all eight parameters of SF-36 score between the baseline and one month later both in men and women; the exception was the men mental health perception. The correlation between the Dizziness Handicap Inventory and the SF-36 scores according to diagnostics type pointed out that the Spearman's correlation coefficient was moderate correlated with the total scores of these instruments. The Dizziness Handicap Inventory and the SF-36 are useful, proved practical and valid instruments for assessing the impact of dizziness on the quality of life of patients with unilateral peripheral vestibular disorders.
BibTeX: @article{Petri2017, author = {Petri, Maria and Chirilă, Magdalena and Bolboacă, Sorana D and Cosgarea, Marcel}, title = {Health-related quality of life and disability in patients with acute unilateral peripheral vestibular disorders.}, journal = {Brazilian journal of otorhinolaryngology}, year = {2017}, volume = {83}, issue = {6}, pages = {611--618}, doi = {https://doi.org/10.1016/j.bjorl.2016.08.004}, keywords = {Adult; Aged; Analysis of Variance; Case-Control Studies; Disability Evaluation; Dizziness, diagnosis, physiopathology, therapy; Female; Humans; Male; Meniere Disease, diagnosis, physiopathology, therapy; Middle Aged; Prospective Studies; Quality of Life; Reference Values; Reproducibility of Results; Severity of Illness Index; Sex Factors; Statistics, Nonparametric; Surveys and Questionnaires; Time Factors; Vertigo, diagnosis, physiopathology, therapy; Vestibular Neuronitis, diagnosis, physiopathology, therapy; DHI; Distúrbios vestibulares periféricos unilaterais; HRQoL; QVRS; SF-36; Unilateral peripheral vestibular disorders}, pmid = {27595924} }
Gámiz, M.J. and Lopez-Escamez, J.A.	Health-related quality of life in patients over sixty years old with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2004	Gerontology Vol. 50(2), pp. 82-86	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is a common cause of dizziness within the geriatric population causing disability. The diagnosis is established by the position-induced rotatory nystagmus, related to the involved ear, demonstrated by the Dix-Hallpike test (DHT). Although the Epley's modified manoeuvre, or particle respositioning manoeuvre (PRM), is an effective treatment for this disorder, its impact on health outcome in patients over 60 years old is unknown. To assess BPPV health-related quality of life in elderly individuals using the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and the Dizziness Handicap Inventory Short Form (DHI-S). A prospective study including new cases of BPPV in patients older than 60 years was carried out. The diagnosis was based on the history of recurrent sudden crises of vertigo and a typical positional-induced nystagmus during the DHT. All patients were treated by a single PRM and relapses were investigated a the 30th post-treatment day. DHT was found negative in 82% (23/28) individuals at 30 days. The eight scales of the SF-36 have a good internal consistency reliability in patients with BPPV (Cronbach's alpha > 0.7). The average standardized score for each SF-36 scale was compared with the reference population normative data, showing differences with norms for role physical, body pain, social function, role emotional and mental health. After PRM, patients restored scores to norms, showing a significant increase in role physical (p < 0.05), body pain (p < 0.04), vitality (p < 0.02), social function (p < 0.003) and mental health scores (p < 0.005). DHI-S total score significantly decreased from 17.19 +/- 9.06 (mean +/- SD) at the first day to 9.70 +/- 10.13 at 30 days (p < 0.001). BPPV has a significant impact on health-related quality of life in elderly patients on their emotional and physical states compared to those unaffected. The PRM can restore health-related quality of life in elderly patients with BPPV.
BibTeX: @article{Gamiz2004, author = {Gámiz, Maria J and Lopez-Escamez, Jose A}, title = {Health-related quality of life in patients over sixty years old with benign paroxysmal positional vertigo.}, journal = {Gerontology}, year = {2004}, volume = {50}, issue = {2}, pages = {82--86}, doi = {https://doi.org/10.1159/000075558}, keywords = {Aged; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, physiopathology; Posture, physiology; Prospective Studies; Quality of Life; Semicircular Canals, physiopathology; Surveys and Questionnaires; Vertigo, physiopathology, psychology, therapy}, pmid = {14963374} }
Seo, T., Hashimoto, M., Saka, N. and Sakagami, M.	Hearing and vestibular functions after plugging surgery for the posterior semicircular canal. [Abstract] [BibTeX]	2009	Acta oto-laryngologica Vol. 129(11), pp. 1148-1152	article	DOI
Abstract: Results of audiometry, caloric testing and vestibular evoked myogenic potential (VEMP) testing were hardly influenced by plugging surgery. To evaluate the influence of surgical plugging of the posterior semicircular canal on inner ear function in patients with benign paroxysmal positional vertigo (BPPV). The subjects were five consecutive patients with intractable BPPV who underwent plugging surgery. The following functions of the inner ear were examined before and 6 months after surgery. Cochlea function was evaluated by the average hearing level of three frequencies (500, 1000 and 2000 Hz), that of the semicircular canal by canal paresis percent (CP%) in caloric testing and that of the otolith by the left-right difference ratio on VEMP testing. Positional vertigo was resolved in all patients. One subject was completely deaf before and after surgery. The average hearing level did not change more than 10 dB after surgery in the other four cases. CP% did not worsen more than 10% in any case. The VEMP results after surgery did not change more than 10% from before surgery in any case.
BibTeX: @article{Seo2009, author = {Seo, Toru and Hashimoto, Misako and Saka, Naoki and Sakagami, Masafumi}, title = {Hearing and vestibular functions after plugging surgery for the posterior semicircular canal.}, journal = {Acta oto-laryngologica}, year = {2009}, volume = {129}, issue = {11}, pages = {1148--1152}, doi = {https://doi.org/10.3109/00016480802609582}, keywords = {Adult; Aged; Audiometry; Caloric Tests; Evoked Potentials, Motor, physiology; Female; Follow-Up Studies; Hearing Loss, Sensorineural, diagnosis, physiopathology; Humans; Male; Middle Aged; Neck Muscles, innervation; Postoperative Complications, diagnosis, physiopathology; Postural Balance, physiology; Semicircular Canals, physiopathology, surgery; Surgical Instruments; Vertigo, physiopathology, surgery; Vestibular Diseases, diagnosis, physiopathology; Vestibular Function Tests}, pmid = {19863302} }
Moore, P., Le, T., Blakley, B., Beiko, J. and Meen, E.	Hemorrhagic stroke after Epley maneuver: a case report. [Abstract] [BibTeX]	2018	Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale Vol. 47(1), pp. 25	article	DOI
Abstract: This is the first case to our knowledge of a serious adverse event following the Epley maneuver, which is the treatment of choice for benign paroxysmal positional vertigo (BPPV), the most common vestibular disorder in adults. A 77 year old female presented for outpatient evaluation of vertigo at a tertiary otolaryngology clinic. She was found to have BPPV clinically, and elected to have a particle repositioning maneuver (Epley maneuver) performed in clinic. Immediately following Epley maneuver, she had severe nausea and vomiting, with evolving visual changes. A CT angiogram of the brain was performed urgently through the emergency department and demonstrated an acute intraparenchymal hemorrhage in the occipital lobe. After medical stabilization and rehabilitation, the patient continues to have a permanent visual field deficit. The Epley maneuver is safe and effective, and there are no prior reports of serious adverse events associated with its use. This case, in which a patient experienced a hemorrhagic stroke after undergoing the Epley maneuver, is the first and sole case in the medical literature of an Epley-associated serious adverse event. The indirect causation and extreme rarity of this event do not warrant any change to patterns of practice.
BibTeX: @article{Moore2018, author = {Moore, Paige and Le, Trung and Blakley, Brian and Beiko, Jason and Meen, Eric}, title = {Hemorrhagic stroke after Epley maneuver: a case report.}, journal = {Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale}, year = {2018}, volume = {47}, issue = {1}, pages = {25}, doi = {https://doi.org/10.1186/s40463-018-0268-9}, keywords = {Aged; Benign Paroxysmal Positional Vertigo, therapy; Female; Humans; Intracranial Hemorrhages, etiology; Manipulation, Spinal, adverse effects; Patient Positioning, adverse effects; Stroke, etiology; Adverse outcome; BPPV; Benign paroxysmal positional vertigo; Epley maneuver; Hemorrhage; Intraparenchymal hemorrhage; Nausea; Risk; Stroke; Valsalva maneuver; Vomiting}, pmid = {29631624} }
He, J.-W., Gong, Q., Wang, X.-F. and Xiao, Z.	High stimulus rate brainstem auditory evoked potential in benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2015	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 272(9), pp. 2095-2100	article	DOI
Abstract: The objective of this study is to use high (49/s) and low (9/s) stimulation rates of the BAEP to investigate the possible mechanism responsible for BPPV. A total of 81 patients (55 women and 26 men, mean age ± SD = 54.6 ± 15.0) with idiopathic BPPV, as well as 106 control subjects (70 women and 36 men, mean age ± SD = 51.2 ± 16.3) participated in the study. The results of high (49/s) and low (9/s) stimulation rates of the BAEP test were compared and analyzed. The difference in BAEP wave I peak latencies between low and high stimulation rate (DPL I) and BAEP wave I peak latency in high stimulation (HPL I) of affected ears (0.24 ± 0.14 and 1.91 ± 0.21 ms) in BPPV patients were significantly prolonged when compared with the controls (0.10 ± 0.08 and 1.76 ± 0.18 ms) and unaffected ears (0.12 ± 0.10 and 1.82 ± 0.21 ms) (p < 0.001). The abnormal rate of DPL I in the affected ear (52/83, 62.65 %) was significantly higher than that in the unaffected ear (7/79, 8.86 %) and the normal left ear (4/106, 3.77 %). We suggest that ischemia of the inner ear might be one of the causes of BPPV and that DPL I may be used to assess the ischemic degree in subjects over 20 years old.
BibTeX: @article{He2015, author = {He, Juan-Wen and Gong, Qiang and Wang, Xue-Feng and Xiao, Zheng}, title = {High stimulus rate brainstem auditory evoked potential in benign paroxysmal positional vertigo.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2015}, volume = {272}, issue = {9}, pages = {2095--2100}, doi = {https://doi.org/10.1007/s00405-014-3172-6}, keywords = {Adult; Benign Paroxysmal Positional Vertigo, physiopathology; Case-Control Studies; Ear, Inner; Evoked Potentials, Auditory, Brain Stem, physiology; Female; Humans; Male; Middle Aged}, pmid = {25005432} }
Schratzenstaller, B., Wagner-Manslau, C., Alexiou, C. and Arnold, W.	High-resolution three-dimensional magnetic resonance imaging of the vestibular labyrinth in patients with atypical and intractable benign positional vertigo. [Abstract] [BibTeX]	2001	ORL; journal for oto-rhino-laryngology and its related specialties Vol. 63(3), pp. 165-177	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is a most common cause of dizziness and usually a self-limited disease, although a small percentage of patients suffer from a permanent form and do not respond to any treatment. This persistent form of BPPV is thought to have a different underlying pathophysiology than the generally accepted canalolithiasis theory. We investigated 5 patients who did not respond to physical treatment, presented with an atypical concomitant nystagmus or both with high-resolution three-dimensional magnetic resonance imaging of the inner ear. This method provides an excellent imaging of the inner ear fluid spaces. In all 5 patients, we found structural changes such as fractures or filling defects in the semicircular canals which we did not find in control groups. One patient clinically presented with the symptoms of a 'heavy cupula'. Whereas crosssections through the ampullary region and the adjoining utricle showed no abnormalities, there were significant structural changes in the semicircular canals, which are able to provide an explanation for the symptoms of a heavy cupula.
BibTeX: @article{Schratzenstaller2001, author = {Schratzenstaller, B and Wagner-Manslau, C and Alexiou, C and Arnold, W}, title = {High-resolution three-dimensional magnetic resonance imaging of the vestibular labyrinth in patients with atypical and intractable benign positional vertigo.}, journal = {ORL; journal for oto-rhino-laryngology and its related specialties}, year = {2001}, volume = {63}, issue = {3}, pages = {165--177}, doi = {https://doi.org/10.1159/000055734}, keywords = {Adult; Aged; Aged, 80 and over; Audiometry, Pure-Tone; Ear, Inner, anatomy & histology; Female; Hearing Loss, Sensorineural, complications, diagnosis; Humans; Imaging, Three-Dimensional; Magnetic Resonance Imaging; Male; Middle Aged; Semicircular Canals, anatomy & histology; Severity of Illness Index; Vertigo, complications, diagnosis; Vestibule, Labyrinth, anatomy & histology}, pmid = {11359095} }
Ismail, E.I., Morgan, A.E. and Abdeltawwab, M.M.	Home particle repositioning maneuver to prevent the recurrence of posterior canal BPPV. [Abstract] [BibTeX]	2018	Auris, nasus, larynx Vol. 45(5), pp. 980-984	article	DOI
Abstract: To check the value of home particle repositioning maneuver in the prevention of the recurrence of posterior canal benign paroxysmal positional vertigo (pc-BPPV). In this study, patients diagnosed as unilateral posterior canal BPPV were selected following an accurate evaluation using video goggle VNG system. All patients were managed by particle repositioning maneuver (PRM). Patients were instructed to do home PRM once weekly for five years. Then, they were divided into two groups (according to choice of patient to do PRM). The first group (control group) consisted of 144 patients who did not do home PRM; whereas the second group (study group) included 165 patients who performed home PRM. All patients (control & study groups) were followed up every four months for five years. The study found out that the recurrence rate of pc-BPPV in control group was 33 patients in the first year (27.2%), 11 patients in second year (9%), 5 patients in third year (4%), 3 patients in fourth year (2.5%) and 3 patients in fifth year (2.5%). The recurrence of pc-BPPV in the treated side (study group) of patients was reported as 5 patients in the first year (3.5%), 3 patients in the second year (2%), 2 patients in the third year (1.4%), 2 patients in the fourth year (1.4%), and 1 patient in the fifth year (0.7%). There was statistically significant difference between the control and the study groups regarding the recurrence rates in the first year follow up which was the highest in first four months. Home particle repositioning maneuver has the capacity to prevent the recurrence of pc-BPPV. It proved to be more successful and functional in minimizing the recurrence of the disease in the study than in the control group. Hence, home particle repositioning maneuver is highly recommended for one year at least in pc-BPPV.
BibTeX: @article{Ismail2018, author = {Ismail, Elshahat Ibrahem and Morgan, Ashraf Elsayed and Abdeltawwab, Mohamed Moustafa}, title = {Home particle repositioning maneuver to prevent the recurrence of posterior canal BPPV.}, journal = {Auris, nasus, larynx}, year = {2018}, volume = {45}, issue = {5}, pages = {980--984}, doi = {https://doi.org/10.1016/j.anl.2018.02.005}, keywords = {Benign Paroxysmal Positional Vertigo, prevention & control; Female; Humans; Male; Middle Aged; Otolithic Membrane; Patient Positioning, methods; Recurrence; Secondary Prevention; Self Care, methods; Particle repositioning maneuver; Posterior canal benign paroxysmal positional vertigo; Recurrence of benign paroxysmal positional vertigo}, pmid = {29526580} }
Xie, S.-J., Wang, J.-C., Ding, L. and Sun, X.-Q.	Horizontal canal benign paroxysmal positional vertigo in a fighter pilot. [Abstract] [BibTeX]	2011	Journal of neurosciences in rural practice Vol. 2(1), pp. 80-83	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most common disorder of the peripheral vestibular system, characterized by intense, positional provoked vertigo. BPPV is thought to occur due to canalithiasis of the posterior semicircular canal. Recently, a new entity of BPPV, known as horizontal canal (HC)-BPPV, has been recognized. Although only 3 to 8% of BPPV is due to horizontal canal involvement, HC-BPPV is not rare. We present a case of a naval fighter pilot who had an incident of HC-BPPV on the ground. The pilot aeromedical evaluation and considerations are discussed.
BibTeX: @article{Xie2011, author = {Xie, Su-Jiang and Wang, Jiang-Chang and Ding, Li and Sun, Xi-Qing}, title = {Horizontal canal benign paroxysmal positional vertigo in a fighter pilot.}, journal = {Journal of neurosciences in rural practice}, year = {2011}, volume = {2}, issue = {1}, pages = {80--83}, doi = {https://doi.org/10.4103/0976-3147.80113}, keywords = {Benign paroxysmal positional vertigo; case report; medical certification}, pmid = {21716841} }
Maranhão, E.T. and Maranhão Filho, P.	Horizontal canal benign paroxysmal positional vertigo: diagnosis and treatment of 37 patients. [Abstract] [BibTeX]	2015	Arquivos de neuro-psiquiatria Vol. 73(6), pp. 487-492	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV), the most frequent cause of vertigo is associated with high morbidity in the elderly population. The most common form is linked to debris in the posterior semicircular canal. However, there has been an increasing number of reported BPPV cases involving the horizontal canals. The purpose of this article is to highlight the clinical features, diagnosis, and treatment in 37 patients with horizontal canal BPPV; twenty-six with geotropic nystagmus, and eleven with the apogeotropic form. Treatment consisted of the Gufoni manoeuver in eighteen patients (48.6%), the barbecue 360° maneuver in twelve patients (32.4%), both manoeuvers in four patients (10.8%), both manoeuvers plus head shaking in one patient (2.7%), and the Gufoni maneuver plus head shaking in two patients. Cupulolithiasis patients were asked to sleep in a forced prolonged position. We obtained a complete resolution of vertigo and nystagmus in 30 patients (81.0%) on the initial visit.
BibTeX: @article{Maranhao2015, author = {Maranhão, Eliana Teixeira and Maranhão Filho, Péricles}, title = {Horizontal canal benign paroxysmal positional vertigo: diagnosis and treatment of 37 patients.}, journal = {Arquivos de neuro-psiquiatria}, year = {2015}, volume = {73}, issue = {6}, pages = {487--492}, doi = {https://doi.org/10.1590/0004-282X20150040}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, diagnosis, physiopathology, therapy; Exercise Therapy, methods; Female; Head Movements, physiology; Humans; Male; Middle Aged; Nystagmus, Pathologic, physiopathology, therapy; Patient Positioning, methods; Semicircular Canals, physiopathology; Supine Position, physiology; Time Factors; Treatment Outcome}, pmid = {26083883} }
Steddin, S., Ing, D. and Brandt, T.	Horizontal canal benign paroxysmal positioning vertigo (h-BPPV): transition of canalolithiasis to cupulolithiasis. [Abstract] [BibTeX]	1996	Annals of neurology Vol. 40(6), pp. 918-922	article	DOI
Abstract: We report on 2 patients with typical features of horizontal canal benign paroxysmal positioning vertigo (h-BPPV). A vigorous head positioning in these patients from supine to a bending-over, head-on-the-knees position reversed the direction of nystagmus from geotropic initially to ageotropic when rolling the head from side to side while supine. We explain this by a conversion of canalolithiasis into cupulolithiasis and conclude that (1) canalolithiasis and cupulolithiasis may sequentially occur in the same semicircular canal with subsequent positioning maneuvers and (2) positional nystagmus beating toward the uppermost ear is not a pathognomonic sign of central vestibular disturbance but can indicate occasional cupulolithiasis.
BibTeX: @article{Steddin1996, author = {Steddin, S and Ing, D and Brandt, T}, title = {Horizontal canal benign paroxysmal positioning vertigo (h-BPPV): transition of canalolithiasis to cupulolithiasis.}, journal = {Annals of neurology}, year = {1996}, volume = {40}, issue = {6}, pages = {918--922}, doi = {https://doi.org/10.1002/ana.410400615}, keywords = {Aged; Female; Head; Humans; Labyrinth Diseases, physiopathology; Male; Middle Aged; Movement; Nystagmus, Pathologic, physiopathology; Semicircular Canals, physiopathology; Vertigo, physiopathology}, pmid = {9007098} }
Rambold, H., Heide, W. and Helmchen, C.	Horizontal canal benign paroxysmal positioning vertigo with ipsilateral hearing loss. [Abstract] [BibTeX]	2004	European journal of neurology Vol. 11(1), pp. 31-35	article
Abstract: The etiology of benign paroxysmal positioning vertigo (h-BPPV) of the horizontal semicircular is unknown. Insight was obtained from two patients with h-BPPV and associated hearing impairment. Based on the different inner ear lesion patterns in neurolabyrinthitis contrary to ischemic labyrinthine infarction we assessed multiple vestibulo-cochlear functions for the first time in two patients who suffered from h-BPPV with sudden unilateral hearing loss. While in patient no. 1 the lesion pattern (posterior canal paresis in addition to the sudden hearing loss) could possibly be caused by ischemia of the common cochlear artery, the lesion pattern of patient no. 2 (hearing loss and ipsilateral paresis of the posterior and horizontal semicircular canal) exceeds the typical vascular labyrinthine territories and may indicate viral neurolabyrinthitis.
BibTeX: @article{Rambold2004, author = {Rambold, H and Heide, W and Helmchen, C}, title = {Horizontal canal benign paroxysmal positioning vertigo with ipsilateral hearing loss.}, journal = {European journal of neurology}, year = {2004}, volume = {11}, issue = {1}, pages = {31--35}, keywords = {Adult; Aged; Electrooculography; Female; Functional Laterality; Hearing Loss, etiology, physiopathology; Humans; Male; Middle Aged; Reflex, Vestibulo-Ocular, physiology; Semicircular Canals, pathology, physiopathology; Vertigo, etiology, pathology, physiopathology; Vestibular Function Tests}, pmid = {14692885} }
Strupp, M., Brandt, T. and Steddin, S.	Horizontal canal benign paroxysmal positioning vertigo: reversible ipsilateral caloric hypoexcitability caused by canalolithiasis? [Abstract] [BibTeX]	1995	Neurology Vol. 45(11), pp. 2072-2076	article
Abstract: Bithermal caloric stimulation in a patient with a benign paroxysmal positioning vertigo of the horizontal (lateral) semicircular canal (HC-BPPV) revealed a significant hypoexcitability of the affected ear that was reversible when treated by liberatory maneuvers. Both the positional vertigo and caloric hypoexcitability in HC-BPPV are caused by canalolithiasis, a concept strongly supported by the intensity of the positioning nystagmus being maximal when the patient turned his head around the longitudinal z-axis from the left lateral to right lateral position while recumbent (maximum slow-phase velocity [SPV] 176 deg/sec) and being much lower (maximum SPV 55 deg/sec) when he turned his head to the right lateral position while in a supine position (nose up). The dependence of this difference in nystagmus intensity on the initial head position and direction of rotation indirectly proves that the clot moves freely (to and fro) within the segment of the HC diametrically opposite to the ampulla. The reversibility of ipsilateral caloric hypoexcitability is attributed to the clot's (functional) plugging of the HC, which agrees with studies in squirrel monkeys. These data support the view that physiologic caloric responses consist of a major convective and minor nonconvective component.
BibTeX: @article{Strupp1995, author = {Strupp, M and Brandt, T and Steddin, S}, title = {Horizontal canal benign paroxysmal positioning vertigo: reversible ipsilateral caloric hypoexcitability caused by canalolithiasis?}, journal = {Neurology}, year = {1995}, volume = {45}, issue = {11}, pages = {2072--2076}, keywords = {Aged; Electronystagmography; Humans; Otolithic Membrane, physiopathology; Posture, physiology; Semicircular Canals, physiopathology; Vertigo, etiology, physiopathology}, pmid = {7501161} }
Ghosh, P.	Horizontal canal paroxysmal positional vertigo (HCPPV) vs classical BPPV (new concepts about mechanism and domiciliary repositioning of particles). [Abstract] [BibTeX]	2002	Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India Vol. 54(3), pp. 175-179	article	DOI
Abstract: Some new modificutiont of existing diagnostic and therapeutic manoeuvres (repositioning of particles) have been proposed, basing an the applications of the principles of hydrodynamics, inertial and gravitational forces in the semicircular canals. The above has been tried successfully on patients with benign paroxysmal positional vertigo (BPPV) and horizontal eanal paroxysmal positional vertigo (HCPPV) which can be executed by the patients themselves at home without the kelp of a therapist.Benign paroxysmal positional vertigo (BPPV) is a well-established entity whereas Horizontal Canal Paroxysmal Positional Vertigo (HCPPV) is a recently proposed one. In positional vertigo any canal may be involved. It is quite possible that in the past this diagnosis (HCPPV) was missed in many of the cases of positional vertigo. Kapfschuttel nystagmus (head-shaking nystanmas) is induced by side to side (to and fro) movements of the head around a vertical axis in the plane of the horizontal semicircular canal which is thought to be sensitise the labyrinth, Any manoeuvres that in induce nystagmus with or without vertino is hound to he a manifestation of an organic lesion and not a non-organic one. In a number of instances the postionul test Jor BPPV may yield negative results; but doing this test after kopfschuttel test a dormant positional nystagmus may appear on the surface i.e. uncovered in a number of cases which may have remained undetected if Kopfschutlel manoeuvre were not done. This implies- that by Kopfsi huttel test both the horizontal and vertical canals are sensitised.Moreover, Kopfschuttel nystaagmus is likely to be a manifestation of the horizontal canal stimulation, at leastin some cases, since the movements are executed in the plane of the horizontal canal (vide infra) when displaced otoconia impinges on the cupula /. crista bringing about its stimulation leading to vertigo and or nystagmus.
BibTeX: @article{Ghosh2002, author = {Ghosh, P}, title = {Horizontal canal paroxysmal positional vertigo (HCPPV) vs classical BPPV (new concepts about mechanism and domiciliary repositioning of particles).}, journal = {Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India}, year = {2002}, volume = {54}, issue = {3}, pages = {175--179}, doi = {https://doi.org/10.1007/BF02993097}, pmid = {23119886} }
Horii, A., Imai, T., Mishiro, Y., Yamaji, Y., Mitani, K., Kawashima, T. and Kubo, T.	Horizontal canal type BPPV: bilaterally affected case treated with canal plugging and Lempert's maneuver. [Abstract] [BibTeX]	2003	ORL; journal for oto-rhino-laryngology and its related specialties Vol. 65(6), pp. 366-369	article	DOI
Abstract: A 54-year-old woman complained of positional vertigo. During 3 months' observation, the patient showed mostly geotropic or apogeotropic nystagmus due to right canalolithiasis or cupulolithiasis, however, she sometimes showed nystagmus which suggested left horizontal canalolithiasis. We suspected that she suffered from bilateral horizontal canal type benign paroxysmal positional vertigo (BPPV) and performed Lempert's maneuver for both directions, however, they were ineffective. She underwent canal plugging for right horizontal canal. After surgery she showed no positional nystagmus of right horizontal canal origin. However, apogeotropic nystagmus of the left horizontal canal origin was still observed. This nystagmus changed to geotropic nystagmus and finally disappeared following Lempert's maneuver for the left side. Bilateral horizontal canal BPPV is difficult to be resolved, probably because physical treatment for one side would move debris to the cupula in the other canal. Canal plugging combined with Lempert's maneuver to the other side is one treatment option for intractable bilateral horizontal canal BPPV.
BibTeX: @article{Horii2003, author = {Horii, Arata and Imai, Takao and Mishiro, Yasuo and Yamaji, Yoshiko and Mitani, Kenji and Kawashima, Takayuki and Kubo, Takeshi}, title = {Horizontal canal type BPPV: bilaterally affected case treated with canal plugging and Lempert's maneuver.}, journal = {ORL; journal for oto-rhino-laryngology and its related specialties}, year = {2003}, volume = {65}, issue = {6}, pages = {366--369}, doi = {https://doi.org/10.1159/000076056}, keywords = {Electronystagmography; Female; Head; Humans; Labyrinth Diseases, complications, physiopathology, therapy; Middle Aged; Nystagmus, Pathologic, physiopathology; Physical Therapy Modalities; Posture; Semicircular Canals, pathology; Vertigo, complications, physiopathology, therapy}, pmid = {14981331} }
Beh, S.C.	Horizontal Direction-Changing Positional Nystagmus and Vertigo: A Case of Vestibular Migraine Masquerading as Horizontal Canal BPPV. [Abstract] [BibTeX]	2018	Headache Vol. 58(7), pp. 1113-1117	article	DOI
Abstract: Episodic positional vertigo is typically due to benign paroxysmal positional vertigo (BPPV) but may also be a manifestation of vestibular migraine. Distinguishing vestibular migraine from BPPV is essential since the treatment of each disorder is markedly different. The 31-month clinical course of a 41-year-old woman with vestibular migraine causing recurrent positional vertigo is described. During vestibular migraine attacks, she developed left-beating nystagmus in the upright position with removal of fixation, and geotropic horizontal nystagmus during the supine roll test. Interictally, her exam demonstrated positional apogeotropic horizontal nystagmus with the supine roll test, more intense in the supine head left position. Her vestibular migraine was successfully controlled with topiramate and eletriptan.
BibTeX: @article{Beh2018, author = {Beh, Shin C}, title = {Horizontal Direction-Changing Positional Nystagmus and Vertigo: A Case of Vestibular Migraine Masquerading as Horizontal Canal BPPV.}, journal = {Headache}, year = {2018}, volume = {58}, issue = {7}, pages = {1113--1117}, doi = {https://doi.org/10.1111/head.13356}, keywords = {BPPV; positional nystagmus; positional vertigo; vestibular migraine}, pmid = {30152162} }
Anastasopoulos, D., Lempert, T., Gianna, C., Gresty, M.A. and Bronstein, A.M.	Horizontal otolith-ocular responses to lateral translation in benign paroxysmal positional vertigo. [Abstract] [BibTeX]	1997	Acta oto-laryngologica Vol. 117(4), pp. 468-471	article
Abstract: Benign paroxysmal positional vertigo (BPPV) is assumed to result from utricular damage, but it is controversial if patients have manifest utricular dysfunction. Therefore, we investigated linear vestibulo-ocular reflexes (LVORs) during lateral whole-body translation in 14 patients with unilateral BPPV. Patients were subjected to linear acceleration steps of 0.24 g along the interaural axis, which were applied randomly to the left and right, both in the dark and in the light with a visual target at a distance of 60 cm. The LVOR was measured by EOG from the slow phase velocity of the averaged and desaccaded compensatory eye movement. In normal cases, maximum asymmetry of LVOR velocity was 13% in the dark and 10% in the light. In patients, LVOR velocities were normal in the dark but mildly reduced in the light (p < 0.05). Five patients had mild LVOR asymmetries in the dark (range 18-38%) and two in the light (11 and 13%), but there was no consistent relationship to the affected side. The absence of gross changes of the LVOR may be explained either by minor utricular damage that is functionally irrelevant or by central compensation of a chronic unilateral deficit.
BibTeX: @article{Anastasopoulos1997, author = {Anastasopoulos, D and Lempert, T and Gianna, C and Gresty, M A and Bronstein, A M}, title = {Horizontal otolith-ocular responses to lateral translation in benign paroxysmal positional vertigo.}, journal = {Acta oto-laryngologica}, year = {1997}, volume = {117}, issue = {4}, pages = {468--471}, keywords = {Adult; Aged; Audiometry, Evoked Response; Female; Humans; Male; Middle Aged; Otolithic Membrane, physiology; Reflex, Vestibulo-Ocular; Saccades; Saccule and Utricle, physiopathology; Vertigo, physiopathology}, pmid = {9288198} }
Casani, A.P., Nacci, A., Dallan, I., Panicucci, E., Gufoni, M. and Sellari-Franceschini, S.	Horizontal semicircular canal benign paroxysmal positional vertigo: effectiveness of two different methods of treatment. [Abstract] [BibTeX]	2011	Audiology & neuro-otology Vol. 16(3), pp. 175-184	article	DOI
Abstract: The aim of this study is to compare the results obtained using 2 methods of treatment for horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV): the barbecue maneuver + forced prolonged position (FPP) versus the Gufoni maneuver. In a randomized prospective clinical trial, we recruited 147 patients affected by HSC-BPPV. The primary outcome was the absence of vertigo and nystagmus upon application of the supine roll test during the follow-up examination. A statistical evaluation was performed in order to assess whether any parameters (e.g. age, duration of nystagmus and symptoms) could influence in any way the results obtained with the 2 methods of treatment. One hundred and three of the 147 patients affected by HSC-BPPV had the geotropic form and 44 had the apogeotropic type. We were able to transform 29 cases of HSC-BPPV from apogeotropic to geotropic. Finally, we obtained a group of 112 patients who were randomized either to the barbecue + FPP procedure (54 patients) or to the Gufoni maneuver (58 patients). The most evident result is the higher percentage of success (statistically significant) with the Gufoni maneuver at the first session of treatment (86 vs. 61%). The final control showed that 44 out of 54 (81%) patients treated with the barbecue maneuver + FPP were symptom free compared to 54 out of 58 (93%) treated with the Gufoni maneuver. Both the barbecue maneuver + FPP and the Gufoni maneuver are valid methods for treating HSC-BPPV (geotropic forms). However, our results also indicate that the Gufoni maneuver has a significant advantage: the success rate shown at the follow-up, although without statistical significance, is undoubtedly higher (93 vs. 81%). This result, together with the fact that it is very easy to perform and that patient compliance is better, make the Gufoni maneuver the method of choice in HSC-BPPV treatment.
BibTeX: @article{Casani2011a, author = {Casani, Augusto Pietro and Nacci, Andrea and Dallan, Iacopo and Panicucci, Erica and Gufoni, Mauro and Sellari-Franceschini, Stefano}, title = {Horizontal semicircular canal benign paroxysmal positional vertigo: effectiveness of two different methods of treatment.}, journal = {Audiology & neuro-otology}, year = {2011}, volume = {16}, issue = {3}, pages = {175--184}, doi = {https://doi.org/10.1159/000317113}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Female; Humans; Male; Middle Aged; Posture; Prospective Studies; Semicircular Canals, pathology; Treatment Outcome; Vertigo, pathology, therapy}, pmid = {20720408} }
Chen, Z., Yu, D., Yin, S. and Wang, J.	Horizontal semicircular canal occlusion in a patient with benign paroxysmal positional vertigo. [BibTeX]	2008	Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale Vol. 37(3), pp. E69-E72	article
BibTeX: @article{Chen2008a, author = {Chen, Zhengnong and Yu, Dongzhen and Yin, Shankai and Wang, Jian}, title = {Horizontal semicircular canal occlusion in a patient with benign paroxysmal positional vertigo.}, journal = {Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale}, year = {2008}, volume = {37}, issue = {3}, pages = {E69--E72}, keywords = {Adult; Diagnosis, Differential; Electronystagmography; Humans; Labyrinth Diseases, complications, diagnosis, surgery; Male; Nystagmus, Pathologic, diagnosis, etiology, physiopathology; Otologic Surgical Procedures, methods; Semicircular Canals, diagnostic imaging, pathology, physiopathology; Tomography, X-Ray Computed; Vertigo, complications, diagnosis, physiopathology}, pmid = {19137637} }
Doijiri, R., Uno, H., Miyashita, K., Ihara, M. and Nagatsuka, K.	How Commonly Is Stroke Found in Patients with Isolated Vertigo or Dizziness Attack? [Abstract] [BibTeX]	2016	Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association Vol. 25(10), pp. 2549-2552	article	DOI
Abstract: The sudden development of vertigo or dizziness without focal neurological symptoms is generally attributable to vestibular diseases such as benign paroxysmal positional vertigo. Isolated vertigo or dizziness attack needs more attention than vestibular diseases. This retrospective study was performed to elucidate the frequency of strokes in patients with isolated vertigo or dizziness attack. We enrolled 221 patients (men, 119; women, 102; mean age, 68.4 ± 10.3 years) who were admitted to our hospital over the last 10 years because of sudden isolated vertigo or dizziness attack without other neurological symptoms except for nystagmus, deafness, or tinnitus. We investigated the clinical features, final diagnosis, neuroimaging findings, and short- or long-term outcome of these patients. One hundred eighteen patients had vertigo whereas the other 103 had dizziness. Brain computed tomography or magnetic resonance imaging revealed recent stroke lesions in 25 patients (11.3%) (ischemic, 21; hemorrhagic, 4).The lesions were generally small and localized in the cerebellum (n = 21), pons (n = 1), medulla oblongata (n = 1), or corona radiata (n = 1). Of the 25 patients, 19 (76%) had dizzy-type spells; none had neurological dysfunction at the time of discharge. In the remaining 196 patients, no stroke was detected on computed tomography or magnetic resonance imaging. Stroke was found in 11% of patients with isolated vertigo or dizziness attack. The posterior inferior cerebellar artery area was the most frequently implicated for isolated vertigo or dizziness.
BibTeX: @article{Doijiri2016, author = {Doijiri, Ryosuke and Uno, Hisakazu and Miyashita, Kotaro and Ihara, Masafumi and Nagatsuka, Kazuyuki}, title = {How Commonly Is Stroke Found in Patients with Isolated Vertigo or Dizziness Attack?}, journal = {Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association}, year = {2016}, volume = {25}, issue = {10}, pages = {2549--2552}, doi = {https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.06.038}, keywords = {Aged; Diffusion Magnetic Resonance Imaging; Dizziness, etiology; Female; Humans; Japan; Lateral Medullary Syndrome, complications, diagnostic imaging, physiopathology; Male; Middle Aged; Multidetector Computed Tomography; Prognosis; Retrospective Studies; Risk Factors; Stroke, complications, diagnostic imaging, physiopathology; Time Factors; Vertigo, etiology; Isolated vertigo; isolated dizziness; posterior inferior cerebellar artery; stroke}, pmid = {27495834} }
Hughes, D., Shakir, A., Goggins, S. and Snow, D.	How many Epley manoeuvres are required to treat benign paroxysmal positional vertigo? [Abstract] [BibTeX]	2015	The Journal of laryngology and otology Vol. 129(5), pp. 421-424	article	DOI
Abstract: To evaluate the total number of Epley manoeuvres required to provide symptomatic relief to patients newly diagnosed with benign paroxysmal positional vertigo. This retrospective audit assessed every patient referred to the audiology department for investigations of their symptoms over a period of one year. Only patients diagnosed with benign paroxysmal positional vertigo confirmed via a positive Dix-Hallpike test result, with no suggestion of dual pathology, were included. Seventy patients with a positive Dix-Hallpike test result were identified. The total number of Epley manoeuvres required ranged from one to five. Thirty-three patients (47 per cent) were asymptomatic following one Epley manoeuvre. Eleven patients (16 per cent) needed 2 manoeuvres and 15 patients (21 per cent) required 3 manoeuvres for symptomatic control. Symptomatic control of benign paroxysmal positional vertigo was obtained following a single Epley manoeuvre for 47 per cent of patients. The majority of patients (84 per cent) experienced symptomatic improvement following three Epley manoeuvres.
BibTeX: @article{Hughes2015, author = {Hughes, D and Shakir, A and Goggins, S and Snow, D}, title = {How many Epley manoeuvres are required to treat benign paroxysmal positional vertigo?}, journal = {The Journal of laryngology and otology}, year = {2015}, volume = {129}, issue = {5}, pages = {421--424}, doi = {https://doi.org/10.1017/S0022215115000481}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, therapy; Female; Humans; Male; Middle Aged; Musculoskeletal Manipulations, methods; Retrospective Studies; Semicircular Canals; Treatment Outcome; Young Adult; Benign Paroxysmal Positional Vertigo}, pmid = {25816719} }
Hamilton, L., Keh, S., Spielmann, P.M. and Hussain, S.S.M.	How we do it: locating the posterior semicircular canal in occlusion surgery for refractory benign paroxysmal positional vertigo: a cadaveric temporal bone study. [BibTeX]	2016	Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery Vol. 41(2), pp. 190-193	article	DOI
BibTeX: @article{Hamilton2016, author = {Hamilton, L and Keh, S and Spielmann, P M and Hussain, S S M}, title = {How we do it: locating the posterior semicircular canal in occlusion surgery for refractory benign paroxysmal positional vertigo: a cadaveric temporal bone study.}, journal = {Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery}, year = {2016}, volume = {41}, issue = {2}, pages = {190--193}, doi = {https://doi.org/10.1111/coa.12479}, keywords = {Anatomic Landmarks; Benign Paroxysmal Positional Vertigo, surgery; Cadaver; Humans; Semicircular Canals, anatomy & histology, surgery; Temporal Bone, anatomy & histology, surgery}, pmid = {26095673} }
Arbusow, V., Theil, D., Strupp, M., Mascolo, A. and Brandt, T.	HSV-1 not only in human vestibular ganglia but also in the vestibular labyrinth. [Abstract] [BibTeX]	2001	Audiology & neuro-otology Vol. 6(5), pp. 259-262	article	DOI
Abstract: Reactivation of herpes simplex virus type 1 (HSV-1) in the vestibular ganglion (VG) is the suspected cause of vestibular neuritis (VN). Recent studies reported the presence of HSV-1 DNA not only in human VGs but also in vestibular nuclei, a finding that indicates the possibility of viral migration to the human vestibular labyrinth. Distribution of HSV-1 DNA was determined in geniculate ganglia, VGs, semicircular canals, and macula organs of 21 randomly obtained human temporal bones by nested PCR. Viral DNA was detected in 48% of the labyrinths, 62% of the VGs, and 57% of the geniculate ganglia. The potential significance of this finding is twofold: (1) Inflammation in VN could also involve the labyrinth and thereby cause acute unilateral vestibular deafferentation. (2) As benign paroxysmal positional vertigo often occurs in patients who have had VN, it could also be a sequel of viral labyrinthitis.
BibTeX: @article{Arbusow2001, author = {Arbusow, V and Theil, D and Strupp, M and Mascolo, A and Brandt, T}, title = {HSV-1 not only in human vestibular ganglia but also in the vestibular labyrinth.}, journal = {Audiology & neuro-otology}, year = {2001}, volume = {6}, issue = {5}, pages = {259--262}, doi = {https://doi.org/10.1159/000046131}, keywords = {Adult; DNA, Viral; Herpes Simplex, genetics, virology; Herpes Zoster Oticus, genetics, virology; Herpesvirus 1, Human; Humans; Infant; Labyrinthitis, genetics, virology; Middle Aged; Polymerase Chain Reaction; Vertigo, etiology; Vestibular Neuronitis, complications, genetics, virology}, pmid = {11729328} }
Agrawal, S.K. and Parnes, L.S.	Human experience with canal plugging. [Abstract] [BibTeX]	2001	Annals of the New York Academy of Sciences Vol. 942, pp. 300-305	article
Abstract: Canal occlusion/plugging is a very effective technique with a low risk to hearing. The series of posterior semicircular canal occlusions described in this review now becomes the largest in the literature to date. It continues to support this procedure as the treatment of choice for intractable benign paroxysmal positional vertigo (BPPV). All 44 operated ears were relieved of BPPV, with one patient having an atypical late recurrence. Of the 40 ears with normal preoperative hearing, one had a delayed (3-month) sudden and permanent profound loss, while one other had a mild (20 dB) loss. Six patients had protracted courses of imbalance and motion sensitivity. Canal plugging has led to several new and innovative developments including the partial labyrinthectomy for difficult-to-access skull base lesions and superior semicircular canal plugging for dehiscence. These new procedures and their development are reviewed in this paper.
BibTeX: @article{Agrawal2001, author = {Agrawal, S K and Parnes, L S}, title = {Human experience with canal plugging.}, journal = {Annals of the New York Academy of Sciences}, year = {2001}, volume = {942}, pages = {300--305}, keywords = {Humans; Semicircular Canals, surgery; Vertigo, surgery}, pmid = {11710471} }
Epley, J.M.	Human experience with canalith repositioning maneuvers. [Abstract] [BibTeX]	2001	Annals of the New York Academy of Sciences Vol. 942, pp. 179-191	article
Abstract: Three distinct pathological conditions, related to different means by which dense intralabyrinthine particles interfere with the function of a semicircular canal and cause nystagmus and vertigo, are amenable to treatment with repositioning maneuvers. Known as benign paroxysmal positional vertigo and variants, these conditions are better designated collectively by the term "vestibular lithiasis." Each form requires a different treatment strategy of head maneuvers and application of other modalities to restore normal semicircular function and thereby eliminate the positional nystagmus and vertigo. Real-time observation of the nystagmus induced by the particles during the maneuvers can greatly facilitate the repositioning process.
BibTeX: @article{Epley2001, author = {Epley, J M}, title = {Human experience with canalith repositioning maneuvers.}, journal = {Annals of the New York Academy of Sciences}, year = {2001}, volume = {942}, pages = {179--191}, keywords = {Ear, Inner, physiology, physiopathology; Humans; Nystagmus, Pathologic, complications, physiopathology; Posture; Vertigo, complications, physiopathology}, pmid = {11710460} }
Gioacchini, F.M., Albera, R., Re, M., Scarpa, A., Cassandro, C. and Cassandro, E.	Hyperglycemia and diabetes mellitus are related to vestibular organs dysfunction: truth or suggestion? A literature review. [Abstract] [BibTeX]	2018	Acta diabetologica Vol. 55(12), pp. 1201-1207	article	DOI
Abstract: Diabetes mellitus is an independent risk factor for falling, particularly in the elderly. Due to chronic hyperglycemia and hyperinsulinemia patients with diabetes mellitus may have neurological deficits as peripheral neuropathy that is a debilitating micro-vascular complication affecting the proximal and distal peripheral sensory and motor nerves. Sensory neuropathy is prominent and represents the chief contributor to postural instability in diabetic subjects. Diabetic retinopathy is another complication consequent to a breakdown of the inner blood-retinal barrier with accumulation of extracellular fluids in the macula and growth of new vessels causing retinal detachment. Together peripheral neuropathy and retinopathy contribute to increase the risk of falls in diabetic patients, but a certain vestibular organs impairment should not be underestimated. Nevertheless, the exact mechanism and localization of peripheral vestibular damage consequent to chronic hyperglycemia and hyperinsulinemia are currently not still understood. Moreover it is not defined the possible role of these two blood conditions in worsening the prognosis of typical vestibular pathologies like "benign paroxysmal positional vertigo" and "Meniere disease". The aim of this review was to retrieve all studies investigating about the balance system alterations in patients suffering of diabetes. A search thorough Ovid MEDLINE was performed to enroll all eligible articles. Fourteen studies comprising a total of 1364 patients were included and analyzed in detail. On the basis of data reported in our review it appears plausible to hypothesize a direct connection among chronic hyperglycemic/hyperinsulinemic damage and peripheral vestibular organ dysfunction.
BibTeX: @article{Gioacchini2018, author = {Gioacchini, Federico Maria and Albera, Roberto and Re, Massimo and Scarpa, Alfonso and Cassandro, Claudia and Cassandro, Ettore}, title = {Hyperglycemia and diabetes mellitus are related to vestibular organs dysfunction: truth or suggestion? A literature review.}, journal = {Acta diabetologica}, year = {2018}, volume = {55}, issue = {12}, pages = {1201--1207}, doi = {https://doi.org/10.1007/s00592-018-1183-2}, keywords = {Diabetes Mellitus, physiopathology; Diabetic Neuropathies, etiology, physiopathology; Humans; Vestibular Diseases, etiology, physiopathology; Diabetes mellitus; Dizziness; Hyperglycemia; Hyperinsulinemia; Vertigo; Vestibular organs}, pmid = {29936650} }
Webster, G., Sens, P.M., Salmito, M.C., Cavalcante, J.D.R., Santos, P.R.B.d., Silva, A.L.M.d. and Souza, É.C.F.d.	Hyperinsulinemia and hyperglycemia: risk factors for recurrence of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2015	Brazilian journal of otorhinolaryngology Vol. 81(4), pp. 347-351	article	DOI
Abstract: Changes in carbohydrate metabolism may lead to recurrence of benign paroxysmal positional vertigo. To evaluate the influence of the disturbance of carbohydrate metabolism in the recurrence of idiopathic BPPV. A longitudinal prospective study of a cohort, with 41 months follow-up. We analyzed the results of 72 glucose-insulin curves in patients with recurrence of BPPV. The curves were classified into intolerance, hyperinsulinemia, hyperglycemia and normal. The RR for hyperinsulinism was 4.66 and p=0.0015. Existing hyperglycemia showed an RR=2.47, with p=0.0123. Glucose intolerance had a RR of 0.63, with p=0.096. When the examination was within normal limits, the result was RR=0.2225 and p=0.030. Metabolic changes can cause dizziness and vertigo and are very common in people who have cochleovestibular disorders. However, few studies discuss the relationship between idiopathic BPPV and alterations in carbohydrate metabolism. In the present study, we found that both hyperglycemia and hyperinsulinemia are risk factors for the recurrence of BPPV, whereas a normal test was considered a protective factor; all these were statistically significant. Glucose intolerance that was already present was not statistically significant in the group evaluated. Hyperinsulinemia and hyperglycemia are risk factors for the recurrence of idiopathic BPPV and a normal exam is considered a protective factor.
BibTeX: @article{Webster2015, author = {Webster, Guilherme and Sens, Patrícia Maria and Salmito, Márcio Cavalcante and Cavalcante, José Diogo Rijo and Santos, Paula Regina Bonifácio dos and Silva, Ana Lívia Muniz da and Souza, Érica Carla Figueiredo de}, title = {Hyperinsulinemia and hyperglycemia: risk factors for recurrence of benign paroxysmal positional vertigo.}, journal = {Brazilian journal of otorhinolaryngology}, year = {2015}, volume = {81}, issue = {4}, pages = {347--351}, doi = {https://doi.org/10.1016/j.bjorl.2014.09.008}, keywords = {Benign Paroxysmal Positional Vertigo, etiology; Glycemic Index; Humans; Hyperglycemia, complications, diagnosis; Hyperinsulinism, complications, diagnosis; Longitudinal Studies; Prospective Studies; Recurrence; Risk Factors; Carbohydrate metabolism; Dizziness; Glucose metabolism disorders; Metabolismo dos carboidratos; Tontura; Transtornos do metabolismo de glucose; Vertigem; Vertigo}, pmid = {26122875} }
Chiarella, G., Leopardi, G., De Fazio, L., Chiarella, R., Cassandro, C. and Cassandro, E.	Iatrogenic benign paroxysmal positional vertigo: review and personal experience in dental and maxillo-facial surgery. [Abstract] [BibTeX]	2007	Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale Vol. 27(3), pp. 126-128	article
Abstract: The post-traumatic origin of benign paroxysmal positional vertigo remains the most likely, from a patho-physiologic point of view. Benign paroxysmal positional vertigo due to surgical "traumas" has been described in the medical literature. According to personal experience, these iatrogenic cases represent a rare possibility and may be the consequence of surgical interventions differing according to the anatomical district involved and surgical technique performed. The temporal relationship with the surgical action and clinical features may be involved in some of these cases, even if it is not possible to define any real cause-effect link. Herewith some cases of paroxysmal positional vertigo are described, strongly held to be of iatrogenic origin, focusing on dental and maxillo-facial surgery as risk factors for benign paroxysmal positional vertigo.
BibTeX: @article{Chiarella2007, author = {Chiarella, G and Leopardi, G and De Fazio, L and Chiarella, R and Cassandro, C and Cassandro, E}, title = {Iatrogenic benign paroxysmal positional vertigo: review and personal experience in dental and maxillo-facial surgery.}, journal = {Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale}, year = {2007}, volume = {27}, issue = {3}, pages = {126--128}, keywords = {Adult; Female; Humans; Iatrogenic Disease; Male; Oral Surgical Procedures, methods; Postoperative Complications, epidemiology; Vertigo, epidemiology, etiology, physiopathology; Vestibule, Labyrinth, physiopathology}, pmid = {17883189} }
Yeo, S.-C., Ahn, S.-K., Lee, H.J., Cho, H.-J., Kim, S.-W., Woo, S.H., Jeon, S.-Y., Joo, Y.-H., Hur, D.G. and Park, J.J.	Idiopathic benign paroxysmal positional vertigo in the elderly: a long-term follow-up study. [Abstract] [BibTeX]	2018	Aging clinical and experimental research Vol. 30(2), pp. 153-159	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral-type vertigo in the elderly. While some studies have investigated BPPV among the elderly, no study has focused on the isolated idiopathic BPPV (iBPPV) in the elderly. To investigate the clinical features and recurrence rate in elderly patients diagnosed with iBPPV. The authors prospectively reviewed the medical records of 627 patients diagnosed with BPPV, and a total of 370 patients fulfilled the inclusion criteria. The subjects were divided into two groups by age (experimental group ≥65 years and control group 17-64 years), and the gender, numbers of canalith reposition maneuver (CRM) for successful treatment, time elapsed from onset of symptoms to clinic visit, the affected semicircular canal, and the 1- and 5-year recurrence proportion were analyzed. The gender, numbers of CRM for successful treatment, affected semicircular canal, and the 1- and 5-year recurrence proportion showed no statistically significant difference between two groups (p > 0.05). The only exception was the experimental group which took a longer duration from manifestation of symptoms to hospital visit than control group (student's t test, p = 0.021). Several previous studies report that the elderly with iBPPV shows more protracted clinical course and much higher recurrence rate than younger adult. Unlike those reports, our study showed no significant differences about the clinical features and recurrence rate between age groups. The elderly with iBPPV could be treated as effective as general population.
BibTeX: @article{Yeo2018, author = {Yeo, Seong-Chul and Ahn, Seong-Ki and Lee, Ho Joong and Cho, Hyun-Jin and Kim, Sang-Wook and Woo, Seung Hoon and Jeon, Sea-Yuong and Joo, Yeon-Hee and Hur, Dong Gu and Park, Jung Je}, title = {Idiopathic benign paroxysmal positional vertigo in the elderly: a long-term follow-up study.}, journal = {Aging clinical and experimental research}, year = {2018}, volume = {30}, issue = {2}, pages = {153--159}, doi = {https://doi.org/10.1007/s40520-017-0763-2}, keywords = {Adolescent; Adult; Age Factors; Aged; Benign Paroxysmal Positional Vertigo, physiopathology, therapy; Case-Control Studies; Disease Progression; Female; Follow-Up Studies; Humans; Male; Middle Aged; Patient Positioning, methods; Prospective Studies; Recurrence; Retrospective Studies; Semicircular Canals, physiopathology; Surveys and Questionnaires; Time Factors; Young Adult; Benign paroxysmal positional vertigo; Dizziness; Elderly; Idiopathic}, pmid = {28429295} }
Kitahara, T., Ota, I., Horinaka, A., Ohyama, H., Sakagami, M., Ito, T., Shiozaki, T., Wada, Y. and Yamanaka, T.	Idiopathic benign paroxysmal positional vertigo with persistent vertigo/dizziness sensation is associated with latent canal paresis, endolymphatic hydrops, and osteoporosis. [Abstract] [BibTeX]	2018	Auris, nasus, larynx	article	DOI
Abstract: The aim of the present study was to examine the association of neuro-otological examination, blood test, and scoring questionnaire data with treatment-resistant intractability in idiopathic benign paroxysmal positional vertigo (BPPV) patients. We experienced 1520 successive vertigo/dizziness patients at the Vertigo/Dizziness Center in Nara Medical University during May 2014 to April 2018. Six hundred and eleven patients were diagnosed as BPPV (611/1520; 40.2%) according to the diagnostic guideline of the International Classification of Vestibular Disorder in 2015. Among BPPV patients, there were 201 intractable patients (201/611; 32.9%), 66 of whom were idiopathic and enrolled to be hospitalized and receive neuro-otological examinations, including the caloric test (C-test), vestibular evoked cervical myogenic potentials (cVEMP), subjective visual vertical (SVV), glycerol test (G-test), electrocochleogram (ECoG), inner ear magnetic resonance imaging (ieMRI), blood tests including anti-diuretic hormone (ADH) and bone alkaline phosphatase (BAP), and self-rating questionnaires of depression score (SDS). Sixty-six patients were diagnosed as horizontal type cupula (hBPPVcu; n=30), horizontal type canal (hBPPVca; n=10), posterior type (n=20), and probable and/or atypical BPPV (n=6). Data are presented as ratios (+) of the number of idiopathic BPPV patients with examination and questionnaire data outside of the normal range. The ratio (+) data were as follows: C-test=21.2% (14/66), cVEMP=24.2% (16/66), SVV=48.5% (32/66), G-test=18.2% (12/66), ECoG=18.2% (12/66), ieMRI=12.1% (8/66), ADH=9.1% (6/66), BAP=13.6% (9/66), and SDS=37.9% (25/66). Multivariate regression analysis revealed that the periods of persistent vertigo/dizziness were significantly longer in BPPV patients with hBPPVcu, C-test (+), endolymphatic hydrops (+), and BAP (+) compared with those with negative findings. Although patients with idiopathic BPPV are usually treatable and curable within 1 month, the presence of hBPPVcu, canal paresis, endolymphatic hydrops, and elevated BAP may make the disease intractable, and thus require additional treatments.
BibTeX: @article{Kitahara2018, author = {Kitahara, Tadashi and Ota, Ichiro and Horinaka, Akira and Ohyama, Hiroki and Sakagami, Masaharu and Ito, Taeko and Shiozaki, Tomoyuki and Wada, Yoshiro and Yamanaka, Toshiaki}, title = {Idiopathic benign paroxysmal positional vertigo with persistent vertigo/dizziness sensation is associated with latent canal paresis, endolymphatic hydrops, and osteoporosis.}, journal = {Auris, nasus, larynx}, year = {2018}, doi = {https://doi.org/10.1016/j.anl.2018.05.010}, keywords = {Bone alkaline phosphatase; Canal paresis; Cupula type; Endolymphatic hydrops; Intractable idiopathic BPPV; Subjective visual vertical}, pmid = {30042018} }
Ralli, G., Atturo, F. and de Filippis, C.	Idiopathic benign paroxysmal vertigo in children, a migraine precursor. [Abstract] [BibTeX]	2009	International journal of pediatric otorhinolaryngology Vol. 73 Suppl 1, pp. S16-S18	article	DOI
Abstract: Vertigo and dizziness are common conditions in the adult population that can be rarely seen during childhood; only a few articles describing vertigo in children can be found in literature. Although many causes of vertigo in adulthood occur also in childhood, their frequency may be different. A typical example is benign paroxysmal positional vertigo, the most common peripheral vestibular disorder in adults, which occurs quite uncommonly in children. Furthermore, many common diseases causing vertigo in children may be unique for this population, such as benign paroxysmal vertigo (BPV) of childhood. At present, BPV is defined as a migraine's equivalent, a precursor of migraine or a periodic syndrome of childhood. The International Headache Society also studied this form of vertigo and included the Benign Paroxysmal Vertigo in section 1.3.3. of the International Classification of Headaches (ICHD-2). The present review analyzes recent patho-physiological and clinical evidences regarding idiopathic BPV in children.
BibTeX: @article{Ralli2009, author = {Ralli, G and Atturo, F and de Filippis, C}, title = {Idiopathic benign paroxysmal vertigo in children, a migraine precursor.}, journal = {International journal of pediatric otorhinolaryngology}, year = {2009}, volume = {73 Suppl 1}, pages = {S16--S18}, doi = {https://doi.org/10.1016/S0165-5876(09)70004-7}, keywords = {Child; Craniocerebral Trauma, diagnosis, epidemiology; Diagnosis, Differential; Humans; Migraine Disorders, diagnosis, epidemiology, physiopathology; Otitis Media, diagnosis, epidemiology; Severity of Illness Index; Vertigo, diagnosis, epidemiology, physiopathology; Vestibular Neuronitis, diagnosis, epidemiology}, pmid = {20114149} }
Pirodda, A., Raimondi, M.C. and Ferri, G.G.	Idiopathic sudden sensorineural hearing loss and comorbid benign paroxysmal positional vertigo: some pathogenic additional considerations. [BibTeX]	2012	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 33(5), pp. 895; author reply 895-895; author reply 896	article	DOI
BibTeX: @article{Pirodda2012, author = {Pirodda, Antonio and Raimondi, Maria Chiara and Ferri, Gian Gaetano}, title = {Idiopathic sudden sensorineural hearing loss and comorbid benign paroxysmal positional vertigo: some pathogenic additional considerations.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2012}, volume = {33}, issue = {5}, pages = {895; author reply 895--895; author reply 896}, doi = {https://doi.org/10.1097/MAO.0b013e3182544e92}, keywords = {Female; Hearing Loss, Sensorineural, complications; Humans; Male; Vertigo, etiology}, pmid = {22525218} }
Heidenreich, K.D.	Images in clinical medicine. Benign paroxysmal positional vertigo. [BibTeX]	2010	The New England journal of medicine Vol. 362(25), pp. e70	article	DOI
BibTeX: @article{Heidenreich2010, author = {Heidenreich, Katherine D}, title = {Images in clinical medicine. Benign paroxysmal positional vertigo.}, journal = {The New England journal of medicine}, year = {2010}, volume = {362}, issue = {25}, pages = {e70}, doi = {https://doi.org/10.1056/NEJMicm0907386}, keywords = {Humans; Nystagmus, Pathologic; Otolithic Membrane; Semicircular Canals; Vertigo, diagnosis, therapy; Vestibular Function Tests}, pmid = {20573921} }
Ban, J.H., Kim, M.-B. and Hong, S.M.	Immediate and Short-Term Therapeutic Results Between Direction-Changing Positional Nystagmus with Short- and Long-Duration Groups. [Abstract] [BibTeX]	2016	Ear and hearing Vol. 37(2), pp. 243-246	article	DOI
Abstract: Clinicians sometimes treat patients with relatively long-duration geotropic direction-changing positional nystagmus (DCPN), without latency. Recently, the concept of a "light cupula" in the lateral canal that reveals persistent geotropic DCPN has been introduced. In the present study, we investigated the immediate and short-term therapeutic findings in long-duration DCPN. The authors prospectively compared the therapeutic efficacy of a canalith-repositioning procedure (CRP) in short- and long-duration geotropic DCPN. In patients with long-duration DCPN, the authors found no immediate therapeutic effect, and the number of patients showing short-term effects (on the next day) was very low compared with the comparable figure among those with short-duration DCPN. In addition, no cases exhibited canal conversion after the CRP. Our results suggest that CRP is not useful in patients with long-duration geotropic DCPN, and the pathogenesis of long-duration geotropic DCPN may not originate from free-floating debris but from deflection of the cupula.
BibTeX: @article{Ban2016, author = {Ban, Jae Ho and Kim, Min-Beom and Hong, Seok Min}, title = {Immediate and Short-Term Therapeutic Results Between Direction-Changing Positional Nystagmus with Short- and Long-Duration Groups.}, journal = {Ear and hearing}, year = {2016}, volume = {37}, issue = {2}, pages = {243--246}, doi = {https://doi.org/10.1097/AUD.0000000000000232}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo, physiopathology, therapy; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, physiopathology, therapy; Nystagmus, Physiologic; Patient Positioning, methods; Posture; Prospective Studies; Semicircular Canals; Time Factors; Young Adult}, pmid = {26469290} }
Seo, T., Miyamoto, A., Saka, N., Shimano, K. and Sakagami, M.	Immediate efficacy of the canalith repositioning procedure for the treatment of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2007	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 28(7), pp. 917-919	article
Abstract: To study the immediate efficacy of the canalith repositioning procedure (CRP) in the treatment of benign paroxysmal positional vertigo. Thirty-four patients with benign paroxysmal positional vertigo. Eighteen patients were treated with CRP (CRP group); 16 control patients did not receive CRP treatment (non-CRP group). We compared the success rates of the CRP and non-CRP groups. The treatment was considered successful if it prevented vertigo and dizziness. Patients were evaluated 3 times: immediately posttreatment (the day after the first visit), in the short term (1 wk after treatment), and in the midterm (1 mo after treatment). Successful outcomes occurred in 12 patients (67%) from the CRP group and in 1 patient (6%) from the non-CRP group as immediate results (p < 0.001), 13 (72%) and 4 patients (25%) in the short term, respectively, (p = 0.007), and 16 (89%) and 14 patients (88%) in the midterm, respectively, (p > 0.05). Among patients in the CRP group who did not report immediate success, 1 patient (6%) reported success after 1 week (short term), and 4 patients (67%) had successful outcomes after 1 month (midterm). The immediate efficacy of CRP supported the canalolithiasis theory. The prognosis of patients with immediate unsuccessful results with CRP was somewhat worse than that for patients without CRP treatment.
BibTeX: @article{Seo2007, author = {Seo, Toru and Miyamoto, Atsushi and Saka, Naoki and Shimano, Koichi and Sakagami, Masafumi}, title = {Immediate efficacy of the canalith repositioning procedure for the treatment of benign paroxysmal positional vertigo.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2007}, volume = {28}, issue = {7}, pages = {917--919}, keywords = {Adult; Aged; Dizziness, prevention & control, surgery; Female; Humans; Male; Middle Aged; Otolithic Membrane, surgery; Otologic Surgical Procedures; Posture; Prognosis; Treatment Outcome; Vertigo, prevention & control, surgery}, pmid = {17955608} }
Seo, T., Miyamoto, A., Saka, N., Shimano, K. and Sakagami, M.	Immediate Efficacy of the Canalith Repositioning Procedure for the Treatment of Benign Paroxysmal Positional Vertigo. [Abstract] [BibTeX]	2007	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 28(7), pp. 917-919	article	DOI
Abstract: OBJECTIVE:: To study the immediate efficacy of the canalith repositioning procedure (CRP) in the treatment of benign paroxysmal positional vertigo. PATIENTS:: Thirty-four patients with benign paroxysmal positional vertigo. INTERVENTION:: Eighteen patients were treated with CRP (CRP group); 16 control patients did not receive CRP treatment (non-CRP group). MAIN OUTCOME MEASURES: We compared the success rates of the CRP and non-CRP groups. The treatment was considered successful if it prevented vertigo and dizziness. Patients were evaluated 3 times: immediately posttreatment (the day after the first visit), in the short term (1 wk after treatment), and in the midterm (1 mo after treatment) RESULTS:: Successful outcomes occurred in 12 patients (67%) from the CRP group and in 1 patient (6%) from the non-CRP group as immediate results (p < 0.001), 13 (72%) and 4 patients (25%) in the short term, respectively, (p = 0.007), and 16 (89%) and 14 patients (88%) in the midterm, respectively, (p > 0.05). Among patients in the CRP group who did not report immediate success, 1 patient (6%) reported success after 1 week (short term), and 4 patients (67%) had successful outcomes after 1 month (midterm). CONCLUSION:: The immediate efficacy of CRP supported the canalolithiasis theory. The prognosis of patients with immediate unsuccessful results with CRP was somewhat worse than that for patients without CRP treatment.
BibTeX: @article{Seo2007a, author = {Seo, Toru and Miyamoto, Atsushi and Saka, Naoki and Shimano, Koichi and Sakagami, Masafumi}, title = {Immediate Efficacy of the Canalith Repositioning Procedure for the Treatment of Benign Paroxysmal Positional Vertigo.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2007}, volume = {28}, issue = {7}, pages = {917--919}, doi = {https://doi.org/10.1097/MAO.0b013e3181468b6e}, pmid = {17704718} }
Papa, L., Amodio, A., Biffi, F. and Mandara, A.	Impact of osteopathic therapy on proprioceptive balance and quality of life in patients with dizziness. [Abstract] [BibTeX]	2017	Journal of bodywork and movement therapies Vol. 21(4), pp. 866-872	article	DOI
Abstract: The aim of the study was to evaluate the efficacy of osteopathic manipulative treatment (OMT) in patients with Benign-Paroxysmal-Positional Vertigo (BPPV). Thirty-one patients with BPPV were randomly assigned into two groups: 19 patients received osteopathic treatments (TG) and 12 patients received sham therapy (SG), both in four weekly sessions. Before the first and the last treatment, those patients were evaluated using Dizziness Handicap Inventory (DHI) and stabilometric platform to assess lifestyle modification and balance functions. After the treatment session, TG compared to SG showed an improvement in DHI global (p = 0.02), functional (p = 0.03) and physical (p = 0.03) components, as well as a reduction of swinging area (p = 0.02). An association between swinging area and lifestyle measures (global [r = 0.53; p = 0.02]; functional [r = 0.50; p = 0.03]; physical [r = 0.60; p = 0.01]) changes were found in TG. These findings suggest that OMT could be a useful approach to reduce imbalance symptoms and to improve the quality of life in patients suffering from dizziness.
BibTeX: @article{Papa2017, author = {Papa, L and Amodio, A and Biffi, F and Mandara, A}, title = {Impact of osteopathic therapy on proprioceptive balance and quality of life in patients with dizziness.}, journal = {Journal of bodywork and movement therapies}, year = {2017}, volume = {21}, issue = {4}, pages = {866--872}, doi = {https://doi.org/10.1016/j.jbmt.2017.03.001}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, therapy; Female; Humans; Male; Manipulation, Osteopathic, methods; Middle Aged; Postural Balance; Proprioception; Quality of Life; Osteopathic manipulative treatment; Peripheral vestibular vertigo; Quality of life}, pmid = {29037641} }
Li, S., Tian, L., Han, Z. and Wang, J.	Impact of postmaneuver sleep position on recurrence of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2013	PloS one Vol. 8(12), pp. e83566	article	DOI
Abstract: The necessity of postural restriction to patients suffering from benign paroxysmal positional vertigo is controversial. To investigate the impact of the sleep position after the repositioning maneuver on BPPV recurrence. 150 unilateral BPPV patients who were treated by repositioning maneuver were distributed into two groups. The patients in group A were instructed to sleep in a semi-sitting position at an angle of approximately 30 degrees and refrain from sleeping on their BPPV affected side for one week. The patients in group B were told to sleep in any preferred position. The comparison of recurrence rates according to different actual sleep positions in one week and one month was performed. There was a statistically significant correlation between the sleeping side and the side affected by BPPV. Without instructions on postural restriction, most patients (82.9%, 73/88) avoided sleeping on their affected side. The patients sleeping on their affected side had a higher recurrence rate (35.3%) than ones sleeping in other positions in the first week after the repositioning maneuver (p<0.05, Chi-square test and Fisher's exact test). The patients sleeping randomly in following 3 weeks had a lower recurrence rate than ones sleeping in other position (p<0.05, Fisher's exact test). BPPV patients had a poor compliance to postural instructions. The habitual sleep side was associated with the side affected by BPPV. The patients sleeping on their affected side had a higher recurrence rate than those sleeping in other positions in first week after the repositioning maneuver.
BibTeX: @article{Li2013, author = {Li, Shufeng and Tian, Liang and Han, Zhao and Wang, Jing}, title = {Impact of postmaneuver sleep position on recurrence of benign paroxysmal positional vertigo.}, journal = {PloS one}, year = {2013}, volume = {8}, issue = {12}, pages = {e83566}, doi = {https://doi.org/10.1371/journal.pone.0083566}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Female; Habits; Humans; Male; Middle Aged; Posture; Secondary Prevention; Sleep, physiology; Vertigo, physiopathology, therapy; Young Adult}, pmid = {24367602} }
Lopez-Escamez, J.A., Gamiz, M.J., Fernandez-Perez, A., Gomez-Fiñana, M. and Sanchez-Canet, I.	Impact of treatment on health-related quality of life in patients with posterior canal benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2003	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 24(4), pp. 637-641	article
Abstract: To determine the impact of the particle repositioning maneuver on posterior canal benign paroxysmal positional vertigo-related quality of life using the Medical Outcomes Study 36-Item Short Form Health Survey and the Dizziness Handicap Inventory Short Form. Prospective, consecutive new cases of posterior canal benign paroxysmal positional vertigo. Ambulatory, primary referral hospital. Forty individuals with posterior canal benign paroxysmal positional vertigo were investigated. The diagnosis was made on the basis of the history of recurrent sudden crisis of vertigo and positional-induced nystagmus during the Dix-Hallpike test. All patients were treated by a single particle repositioning maneuver, and relapses were investigated at Days 7 and 30 posttreatment. Percentage of patients with negative Dix-Hallpike test after treatment, scores obtained on the 36-Item Short Form Health Survey and Dizziness Handicap Inventory Short Form before and 30 days after treatment. DHT was found negative in 76% (28 of 37) individuals at 30 days. The eight scales of the 36-Item Short Form Health Survey had a good internal consistency reliability (Cronbach's alpha > 0.7) in patients with posterior canal benign paroxysmal positional vertigo. The average standardized score for each 36-Item Short Form Health Survey scale was compared with the reference population normative data, showing differences with norms for all scales, except for Vitality. After particle repositioning maneuver, patients scored closer to norms, and Social Function and Mental Health scores were significantly higher than the scores obtained before the particle repositioning maneuver (p < 0.05). Dizziness Handicap Inventory Short Form total score significantly decreased from 18.05 +/- 9.91 (mean +/- standard deviation) at the first day to 9.54 +/- 9.94 at 30 days (p < 0.001). All 36-Item Short Form Health Survey scale scores were correlated significantly with Dizziness Handicap Inventory Short Form total scores at 30 days after treatment. Posterior canal benign paroxysmal positional vertigo has a significant impact on health-related quality of life, and patients experienced a decrease in quality of life as compared with norms. The particle repositioning maneuver improves health-related quality of life in posterior canal benign paroxysmal positional vertigo.
BibTeX: @article{Lopez-Escamez2003, author = {Lopez-Escamez, Jose A and Gamiz, Maria J and Fernandez-Perez, Antonio and Gomez-Fiñana, Manuel and Sanchez-Canet, Isabel}, title = {Impact of treatment on health-related quality of life in patients with posterior canal benign paroxysmal positional vertigo.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2003}, volume = {24}, issue = {4}, pages = {637--641}, keywords = {Adult; Disability Evaluation; Dizziness, etiology; Female; Health Status; Health Surveys; Humans; Interpersonal Relations; Male; Mental Health; Middle Aged; Prospective Studies; Quality of Life; Vertigo, complications, physiopathology, psychology, therapy}, pmid = {12851558} }
Janssens, J.-P., Metzger, M. and Sforza, E.	Impact of volume targeting on efficacy of bi-level non-invasive ventilation and sleep in obesity-hypoventilation. [Abstract] [BibTeX]	2009	Respiratory medicine Vol. 103(2), pp. 165-172	article	DOI
Abstract: Volume targeting by bi-level positive pressure ventilation (BPPV) has recently been made available by several manufacturers for home care ventilators. Although it may improve nocturnal ventilation, we hypothesized that increased pressure swings related to volume targeting may have a deleterious effect on sleep structure and patient comfort. Patients in stable clinical condition (n=12) treated by BPPV for obesity-hypoventilation (BMI: 44+/-8 kg/m(2)) for a median of 30 months (range: 2-138), underwent nocturnal polysomnography with transcutaneous capnography on 2 consecutive nights with either BPPV and usual ventilator settings or BPPV with volume targeting, in randomized sequence. Subjective quality of sleep (St. Mary's Hospital Questionnaire) and comfort of ventilation (VAS scales) were also assessed. Mean IPAP, mean tidal volume, and total ventilation increased significantly with volume targeting. Control of nocturnal hypoventilation was slightly improved with volume targeting (nocturnal TcPCO(2): 42+/-9 vs. 45+/-5 mmHg, p=0.04). However, total sleep time and stage 2 sleep were greater without volume targeting, and wake after sleep onset and awakenings >20s increased with volume targeting. Subjectively, patients described a lighter sleep, of lesser quality and more frequent awakenings with volume targeting; ventilation was perceived as less comfortable, with an increased perception of leaks and of "too much air". In stable patients treated by BPPV for obesity-hypoventilation, volume targeting improved control of nocturnal hypoventilation at the expense of a slight decrease in objective and subjective sleep quality, and comfort of ventilation.
BibTeX: @article{Janssens2009, author = {Janssens, Jean-Paul and Metzger, Marie and Sforza, Emilia}, title = {Impact of volume targeting on efficacy of bi-level non-invasive ventilation and sleep in obesity-hypoventilation.}, journal = {Respiratory medicine}, year = {2009}, volume = {103}, issue = {2}, pages = {165--172}, doi = {https://doi.org/10.1016/j.rmed.2008.03.013}, keywords = {Capnography, methods; Carbon Dioxide, physiology; Female; Humans; Male; Obesity Hypoventilation Syndrome, physiopathology, therapy; Oximetry, methods; Patient Satisfaction; Polysomnography; Positive-Pressure Respiration, instrumentation, methods; Sleep, physiology; Treatment Outcome}, pmid = {18579368} }
Candidi, M., Micarelli, A., Viziano, A., Aglioti, S.M., Minio-Paluello, I. and Alessandrini, M.	Impaired mental rotation in benign paroxysmal positional vertigo and acute vestibular neuritis. [Abstract] [BibTeX]	2013	Frontiers in human neuroscience Vol. 7, pp. 783	article	DOI
Abstract: Vestibular processing is fundamental to our sense of orientation in space which is a core aspect of the representation of the self. Vestibular information is processed in a large subcortical-cortical neural network. Tasks requiring mental rotations of human bodies in space are known to activate neural regions within this network suggesting that vestibular processing is involved in the control of mental rotation. We studied whether mental rotation is impaired in patients suffering from two different forms of unilateral vestibular disorders (vestibular neuritis - VN - and Benign Paroxysmal positional Vertigo - BPPV) with respect to healthy matched controls (C). We used two mental rotation tasks in which participants were required to: (i) mentally rotate their own body in space (egocentric rotation) thus using vestibular processing to a large extent and (ii) mentally rotate human figures (allocentric rotation) thus using own body representations to a smaller degree. Reaction times and accuracy of responses showed that VN and BPPV patients were impaired in both tasks with respect to C. Significantly, the pattern of results was similar in the three groups suggesting that patients were actually performing the mental rotation without using a different strategy from the control individuals. These results show that dysfunctional vestibular inflow impairs mental rotation of both own body and human figures suggesting that unilateral acute disorders of the peripheral vestibular input massively affect the cerebral processes underlying mental rotations.
BibTeX: @article{Candidi2013, author = {Candidi, Matteo and Micarelli, Alessandro and Viziano, Andrea and Aglioti, Salvatore M and Minio-Paluello, Ilaria and Alessandrini, Marco}, title = {Impaired mental rotation in benign paroxysmal positional vertigo and acute vestibular neuritis.}, journal = {Frontiers in human neuroscience}, year = {2013}, volume = {7}, pages = {783}, doi = {https://doi.org/10.3389/fnhum.2013.00783}, keywords = {benign paroxysmal positional vertigo; body rotations; embodied cognition; mental imagery; vestibular disorder; vestibular neuritis}, pmid = {24324422} }
Meurer, W.J., Beck, K.E., Rowell, B., Brown, D., Tsodikov, A., Fagerlin, A., Telian, S.A., Damschroder, L., An, L.C., Morgenstern, L.B., Ujhely, M., Loudermilk, L., Vijan, S. and Kerber, K.A.	Implementation of evidence-based practice for benign paroxysmal positional vertigo: DIZZTINCT- A study protocol for an exploratory stepped-wedge randomized trial. [Abstract] [BibTeX]	2018	Trials Vol. 19(1), pp. 697	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder, and accounts for 8% of individuals with moderate or severe dizziness. BPPV patients experience substantial inconveniences and disabilities during symptomatic periods. BPPV therapeutic processes - the Dix-Hallpike Test (DHT) and the Canalith Repositioning Maneuver (CRM) - have an evidence base that is at the clinical practice guideline level. The most commonly used CRM is the modified Epley maneuver. The DHT is the gold standard test for BPPV and the CRM is supported by numerous randomized controlled trials and systematic reviews. Despite this, BPPV care processes are underutilized. This is a stepped-wedge, randomized clinical trial of a multi-faceted educational and care-process-based intervention designed to improve the guideline-concordant care of patients with BPPV presenting to the emergency department (ED) with dizziness. The unit of randomization and target of intervention is the hospital. After an initial observation period, the six hospitals will undergo the intervention in five waves (two closely integrated hospitals will be paired). The order will be randomized. The primary endpoint is measured at the individual patient level, and is the presence of documentation of either the Dix-Hallpike Test or CRM. The secondary endpoints are referral to a health care provider qualified to treat dizziness for CRM and 90-day stroke rates following an ED dizziness visit. Formative evaluations are also performed to monitor and identify potential and actual influences on the progress and effectiveness of the implementation efforts. If this study safely increases documentation of the DHT/CRM, this will be an important step in implementing the use of these evidenced-based processes of care. Positive results will support conducting larger-scale follow-up studies that assess patient outcomes. The data collection also enables evaluation of potential and actual influences on the progress and effectiveness of the implementation efforts. ClinicalTrials.gov, ID: NCT02809599 . The record was first available to the public on 22 June 2016 prior to the enrollment of the first patients in October 2016.
BibTeX: @article{Meurer2018, author = {Meurer, William J and Beck, Kathryn E and Rowell, Brigid and Brown, Devin and Tsodikov, Alexander and Fagerlin, Angela and Telian, Steven A and Damschroder, Laura and An, Lawrence C and Morgenstern, Lewis B and Ujhely, Misty and Loudermilk, Laura and Vijan, Sandeep and Kerber, Kevin A}, title = {Implementation of evidence-based practice for benign paroxysmal positional vertigo: DIZZTINCT- A study protocol for an exploratory stepped-wedge randomized trial.}, journal = {Trials}, year = {2018}, volume = {19}, issue = {1}, pages = {697}, doi = {https://doi.org/10.1186/s13063-018-3099-0}, keywords = {Benign paroxysmal peripheral vertigo; Clinical trial; Emergency medicine; Stepped wedge}, pmid = {30577834} }
Maslovara, S., Vešligaj, T., Butković Soldo, S., Pajić-Penavić, I., Maslovara, K., Mirošević Zubonja, T. and Soldo, A.	Importance of accurate diagnosis in benign paroxysmal positional vertigo (BPPV) therapy. [Abstract] [BibTeX]	2014	Medicinski glasnik : official publication of the Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina Vol. 11(2), pp. 300-306	article
Abstract: To determine the importance of accurate topological diagnostics of the otolith and the differentiation of certain clinical forms of benign paroxysmal positional vertigo (BPPV). A prospective study was conducted at the County General Hospital Vukovar in the period from January 2011 till January 2012. A total of 81 patients with BPPV, 59 females (72.84%) and 22 (27.16%) males (p less than 0.001), mean age 60.1 (± 12.1) were examined. The diagnosis was confirmed and documented by videonystagmography (VNG). The disability due to disease and risk of falling were monitored by filling in the Dizziness Handicap Inventory (DHI) and Activities-specific Balance Confidence Scale (ABC) questionnaires at the beginning and at the end of the repositioning treatment. In 79 (97.3%) patients posterior semicircular canal was affected, and in a small number of patients, two (2.47%) the lateral one. After the repositioning procedures were performed, there was a significant reduction or complete elimination of symptoms in the majority of subjects, 76 (93.82%). The median total DHI sum amounted to 50.5 (± 22.2) at the beginning and 20.4 (± 18.5) at the end of the study (p less than 0.00). Similarly, the results of ABC questionnaires at the beginning of the study demonstrated a result of 59.2% (± 22.4%), and at the end of the treatment the average result of examinees was significantly higher, 84.9% (± 15.2%) (p less than 0.00). Although a subjectively positive Dix-Hallpike or a "supine roll" test is sufficient for the diagnosis of BPPV, it is necessary perform the VNG as well in order to precisely determine the exact localization of the otolith, so that an appropriate repositioning procedure can be applied.
BibTeX: @article{Maslovara2014, author = {Maslovara, Siniša and Vešligaj, Tihana and Butković Soldo, Silva and Pajić-Penavić, Ivana and Maslovara, Karmela and Mirošević Zubonja, Tea and Soldo, Anamarija}, title = {Importance of accurate diagnosis in benign paroxysmal positional vertigo (BPPV) therapy.}, journal = {Medicinski glasnik : official publication of the Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina}, year = {2014}, volume = {11}, issue = {2}, pages = {300--306}, keywords = {Aged; Benign Paroxysmal Positional Vertigo, diagnosis, physiopathology, therapy; Electronystagmography, methods; Female; Humans; Male; Middle Aged; Patient Positioning, methods; Prospective Studies; Semicircular Canals, physiopathology; Statistics, Nonparametric; Surveys and Questionnaires; Vestibule, Labyrinth, physiopathology}, pmid = {25082244} }
Rodriguez, A.I., Zupancic, S., Song, M.M., Cordero, J., Nguyen, T.Q. and Seifert, C.	Importance of an Interprofessional Team Approach in Achieving Improved Management of the Dizzy Patient. [Abstract] [BibTeX]	2017	Journal of the American Academy of Audiology Vol. 28(3), pp. 177-186	article	DOI
Abstract: Because of its multifaceted nature, dizziness is difficult for clinicians to diagnose and manage independently. Current treatment trends suggest that patients are often referred to the otolaryngologist for intervention despite having a nonotologic disorder. Additionally, many individuals with atypical presentations are often misdiagnosed and spend a significant amount of time waiting for consultation by the otolaryngologist. Few studies have alluded that implementation of an interprofessional team approach in the diagnosis and management of the dizzy patient can improve clinical decision-making. However, to the authors' knowledge, there is no information specifically quantifying the outcomes and potential benefits of using an interprofessional balance care team approach. To compare dizziness diagnoses trends and referral practices with and without the use of an interprofessional management approach within a university healthcare system. Over the course of a 3-yr period, a retrospective review of the diagnosis and management of dizziness was performed with and without implementation of an interprofessional team. To observe potential differences, year 3 incorporated the interprofessional management approach while years 1-2 did not. The two periods were then compared to each other. A total of 134 patients referred to a university hearing clinic for a vestibular and balance function evaluation. Diagnoses and management trends were examined with descriptive statistics (percentages and frequencies). Fisher's exact tests, analysis of contingency tables, were conducted to evaluate the influence of interprofessional management on dizziness diagnoses and treatment patterns. Results demonstrated that before implementation of an interprofessional team approach, (1) referring clinicians used unspecific dizziness diagnosis codes (e.g., dizziness and giddiness), (2) a low number of patients with dizziness were referred for balance function testing, (3) diagnoses remained unspecific following the balance function assessment, and (4) the most frequently occurring vestibular diagnoses were unilateral vestibular hypofunction and benign paroxysmal positional vertigo. Following the use of an interprofessional management approach, it was determined that (1) disease-specific diagnoses increased, (2) patients with dizziness were referred for balance function testing mainly by otolaryngologists, (3) dizziness was considered to be multifaceted for a greater number of patients, (4) a larger percentage of patients were referred to a specialist other than the otolaryngologist as a result of their diagnosis, and (5) patients reported reduction or resolution of their symptoms. An interprofessional management approach for the dizzy patient can lead to more specific diagnoses and provide alternative referral pathways to other health-care professionals (e.g., audiologists, physical therapists, and pharmacists) in an effort to reduce over-referral to one specialist. Future studies should address the utility of an interprofessional team approach in the overall management of patients with dizziness.
BibTeX: @article{Rodriguez2017, author = {Rodriguez, Amanda I and Zupancic, Steven and Song, Michael M and Cordero, Joehassin and Nguyen, Tam Q and Seifert, Charles}, title = {Importance of an Interprofessional Team Approach in Achieving Improved Management of the Dizzy Patient.}, journal = {Journal of the American Academy of Audiology}, year = {2017}, volume = {28}, issue = {3}, pages = {177--186}, doi = {https://doi.org/10.3766/jaaa.15054}, keywords = {Adult; Cohort Studies; Combined Modality Therapy, methods; Disease Management; Dizziness, diagnosis, therapy; Female; Humans; Interprofessional Relations; Male; Middle Aged; Patient Care Team, organization & administration; Prognosis; Recurrence; Retrospective Studies; Risk Assessment; Severity of Illness Index; Treatment Outcome; Vertigo, diagnosis, therapy}, pmid = {28277209} }
Pavlin-Premrl, D., Waterston, J., McGuigan, S., Infeld, B., Sultana, R., O'Sullivan, R. and Gerraty, R.P.	Importance of spontaneous nystagmus detection in the differential diagnosis of acute vertigo. [Abstract] [BibTeX]	2015	Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia Vol. 22(3), pp. 504-507	article	DOI
Abstract: Vertigo is a common cause of emergency department attendance. Detection of spontaneous nystagmus may be a useful sign in distinguishing vestibular neuritis from other vestibular diagnoses. We aimed to assess the contribution of spontaneous nystagmus in the diagnosis of acute vertigo. We enrolled consecutive consenting patients arriving at a single emergency department with acute vertigo. There was no declared protocol for the emergency department staff. A standardized history and examination was conducted by the investigators. Observation for spontaneous nystagmus, its response to visual fixation, and testing the vestibulo-ocular reflex with the horizontal head impulse test were the chief examination components. MRI was obtained within 24 hours. Clinical criteria and MRI were used to reach the final diagnosis. The investigators' physical findings and final neurological diagnosis were compared with the initial emergency department examination findings and the referral diagnosis. There were 28 patients, 15 with vestibular neuritis, six with benign paroxysmal positional vertigo, one with stroke, suspected clinically, and three with migraine. In three the diagnosis remained uncertain. Spontaneous nystagmus was seen in all 15 patients with vestibular neuritis, fixation-suppressed in eight of 11 tested for this. The head impulse test was positive in 12 of 15 with vestibular neuritis. The emergency department referral diagnosis was correct in six of 23 patients. The ability to detect spontaneous nystagmus is useful in vestibular diagnosis, both in support of a diagnosis of vestibular neuritis and in avoiding false positive diagnoses of benign paroxysmal positional vertigo.
BibTeX: @article{Pavlin-Premrl2015, author = {Pavlin-Premrl, Davor and Waterston, John and McGuigan, Sean and Infeld, Bernard and Sultana, Ron and O'Sullivan, Richard and Gerraty, Richard P}, title = {Importance of spontaneous nystagmus detection in the differential diagnosis of acute vertigo.}, journal = {Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia}, year = {2015}, volume = {22}, issue = {3}, pages = {504--507}, doi = {https://doi.org/10.1016/j.jocn.2014.09.011}, keywords = {Acute Disease; Adult; Aged; Benign Paroxysmal Positional Vertigo, diagnosis, physiopathology; Diagnosis, Differential; Female; Head Impulse Test; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Nystagmus, Pathologic, diagnosis, physiopathology; Physical Examination; Predictive Value of Tests; Reflex, Vestibulo-Ocular; Stroke, diagnosis; Vertigo, diagnosis, physiopathology; Vestibular Neuronitis, diagnosis, physiopathology; Acute vestibular neuritis; Spontaneous ocular nystagmus; Vestibular diseases}, pmid = {25537400} }
Bojrab, D. and Schutt, C.	In reference to Otoconia and Otolithic Membrane Fragments Within the Posterior Semicircular Canal in Benign Paroxysmal Positional Vertigo. [BibTeX]	2018	The Laryngoscope Vol. 128(5), pp. E196	article	DOI
BibTeX: @article{Bojrab2018, author = {Bojrab, Dennis and Schutt, Christopher}, title = {In reference to Otoconia and Otolithic Membrane Fragments Within the Posterior Semicircular Canal in Benign Paroxysmal Positional Vertigo.}, journal = {The Laryngoscope}, year = {2018}, volume = {128}, issue = {5}, pages = {E196}, doi = {https://doi.org/10.1002/lary.26810}, keywords = {Benign Paroxysmal Positional Vertigo; Humans; Otolithic Membrane; Semicircular Canals}, pmid = {28782301} }
Obrist, D., Hegemann, S., Kronenberg, D., Häuselmann, O. and Rösgen, T.	In vitro model of a semicircular canal: design and validation of the model and its use for the study of canalithiasis. [Abstract] [BibTeX]	2010	Journal of biomechanics Vol. 43(6), pp. 1208-1214	article	DOI
Abstract: We present an experimental model for a semicircular canal with canalithiasis. Canalithiasis is a pathological condition where free-floating particles disturb the flow field in the semicircular canals. It may lead to a specific form of vertigo known as BPPV or top-shelf vertigo. A careful scaling of the physical and geometrical parameters allows us to study the mechanics of this disease on an enlarged model of a single semicircular canal with laser vibrometry and video particle tracking. Early results confirm the proper operation of the model canal and support the current theories on the mechanisms of BPPV.
BibTeX: @article{Obrist2010, author = {Obrist, Dominik and Hegemann, Stefan and Kronenberg, Dominique and Häuselmann, Oliver and Rösgen, Thomas}, title = {In vitro model of a semicircular canal: design and validation of the model and its use for the study of canalithiasis.}, journal = {Journal of biomechanics}, year = {2010}, volume = {43}, issue = {6}, pages = {1208--1214}, doi = {https://doi.org/10.1016/j.jbiomech.2009.11.027}, keywords = {Acceleration; Biomechanical Phenomena; Biomedical Engineering, instrumentation; Endolymph, physiology; Equipment Design; Humans; In Vitro Techniques; Lithiasis, pathology, physiopathology; Models, Biological; Otolaryngology, instrumentation; Rotation; Semicircular Canals, pathology, physiopathology; Vertigo, pathology, physiopathology}, pmid = {20035941} }
Pollak, L., Huna-Baron, R., Osherov, M. and Roni, M.	In whom does horizontal canal BPPV recur? [Abstract] [BibTeX]	2018	American journal of otolaryngology Vol. 39(4), pp. 410-412	article	DOI
Abstract: The objective of this study is to examine the rate of horizontal canal BPPV recurrence of the same type and search for predisposing factors.
BibTeX: @article{Pollak2018, author = {Pollak, L and Huna-Baron, R and Osherov, Michael and Roni, Milo}, title = {In whom does horizontal canal BPPV recur?}, journal = {American journal of otolaryngology}, year = {2018}, volume = {39}, issue = {4}, pages = {410--412}, doi = {https://doi.org/10.1016/j.amjoto.2018.04.003}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, diagnosis, etiology, therapy; Female; Humans; Male; Middle Aged; Prognosis; Recurrence; Retrospective Studies; Risk Factors; Horizontal canal BPPV; Rate of recurrence}, pmid = {29650422} }
Oh, E.H., Lee, J.H., Kim, H.J., Choi, S.Y., Choi, K.D. and Choi, J.H.	Incidence and Clinical Significance of Positional Downbeat Nystagmus in Posterior Canal Benign Paroxysmal Positional Vertigo. [Abstract] [BibTeX]	2018	Journal of clinical neurology (Seoul, Korea)	article
Abstract: The aim of this study was to determine the incidence and clinical significance of positional downbeat nystagmus (pDBN) after treatment of posterior canal (PC) benign paroxysmal positional vertigo (BPPV). We recruited 77 patients with a diagnosis of PC BPPV, and assessed the presence of pDBN during follow-up positional tests after performing the Epley maneuver. An immediate response to the Epley maneuver was exhibited by 57 of the 77 patients, with resolution of their positional torsional upbeat nystagmus (pT-UBN). Twenty-two (39%) of them exhibited pDBN during follow-up tests performed 1 hour later. The latency and duration of pDBN were 3.2±2.0 and 12.0±10.0 s (mean±SD), respectively. The maximum slow-phase velocity of pDBN was 5.1±2.5 degrees, and ranged from 2.0 to 12.2 degrees. A torsional component was also observed in six patients. The patients with pDBN were much more likely to develop a typical form of PC BPPV again at a 1-week follow-up (5/22, 23%) compared to those without pDBN (1/31, 3%; p=0.036). pDBN disappeared in all patients within 6 months. Our study found transient pDBN in 40% of patients with PC BPPV after the immediate resolution of positional vertigo and pT-UBN. pDBN may be attributed to residual debris in the distal portion of the PC, which can move toward the ampulla producing an ampullopetal flow of endolymph during positioning.
BibTeX: @article{Oh2018, author = {Oh, Eun Hye and Lee, Jae Hoon and Kim, Hyo Jung and Choi, Seo Young and Choi, Kwang Dong and Choi, Jae Hwan}, title = {Incidence and Clinical Significance of Positional Downbeat Nystagmus in Posterior Canal Benign Paroxysmal Positional Vertigo.}, journal = {Journal of clinical neurology (Seoul, Korea)}, year = {2018}, keywords = {Epley maneuver; positional downbeat nystagmus; posterior canal benign paroxysmal positional vertigo}, pmid = {29856161} }
Haripriya, G.R., Mary, P., Dominic, M., Goyal, R. and Sahadevan, A.	Incidence and Treatment Outcomes of Post Traumatic BPPV in Traumatic Brain Injury Patients. [Abstract] [BibTeX]	2018	Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India Vol. 70(3), pp. 337-341	article	DOI
Abstract: The aim of this study is to assess the incidence of post traumatic BPPV and evaluate its treatment outcomes in mild and moderate traumatic head injury patients. The study population consisted of 128 patients (89 male:39 female) who were admitted with head and neck injury (Motor Vehicle Accident, Blow to the head, Fall from Height, Whiplash injury) as inpatients in Department of Neurosurgery in Tertiary care hospital in Kerala during a 2 month period from 1st April 2014 to 31st May 2014. The age range was 10-70 years and mean 39.8 with standard deviation 15.5. All cases were evaluated and serially followed up to a period of 6 months in Department of Otorhinolaryngology. In our study, the number of patients with mild injuries (Glasgow coma scale 13-15) were 108 and moderate injury (Glasgow coma scale 9-12) were 20. We found out that post traumatic BPPV was found to be 17% of the traumatic brain injury patients. All patients were treated with particle re-positioning maneuvers and were followed up for a period of 6 months. Recurrence were reported in 9 (40.9%) patients. In these patients re positioning maneuvers were repeated.
BibTeX: @article{Haripriya2018, author = {Haripriya, G R and Mary, Preethy and Dominic, Mathew and Goyal, Rashmi and Sahadevan, Ambily}, title = {Incidence and Treatment Outcomes of Post Traumatic BPPV in Traumatic Brain Injury Patients.}, journal = {Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India}, year = {2018}, volume = {70}, issue = {3}, pages = {337--341}, doi = {https://doi.org/10.1007/s12070-018-1329-0}, keywords = {Benign paroxysmal positional vertigo (BPPV); Dix–Hallpike maneuver; Epleys maneuver; Traumatic brain injury (TBI)}, pmid = {30211085} }
Wada, M., Takeshima, T., Nakamura, Y., Nagasaka, S., Kamesaki, T., Oki, H. and Kajii, E.	Incidence of dizziness and vertigo in Japanese primary care clinic patients with lifestyle-related diseases: an observational study. [Abstract] [BibTeX]	2015	International journal of general medicine Vol. 8, pp. 149-154	article	DOI
Abstract: Dizziness and vertigo are highly prevalent symptoms among patients presenting at primary care clinics, and peripheral vestibular disorder (PVD) is their most frequent cause. However, the incidence of PVD has not been well documented. This study aimed to investigate the incidence of dizziness, vertigo, and PVD among patients presenting at a primary care clinic. This was an observational study. Between November 2011 and March 2013, we observed 393 patients, all at least 20 years old, who had been treated for chronic diseases such as hypertension, dyslipidemia, and diabetes mellitus for at least 6 months at a primary clinic (Oki Clinic) in Japan. The main outcome of interest was new incidence of dizziness, vertigo, and PVD events. During the 1-year follow-up period, the otorhinolaryngologist diagnosed and reported new PVD events. The mean age of the 393 participants at entry was 65.5 years. Of the study participants, 12.7%, 82.4%, and 92.6% had diabetes mellitus, hypertension, and dyslipidemia, respectively. We followed up all the participants (100%). During the 662.5 person-years of follow-up, 121 cases of dizziness or vertigo (dizziness/vertigo) and 76 cases of PVD were observed. The incidence of dizziness/vertigo and PVD was 194.7 (95% confidence interval: 161.6-232.6) per 1,000 person-years and 115.7 (95% confidence interval: 92.2-142.6) per 1,000 person-years, respectively. There were 61 cases of acute peripheral vestibulopathy, 12 of benign paroxysmal positional vertigo, and three of Meniere's disease among the 76 PVD patients. We reported the incidence of dizziness/vertigo among Japanese primary care clinic patients, which was higher than that usually observed in the general population. Furthermore, we described the incidence of PVD and found that it was a major cause of dizziness/vertigo.
BibTeX: @article{Wada2015, author = {Wada, Masaoki and Takeshima, Taro and Nakamura, Yosikazu and Nagasaka, Shoichiro and Kamesaki, Toyomi and Oki, Hiroshi and Kajii, Eiji}, title = {Incidence of dizziness and vertigo in Japanese primary care clinic patients with lifestyle-related diseases: an observational study.}, journal = {International journal of general medicine}, year = {2015}, volume = {8}, pages = {149--154}, doi = {https://doi.org/10.2147/IJGM.S82018}, keywords = {dizziness; incidence; observational study; primary health care}, pmid = {25931828} }
Chung, K.W., Park, K.N., Ko, M.H., Jeon, H.K., Choi, J.Y., Cho, Y.-S., Hong, S.H. and Chung, W.-H.	Incidence of horizontal canal benign paroxysmal positional vertigo as a function of the duration of symptoms. [Abstract] [BibTeX]	2009	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 30(2), pp. 202-205	article
Abstract: The incidence of horizontal canal involvement in benign paroxysmal positional vertigo (HC-BPPV) varies between reports. One of the reasons for these differences is that the duration of symptoms was not considered. Because of the high spontaneous resolution rate in HC-BPPV and the medical referral system, the frequency of HC-BPPV might change according to the duration of symptoms. We evaluated the frequency of involved canals in BPPV according to the duration of symptoms. A retrospective review. A retrospective review was conducted involving 589 patients diagnosed with BPPV from January 2001 to December 2006. The patients were divided into 3 groups according to the duration of symptoms: Group A included patients who sought evaluation in the clinics within 24 hours from the onset of symptoms (n = 328); Group B was composed of patients who experienced symptoms from 24 hours to 7 days (n = 87) before evaluation; and Group C patients had symptoms for more than 7 days (n = 174) before evaluation. The frequencies of involved canals were assessed and compared between the groups. The correlation between the frequency of involved canals and symptom duration was also analyzed. The posterior, horizontal, and anterior canals were involved in 61.8, 35.3, and 2.9% of the patients, respectively. However, the frequency of HC-BPPV was 40.5% in Group A, 33.3% in Group B, and 26.4% in Group C (p < 0.01). There was a significant negative correlation between the frequency of HC-BPPV and the duration of symptoms (r =-0.670; p < 0.01). The incidence of HC-BPPV was higher than reported; however, it significantly decreased according to the duration of symptoms.
BibTeX: @article{Chung2009, author = {Chung, Kyu Whan and Park, Ki Nam and Ko, Moon Hee and Jeon, Hyung Ki and Choi, Jae Yeon and Cho, Yang-Sun and Hong, Sung Hwa and Chung, Won-Ho}, title = {Incidence of horizontal canal benign paroxysmal positional vertigo as a function of the duration of symptoms.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2009}, volume = {30}, issue = {2}, pages = {202--205}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Disease Progression; Female; Humans; Male; Middle Aged; Nystagmus, Physiologic, physiology; Retrospective Studies; Semicircular Canals, pathology; Time Factors; Vertigo, epidemiology, pathology; Young Adult}, pmid = {19180679} }
Lee, S.-Y., Kong, I.G., Oh, D.J. and Choi, H.G.	Increased Risk of Benign Paroxysmal Positional Vertigo in Patients With a History of Sudden Sensory Neural Hearing Loss: A Longitudinal Follow-up Study Using a National Sample Cohort. [Abstract] [BibTeX]	2019	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 40(2), pp. e135-e141	article	DOI
Abstract: To evaluate the association between benign paroxysmal positional vertigo (BPPV) and sudden sensorineural hearing loss (SSNHL) using a national sample cohort from Korea. Data from the years 2002 through 2013 were collected for individuals aged more than or equal to 20 years from the Korean National Health Insurance Service-National Sample Cohort. SSNHL was classified based on the International Classification of Disease-10 (ICD-10) code H91.2. We included only participants who received an audiometry examination and steroid treatment. After exclusion of participants diagnosed with Menière's disease (H81.0), we extracted data for SSNHL patients (n = 4,109) and 1:4-matched controls (n = 16,436). Matching was performed based on age, sex, income, region of residence, and medical history. BPPV was diagnosed with the ICD-10 code H81.1. Among them, we only included the participants who visit more than or equal to two times for BPPV that does not mean recurrent BPPV. The crude and adjusted hazard ratios (HRs) were calculated using Cox proportional hazard models, and the 95% confidence intervals (CIs) were determined. Subgroup analyses were also performed according to age and sex. The rate of BPPV in the SSNHL group (3.8% [157/4,109]) was higher than that in the control group (1.9% [220/16,436], p < 0.001). The adjusted HR of BPPV was 2.90 (95% CI = 2.36-3.56, p < 0.05). After experiencing SSNHL, the rate of BPPV in the SSNHL group was significantly higher for patients with two, three to four, and more than or equal to five visits for BPPV. In the subgroup analyses, a significant association between SSNHL and BPPV was observed regardless of age and sex. The risk of BPPV is greater in patients with SSNHL.
BibTeX: @article{Lee2019, author = {Lee, Sang-Yeon and Kong, Il Gyu and Oh, Dong Jun and Choi, Hyo Geun}, title = {Increased Risk of Benign Paroxysmal Positional Vertigo in Patients With a History of Sudden Sensory Neural Hearing Loss: A Longitudinal Follow-up Study Using a National Sample Cohort.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2019}, volume = {40}, issue = {2}, pages = {e135--e141}, doi = {https://doi.org/10.1097/MAO.0000000000002084}, pmid = {30624405} }
Chen, Z.-J., Chang, C.-H., Hu, L.-Y., Tu, M.-S., Lu, T., Chen, P.-M. and Shen, C.-C.	Increased risk of benign paroxysmal positional vertigo in patients with anxiety disorders: a nationwide population-based retrospective cohort study. [Abstract] [BibTeX]	2016	BMC psychiatry Vol. 16, pp. 238	article	DOI
Abstract: The objective of this study was to evaluate the risk of benign peripheral persistent vertigo (BPPV) among patients with anxiety disorders by using the Taiwan National Health Insurance Research Database (NHIRD). We conducted a retrospective study of 15,470 participants (7735 anxiety disorder patients and 7735 control patients) selected from the NHIRD. Patients were observed for a maximum of 9 years to determine the rates of newly diagnosed BPPV. A Cox regression model was used to evaluate the risk of BPPV among the patients with anxiety disorders. During the 9-year follow-up period, 178 (2.05 per 1000 person-years) anxiety disorder patients and 71 (0.81 per 1000 person-years) control patients were diagnosed with BPPV. The incidence risk ratio of BPPV between anxiety disorder patients and control patients was 2.52 (95 % confidence interval [CI], 1.90-3.37, P < .001). After adjustment for age, sex, and comorbidities, patients with anxiety disorders were found to be 2.17 times more likely to develop BPPV (95 % CI, 1.63-2.90, P < .001) than the control patients. Furthermore, female sex (HR = 1.81, 95 % CI, 1.31-2.50, P < .001) and cerebrovascular disease (HR = 1.53, 95 % CI, 1.00-2.34, P = .050) were independent risk factors for developing new-onset BPPV in patients with anxiety disorders. Anxiety disorder patients may have an increased risk of developing BPPV, especially those who are female or have cerebrovascular disease.
BibTeX: @article{Chen2016, author = {Chen, Zi-Jun and Chang, Cheng-Ho and Hu, Li-Yu and Tu, Ming-Shium and Lu, Ti and Chen, Pan-Ming and Shen, Cheng-Che}, title = {Increased risk of benign paroxysmal positional vertigo in patients with anxiety disorders: a nationwide population-based retrospective cohort study.}, journal = {BMC psychiatry}, year = {2016}, volume = {16}, pages = {238}, doi = {https://doi.org/10.1186/s12888-016-0950-2}, keywords = {Adult; Aged; Anxiety Disorders, epidemiology; Benign Paroxysmal Positional Vertigo, epidemiology; Comorbidity; Databases, Factual; Female; Humans; Incidence; Male; Middle Aged; Odds Ratio; Retrospective Studies; Risk Factors; Sex Factors; Taiwan, epidemiology; Anxiety disorder; Benign peripheral persistent vertigo; Risk factor}, pmid = {27416989} }
Shih, C.-P., Wang, C.-H., Chung, C.-H., Lin, H.-C., Chen, H.-C., Lee, J.-C. and Chien, W.-C.	Increased Risk of Benign Paroxysmal Positional Vertigo in Patients With Non-Apnea Sleep Disorders: A Nationwide, Population-Based Cohort Study. [Abstract] [BibTeX]	2018	Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine Vol. 14(12), pp. 2021-2029	article	DOI
Abstract: To investigate the association between non-apnea sleep disorders (NSD) and subsequent benign paroxysmal positional vertigo (BPPV) risk. This retrospective cohort study was conducted using the Taiwan National Health Insurance Research Database from 2000 to 2013. We established an NSD group (n = 24,624) and an age-, sex- and index year-matched comparison group (n = 98,496). The primary outcome was the occurrence of BPPV. The incidence rates of BPPV in the two cohorts were compared with a 14-year follow-up. Cox proportional hazard regression analysis was used to evaluate the effects of NSD on BPPV risk. The incidence rate of BPPV was 43.33 per 100,000 person-years for the NSD cohort and 29.33 per 100,000 person-years for the comparison cohort. NSD significantly increased the risk of BPPV (adjusted hazard ratio [HR] = 2.487; 95% confidence interval = 1.996-3.099, < .001). Subgroup analysis revealed that NSD increase the risk of development of BPPV by 2.357- to 3.658-fold in patients with hypertension, diabetes mellitus, chronic obstructive pulmonary disease, and hyperlipidemia. Furthermore, when comparing different types of NSD, chronic insomnia carries the highest risk of BPPV (adjusted HR = 3.563), followed by organic sleep disorders (adjusted HR = 2.763), sleep disturbance (adjusted HR = 2.506), and acute insomnia (adjusted HR = 2.237). We demonstrate that NSD are associated with an increased risk of BPPV. Relative to other types of NSD, patients with chronic insomnia are at the highest risk for development of BPPV.
BibTeX: @article{Shih2018, author = {Shih, Cheng-Ping and Wang, Chih-Hung and Chung, Chi-Hsiang and Lin, Hung-Che and Chen, Hsin-Chien and Lee, Jih-Chin and Chien, Wu-Chien}, title = {Increased Risk of Benign Paroxysmal Positional Vertigo in Patients With Non-Apnea Sleep Disorders: A Nationwide, Population-Based Cohort Study.}, journal = {Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine}, year = {2018}, volume = {14}, issue = {12}, pages = {2021--2029}, doi = {https://doi.org/10.5664/jcsm.7528}, keywords = {benign paroxysmal positional vertigo; insomnia; non-apnea sleep disorders; vestibular system}, pmid = {30518450} }
Kao, C.-L., Cheng, Y.-Y., Leu, H.-B., Chen, T.-J., Ma, H.-I., Chen, J.-W., Lin, S.-J. and Chan, R.-C.	Increased risk of ischemic stroke in patients with benign paroxysmal positional vertigo: a 9-year follow-up nationwide population study in taiwan. [Abstract] [BibTeX]	2014	Frontiers in aging neuroscience Vol. 6, pp. 108	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is a common form of vertigo and is characterized by episodic dizziness related to changes in head position relative to gravity. BPPV symptoms can be similar to those of central nervous system vascular diseases. The association between BPPV and ischemic stroke has not yet been investigated. The study cohort consisted of patients who were diagnosed with BPPV at least twice in the previous year as an outpatient or for whom BPPV was the primary diagnosis as an inpatient (n = 4104). An age- and gender-matched sample that excluded patients with a diagnosis of any form of vertigo was selected as the comparison cohort (n = 8397). All cases were followed up from January 1, 2000, to December 31, 2008. The demographic characteristics, medical comorbidities, and use of medications in both groups were investigated using chi-square tests. A stratified analysis of stroke risk factors was performed to determine the hazard ratios of BPPV. During the 9-year follow-up period, 185 of the 4104 (4.5%) subjects with BPPV and 240 of the 8379 (2.9%) subjects without BPPV developed ischemic strokes. The crude hazard ratio of BPPV for developing ischemic strokes was 1.708. After adjusting for stroke risk factors, the risk of developing ischemic strokes in BPPV subjects was 1.415-fold higher than the risk among those without BPPV (confidence interval: 1.162-1.732, p = 0.001). After a subgroup analysis stratified according to stroke risk factors, BPPV remained independently associated with a higher risk of developing future ischemic stroke. We conclude that BPPV is independently associated with a risk of subsequent ischemic stroke. More aggressive control of modifiable risk factors for ischemic strokes should be conducted in patients with BPPV.
BibTeX: @article{Kao2014, author = {Kao, Chung-Lan and Cheng, Yuan-Yang and Leu, Hsin-Bang and Chen, Tzeng-Ji and Ma, Hsin-I and Chen, Jaw-Wen and Lin, Shing-Jong and Chan, Rai-Chi}, title = {Increased risk of ischemic stroke in patients with benign paroxysmal positional vertigo: a 9-year follow-up nationwide population study in taiwan.}, journal = {Frontiers in aging neuroscience}, year = {2014}, volume = {6}, pages = {108}, doi = {https://doi.org/10.3389/fnagi.2014.00108}, keywords = {benign paroxysmal positional vertigo; dizziness; risk factors; stroke; vertigo}, pmid = {24917815} }
Burrows, L., Lesser, T.H., Kasbekar, A.V., Roland, N. and Billing, M.	Independent prescriber physiotherapist led balance clinic: the Southport and Ormskirk pathway. [Abstract] [BibTeX]	2017	The Journal of laryngology and otology Vol. 131(5), pp. 417-424	article	DOI
Abstract: To report the introduction and impact of non-medical prescribing, initiated to improve patient pathways for those presenting with dizziness and balance disorders. The Southport and Ormskirk physiotherapy-led vestibular clinic sees and treats all patients with dizziness and balance disorders referred to the ENT department. Letters are triaged by an audiologist, who also performs an otological examination and hearing test; this is followed by an assessment with the independent prescriber physiotherapist. An ENT consultant is nearby if joint consultation is needed. Diagnoses, treatments and patient satisfaction were studied, with an analysis of the impact of medication management (stopping or starting medicines) on patients and service. In 12 months, 413 new patients with dizziness and balance disorders had appointments. The most common diagnoses were benign paroxysmal positional vertigo and vestibular migraine. Eighty-four per cent of patients required self-management strategies, 50 per cent exercise therapy, 48 per cent medication management and 24 per cent a particle repositioning manoeuvre. Patient satisfaction was high (99 per cent). Having an independent prescriber physiotherapist leading the balance clinic has reduced the number of hospital visits and onward referrals. Nearly half of all patients required medication management as part of their dizziness or balance treatment.
BibTeX: @article{Burrows2017a, author = {Burrows, L and Lesser, T H and Kasbekar, A V and Roland, N and Billing, M}, title = {Independent prescriber physiotherapist led balance clinic: the Southport and Ormskirk pathway.}, journal = {The Journal of laryngology and otology}, year = {2017}, volume = {131}, issue = {5}, pages = {417--424}, doi = {https://doi.org/10.1017/S0022215117000342}, keywords = {Ambulatory Care Facilities, organization & administration, statistics & numerical data; Benign Paroxysmal Positional Vertigo, psychology, therapy; Dizziness, psychology, therapy; Female; Humans; Male; Middle Aged; Migraine Disorders, psychology, therapy; Patient Satisfaction; Physical Therapy Modalities, organization & administration, psychology, statistics & numerical data; Physical Therapy Specialty, organization & administration; Postural Balance; Referral and Consultation, organization & administration, statistics & numerical data; Sensation Disorders, psychology, therapy; United Kingdom; Vertigo, psychology, therapy; Balance Clinic; Dizziness; Independent Prescriber; Non-Medical Prescribing; Physiotherapist; Postural Balance}, pmid = {28202097} }
Tekeşin, A. and Tunç, A.	Inflammatory biomarkers in benign paroxysmal positional vertigo: A Turkey case-control study. [Abstract] [BibTeX]	2018	Ideggyogyaszati szemle Vol. 71(11-12), pp. 411-416	article	DOI
Abstract: Objective - Benign paroxysmal positional vertigo (BPPV) is the most common cause of recurrent vertigo. Inflammation is a hypothetic etiological factor in BPPV. The aim of this study was to evaluate inflammatory biomarker levels in BPPV patients and compare these with the healthy subjects. Materials and methods - This prospective case-control study was conducted with 114 newly diagnosed BPPV patients and age- and sex- matched 83 healthy subjects. The laboratory investigations included serum hemogram, full biochemistry profiles, vitamin levels, thyroid hormone profiles, high sensitivity C-reactive protein (hsCRP) and erythrocyte sedimentation rate (ESR). Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte to HDL-cholesterol ratio (MHR) values were calculated and compared between the patients and healthy subjects. Results - The mean age was 39.1 ± 12.4 years for patients, and 37.0 ± 11.9 for controls. Vitamin B12, hematocrit (Hct), creatinine, urea, and fT4 values, lymphocyte, total bilirubin, direct bilirubin and indirect bilirubin levels were significantly lower in BPPV patients (p ˂ 0.05), while HDL, SGOT, and ESR values were significantly higher. In the BPPV patients the mean NLR, PLR, and mean platelet volume (MPV) values were significantly higher than in the control subjects. Neutrophil, platelet, monocyte, MHR, and CRP values were similar in both groups (p ˃ 0.05). Conclusion - Our result suggests that NLR, PLR, MPV, ESR, and bilirubin levels should be taken into account as potential biomarkers of BPPV. As they are inexpensive parameters and widely available, they can be used in clinical practice for prediction of BPPV. However, further large-scale studies are required to confirm this relationship.
BibTeX: @article{Tekesin2018, author = {Tekeşin, Aysel and Tunç, Abdulkadir}, title = {Inflammatory biomarkers in benign paroxysmal positional vertigo: A Turkey case-control study.}, journal = {Ideggyogyaszati szemle}, year = {2018}, volume = {71}, issue = {11-12}, pages = {411--416}, doi = {https://doi.org/10.18071/isz.71.0411}, keywords = {benign paroxysmal positional vertigo; inflammation; laboratories}, pmid = {30604940} }
Toupet, M., Van Nechel, C. and Bozorg Grayeli, A.	Influence of body laterality on recovery from subjective visual vertical tilt after vestibular neuritis. [Abstract] [BibTeX]	2014	Audiology & neuro-otology Vol. 19(4), pp. 248-255	article	DOI
Abstract: The subjective visual vertical (SVV) is an indicator of vestibular otolithic function and mainly processed by the nondominant parietal cortex. We investigated the hypothesis that recovery from SVV tilt after vestibular neuritis can be influenced by the body's lateral preference. This prospective cohort follow-up study included 254 consecutive adult patients with vestibular neuritis. The recovery from SVV tilt was faster in patients with a left hand or eye dominance than in those with a right dominance. While in left-handers the side of the neuritis did not affect the speed of recovery, in right-handed subjects, the recovery from a right-sided neuritis was significantly slower than from a left-sided affection. These observations suggest that subjects with a left sensorimotor dominance have developed more significant midline-crossing projections to the parietal cortex, allowing them to cope faster with a unilateral vestibular deficit.
BibTeX: @article{Toupet2014, author = {Toupet, Michel and Van Nechel, Christian and Bozorg Grayeli, Alexis}, title = {Influence of body laterality on recovery from subjective visual vertical tilt after vestibular neuritis.}, journal = {Audiology & neuro-otology}, year = {2014}, volume = {19}, issue = {4}, pages = {248--255}, doi = {https://doi.org/10.1159/000360266}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, complications, physiopathology; Child; Cohort Studies; Female; Follow-Up Studies; Functional Laterality; Humans; Male; Middle Aged; Prospective Studies; Recovery of Function; Vestibular Function Tests; Vestibular Neuronitis, complications, physiopathology; Visual Perception, physiology; Young Adult}, pmid = {25074802} }
Sheikhzadeh, M., Lotfi, Y., Mousavi, A., Heidari, B., Monadi, M. and Bakhshi, E.	Influence of supplemental vitamin D on intensity of benign paroxysmal positional vertigo: A longitudinal clinical study. [Abstract] [BibTeX]	2016	Caspian journal of internal medicine Vol. 7(2), pp. 93-98	article
Abstract: Benign paroxysmal positional vertigo (BPPV) is linked to vitamin D deficiency. This clinical trial aimed to determine the influence of vitamin D supplementation on intensity of BPPV. The study population was selected consecutively and the diagnosis of BPPV was made by history and clinical examination and exclusion of other conditions. Intensity of BPVV was assessed based on VAS score (0-10). Serum 25-hydroxyvitamin D (25-OHD) was measured using ELISA method and levels < 20 ng/ml was considered a deficiency. All patients received rehabilitation treatment using Epley's maneuver one time per week for one month. Serum 25-OHD deficient patients were classified as treated and non-treated groups (rehabilitation with or without 50.000 IU cholecalciferol weekly for two months).The results of treatment were compared with vitamin D sufficient group as control. All patients were followed-up for 6 months. After two months of treatment, in both vitamin D treated and non-treated groups the intensity of BPPV decreased significantly as compared with control (P=0.001 for both groups) but at endpoint, the intensity of BPPV aggravated and regressed to the baseline value in vitamin D deficient non-treated group (P=0.001) whereas, in vitamin D treated group, improvement of BPPV remained stable and unchanged over the study period. This study indicates that correction of vitamin D deficiency in BPPV provides additional benefit to rehabilitation therapy (Epley maneuver) regarding duration of improvement. These findings suggest serum 25-OHD measurement in recurrent BPPV.
BibTeX: @article{Sheikhzadeh2016a, author = {Sheikhzadeh, Mahboobeh and Lotfi, Yones and Mousavi, Abdollah and Heidari, Behzad and Monadi, Mohsen and Bakhshi, Enayatollah}, title = {Influence of supplemental vitamin D on intensity of benign paroxysmal positional vertigo: A longitudinal clinical study.}, journal = {Caspian journal of internal medicine}, year = {2016}, volume = {7}, issue = {2}, pages = {93--98}, keywords = {Benign paroxysmal positional vertigo; Intensity; Rehabilitation Therapy.; Vitamin D}, pmid = {27386060} }
Labuguen, R.H.	Initial evaluation of vertigo. [Abstract] [BibTeX]	2006	American family physician Vol. 73(2), pp. 244-251	article
Abstract: Benign paroxysmal positional vertigo, acute vestibular neuronitis, and Meniere's disease cause most cases of vertigo; however, family physicians must consider other causes including cerebrovascular disease, migraine, psychological disease, perilymphatic fistulas, multiple sclerosis, and intracranial neoplasms. Once it is determined that a patient has vertigo, the next task is to determine whether the patient has a peripheral or central cause of vertigo. Knowing the typical clinical presentations of the various causes of vertigo aids in making this distinction. The history (i.e., timing and duration of symptoms, provoking factors, associated signs and symptoms) and physical examination (especially of the head and neck and neurologic systems, as well as special tests such as the Dix-Hallpike maneuver) provide important clues to the diagnosis. Associated neurologic signs and symptoms, such as nystagmus that does not lessen when the patient focuses, point to central (and often more serious) causes of vertigo, which require further work-up with selected laboratory and radiologic studies such as magnetic resonance imaging.
BibTeX: @article{Labuguen2006, author = {Labuguen, Ronald H}, title = {Initial evaluation of vertigo.}, journal = {American family physician}, year = {2006}, volume = {73}, issue = {2}, pages = {244--251}, keywords = {Algorithms; Diagnosis, Differential; Ear Diseases, complications, diagnosis; Humans; Nervous System Diseases, complications, diagnosis; Physical Examination, methods; Precipitating Factors; Vertigo, diagnosis, etiology}, pmid = {16445269} }
Riga, M., Bibas, A., Xenellis, J. and Korres, S.	Inner ear disease and benign paroxysmal positional vertigo: a critical review of incidence, clinical characteristics, and management. [Abstract] [BibTeX]	2011	International journal of otolaryngology Vol. 2011, pp. 709469	article	DOI
Abstract: Background. This study is a review of the incidence, clinical characteristics, and management of secondary BPPV. The different subtypes of secondary BPPV are compared to each other, as well as idiopathic BPPV. Furthermore, the study highlights the coexistence of BPPV with other inner ear pathologies. Methods. A comprehensive search for articles including in the abstract information on incidence, clinical characteristics, and management of secondary BPPV was conducted within the PubMed library. Results. Different referral patterns, different diagnostic criteria used for inner ear diseases, and different patient populations have led to greatly variable incidence results. The differences regarding clinical characteristics and treatment outcomes may support the hypothesis that idiopathic BPPV and the various subtypes of secondary BPPV do not share the exact same pathophysiological mechanisms. Conclusions. Secondary BPPV is often under-diagnosed, because dizziness may be atypical and attributed to the primary inner ear pathology. Reversely, a limited number of BPPV patients may not be subjected to a full examination and characterized as idiopathic, while other inner ear diseases are underdiagnosed. A higher suspicion index for the coexistence of BPPV with other inner ear pathologies, may lead to a more integrated diagnosis and consequently to a more efficient treatment of these patients.
BibTeX: @article{Riga2011, author = {Riga, M and Bibas, A and Xenellis, J and Korres, S}, title = {Inner ear disease and benign paroxysmal positional vertigo: a critical review of incidence, clinical characteristics, and management.}, journal = {International journal of otolaryngology}, year = {2011}, volume = {2011}, pages = {709469}, doi = {https://doi.org/10.1155/2011/709469}, pmid = {21837242} }
Smouha, E.	Inner ear disorders. [Abstract] [BibTeX]	2013	NeuroRehabilitation Vol. 32(3), pp. 455-462	article	DOI
Abstract: To present a framework for the diagnosis and treatment of inner ear disorders, with an emphasis on problems common to neuro-rehabilitation. Disorders of the inner ear can cause hearing loss, tinnitus, vertigo and imbalance. Hearing loss can be conductive, sensorineural, or mixed; conductive hearing loss arises from the ear canal or middle ear, while sensorineural hearing loss arises from the inner ear or auditory nerve. Vertigo is a hallucination of motion, and is the cardinal symptom of vestibular system disease. It should be differentiated from other causes of dizziness: gait imbalance, disequilibrium, lightheadedness (pre-syncope). Vertigo can be caused by problems in the inner ear or central nervous system. The diagnosis of inner ear disorders begins with a targeted physical examination. The initial work-up of hearing loss is made by audiometry, and vertigo by electronystagmography (ENG). Supplemental tests and MRI are obtained when clinically indicated. The clinical pattern and duration of vertigo are the most important clinical features in the diagnosis. Common inner ear causes of vertigo include: vestibular neuritis (sudden, unilateral vestibular loss), Meniere's disease (episodic vertigo), benign paroxysmal positional vertigo (BPPV), and bilateral vestibular loss. Common central nervous system causes of vertigo include: post concussion syndrome, cervical vertigo, vestibular migraine, cerebrovascular disease, and acoustic neuroma. A basic knowledge of vestibular physiology, coupled with a understanding of common vestibular syndromes, will lead to correct diagnosis and treatment in most cases.
BibTeX: @article{Smouha2013, author = {Smouha, Eric}, title = {Inner ear disorders.}, journal = {NeuroRehabilitation}, year = {2013}, volume = {32}, issue = {3}, pages = {455--462}, doi = {https://doi.org/10.3233/NRE-130868}, keywords = {Animals; Ear, Inner, pathology; Humans; Labyrinth Diseases, pathology, physiopathology}, pmid = {23648600} }
Berrettini, S., Ferri, C., La Civita, L., Segnini, G., Lombardini, F., Bruschini, P., Longombardo, G. and Sellari-Franceschini, S.	Inner ear involvement in mixed cryoglobulinaemia patients. [Abstract] [BibTeX]	1995	British journal of rheumatology Vol. 34(4), pp. 370-374	article
Abstract: In order to evaluate the nature and prevalence of audiovestibular disturbances in mixed cryoglobulinaemia (MC), 32 consecutive MC patients were studied by a wide audiological and vestibular examination. Pure tone audiometry, impedance audiometry, brainstem response audiometry and vestibular function were performed. Patients with a previous history of ear damage due to other well-known agents were excluded from the study. In MC patients we found a rather frequent audiovestibular involvement (34.3%). Bilateral sensorineural hearing loss was found in seven MC patients (22%) and altered vestibular function test values in other seven subjects (22%). Moreover, anamnestic and clinical data revealed a high incidence of benign positional paroxysmal vertigo in our MC series. We can suppose that immune complex-mediated microvascular involvement of the labyrinthine vessels may be responsible for inner ear damage in MC. Thus, audiovestibular disturbances may be included among various organ involvement of the MC.
BibTeX: @article{Berrettini1995, author = {Berrettini, S and Ferri, C and La Civita, L and Segnini, G and Lombardini, F and Bruschini, P and Longombardo, G and Sellari-Franceschini, S}, title = {Inner ear involvement in mixed cryoglobulinaemia patients.}, journal = {British journal of rheumatology}, year = {1995}, volume = {34}, issue = {4}, pages = {370--374}, keywords = {Adult; Aged; Audiometry; Cryoglobulinemia, complications, physiopathology; Ear, Inner, physiopathology; Female; Hearing Loss, Sensorineural, epidemiology, etiology; Humans; Male; Middle Aged; Prevalence; Vertigo, epidemiology, etiology; Vestibular Function Tests}, pmid = {7788154} }
Parham, K., Sacks, D., Bixby, C. and Fall, P.	Inner ear protein as a biomarker in circulation? [Abstract] [BibTeX]	2014	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 151(6), pp. 1038-1040	article	DOI
Abstract: Serum biomarkers detect the earliest events in disease, monitor management, and provide insight into disease pathogenesis. At this time, there are no biomarkers available for otologic disorders. Otolin-1 is a scaffolding protein exclusively expressed in otoconia and cells of the vestibule and the cochlea; therefore, it may be a biomarker candidate for assessing the health of the inner ear. As a proof of concept, we used serum samples from controls without otologic history and subjects with a history of benign paroxysmal positional vertigo (BPPV), performed enzyme-linked immunosorbent assay for otolin-1, and measured the optical density of the substrate. Otolin-1 was detectable and quantifiable in all subjects, indicating that this inner ear protein crosses the blood-labyrinthine barrier. Furthermore, subjects with BPPV had significantly higher levels, with about one-third being above the control range. This promising preliminary result suggests that inner ear-specific proteins have the potential to serve as biomarkers for otologic disease processes.
BibTeX: @article{Parham2014, author = {Parham, Kourosh and Sacks, Daniel and Bixby, Catherine and Fall, Pamela}, title = {Inner ear protein as a biomarker in circulation?}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2014}, volume = {151}, issue = {6}, pages = {1038--1040}, doi = {https://doi.org/10.1177/0194599814551127}, keywords = {Aged; Benign Paroxysmal Positional Vertigo, blood, physiopathology; Biomarkers, blood; Case-Control Studies; Disease Progression; Enzyme-Linked Immunosorbent Assay; Extracellular Matrix Proteins, blood; Female; Follow-Up Studies; Humans; Middle Aged; Otolithic Membrane, metabolism, physiopathology; Postmenopause; Predictive Value of Tests; Reference Values; Risk Assessment; Sensitivity and Specificity; Severity of Illness Index; benign paroxysmal positional vertigo; biomarker; inner ear; otoconia; otolin; stria vascularis}, pmid = {25245136} }
Wada, M., Naganuma, H., Tokumasu, K., Ito, A. and Okamoto, M.	Inner-ear function test in cases of posterior canal-type benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2009	The international tinnitus journal Vol. 15(1), pp. 91-93	article
Abstract: Otolaryngologists typically perform diagnoses and offer medical treatment for vestibular dysfunction. This vestibular dysfunction manifests as benign paroxysmal positional vertigo (BPPV), Ménière's disease, vestibular neuronitis, and so on. The etiology of BPPV is still not clear, so in this article we discuss inner-ear function, etiology, and factors related to BPPV. We examined by pure-tone audiometry and hot and cold caloric tests patients whom we identified as having diagnosed posterior canal-type BPPV. We observed canal paresis at a high rate on the affected side (p < .01). The term of recovery at the first treatment was longer in patients with canal paresis as compared to those without. Deterioration of hearing level was observed more frequently on the affected side (p < .01). The horizontal semicircular canal and cochlea are important potential sites of lesions affecting posterior canal-type BPPV, and the posterior circular canal and otolith are already considered to be sites of affecting lesions.
BibTeX: @article{Wada2009, author = {Wada, Masaoki and Naganuma, Hideaki and Tokumasu, Koji and Ito, Akihiko and Okamoto, Makito}, title = {Inner-ear function test in cases of posterior canal-type benign paroxysmal positional vertigo.}, journal = {The international tinnitus journal}, year = {2009}, volume = {15}, issue = {1}, pages = {91--93}, keywords = {Adult; Aged; Audiometry, Pure-Tone; Caloric Tests; Ear, Inner, physiopathology; Electronystagmography; Female; Hearing Loss, Unilateral, diagnosis, physiopathology; Humans; Male; Middle Aged; Otolithic Membrane, physiopathology; Semicircular Canals, physiopathology; Vertigo, diagnosis, physiopathology, therapy; Vestibular Function Tests}, pmid = {19842351} }
Renner, V., Geißler, K., Boeger, D., Buentzel, J., Esser, D., Hoffmann, K., Jecker, P., Mueller, A., Radtke, G., Axer, H. and Guntinas-Lichius, O.	Inpatient Treatment of Patients Admitted for Dizziness: A Population-Based Healthcare Research Study on Epidemiology, Diagnosis, Treatment, and Outcome. [Abstract] [BibTeX]	2017	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 38(10), pp. e460-e469	article	DOI
Abstract: To determine inpatient treatment rates of patients with dizziness with focus on diagnostics, treatment and outcome. Retrospective population-based study. Inpatients in the federal state Thuringia in 2014. All 1,262 inpatients (62% females, median age: 61 yr) treated for inpatient dizziness were included. The association between analyzed parameters and probability of improvement and recovery was tested using univariable and multivariable statistics. Final diagnosis at demission was peripheral vestibular disorder (PVD), central vestibular disorder (CVD), cardiovascular syndrome, somatoform syndrome, and unclassified disease in 75, 9, 3, 0.6, and 13%, respectively. The most frequent diseases were acute vestibular neuritis (28%) and benign paroxysmal positional vertigo (22%). The follow-up time was 38 ± 98 days. 88.5% of patients showed at least an improvement of complaints and 31.4% a complete recovery. The probability for no improvement from inpatient dizziness was higher if the patient had a history of ear/vestibular disease (hazard ratio [HR] = 1.506; 95% confidence interval [CI] = 1.301-1.742), and was taking more than two drugs for comorbidity (HR = 1.163; CI = 1.032-1.310). Compared with final diagnosis of cardiovascular syndrome, patients with PVD (HR = 1.715; CI = 1.219-2.415) and CVD (HR = 1.587; CI = 1.076-2.341) had a worse outcome. Inpatient treatment of dizziness was highly variable in daily practice. The population-based recovery rate was worse than reported in clinical trials. We need better ways to implement clinical trial findings for inpatients with dizziness.
BibTeX: @article{Renner2017, author = {Renner, Vera and Geißler, Katharina and Boeger, Daniel and Buentzel, Jens and Esser, Dirk and Hoffmann, Kerstin and Jecker, Peter and Mueller, Andreas and Radtke, Gerald and Axer, Hubertus and Guntinas-Lichius, Orlando}, title = {Inpatient Treatment of Patients Admitted for Dizziness: A Population-Based Healthcare Research Study on Epidemiology, Diagnosis, Treatment, and Outcome.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2017}, volume = {38}, issue = {10}, pages = {e460--e469}, doi = {https://doi.org/10.1097/MAO.0000000000001568}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, epidemiology; Cardiovascular Diseases, complications, epidemiology; Child; Child, Preschool; Dizziness, diagnosis, epidemiology, therapy; Female; Germany, epidemiology; Guideline Adherence; Humans; Inpatients; Male; Middle Aged; Population; Retrospective Studies; Treatment Outcome; Vestibular Diseases, diagnosis, epidemiology, therapy; Vestibular Neuronitis, diagnosis, epidemiology, therapy; Young Adult}, pmid = {28938275} }
Aron, M. and Bance, M.	Insights into horizontal canal benign paroxysmal positional vertigo from a human case report. [Abstract] [BibTeX]	2013	The Laryngoscope Vol. 123(12), pp. 3197-3200	article	DOI
Abstract: For horizontal canal benign paroxysmal positional vertigo, determination of the pathologic side is difficult and based on many physiological assumptions. This article reports findings on a patient who had one dysfunctional inner ear and who presented with horizontal canal benign paroxysmal positional vertigo, giving us a relatively pure model for observing nystagmus arising in a subject in whom the affected side is known a priori. It is an interesting human model corroborating theories of nystagmus generation in this pathology and also serves to validate Ewald's second law in a living human subject.
BibTeX: @article{Aron2013, author = {Aron, Margaret and Bance, Manohar}, title = {Insights into horizontal canal benign paroxysmal positional vertigo from a human case report.}, journal = {The Laryngoscope}, year = {2013}, volume = {123}, issue = {12}, pages = {3197--3200}, doi = {https://doi.org/10.1002/lary.24260}, keywords = {Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Diagnosis, Differential; Electronystagmography; Humans; Male; Nystagmus, Pathologic, etiology, physiopathology; Posture, physiology; Semicircular Canals, physiopathology; Vertigo, complications, diagnosis, physiopathology; Benign paroxysmal positional vertigo; Ewald; ageotropic; horizontal canal; human model; in vivo; lateral canal; positional vertigo; vertigo}, pmid = {23775485} }
Best, C., Eckhardt-Henn, A., Diener, G., Bense, S., Breuer, P. and Dieterich, M.	Interaction of somatoform and vestibular disorders. [Abstract] [BibTeX]	2006	Journal of neurology, neurosurgery, and psychiatry Vol. 77(5), pp. 658-664	article	DOI
Abstract: The high coincidence of organic vestibular and somatoform vertigo syndromes has appeared to support pathogenic models showing a strong linkage between them. It was hypothesised that a persisting vestibular dysfunction causes the development of anxiety disorders. To determine the relation between vestibular deficits and somatoform vertigo disorders in an interdisciplinary prospective study. Participants were divided into eight diagnostic groups: healthy volunteers (n=26) and patients with benign paroxysmal positioning vertigo (BPPV, n=11), vestibular neuritis (n=11), Menière's disease (n=7), vestibular migraine (n=15), anxiety (n=23), depression (n=12), or somatoform disorders (n=22). Neuro-otological diagnostic procedures included electro-oculography with rotatory and caloric testing, orthoptic examination with measurements of subjective visual vertical (SVV) and ocular torsion, and a neurological examination. Psychosomatic diagnostic procedures comprised interviews and psychometric instruments. Patients with BPPV (35.3%) and with vestibular neuritis (52.2%) had pathological test values on caloric irrigation (p<0.001). Otolith dysfunction with pathological tilts of SVV and ocular torsion was found only in patients with vestibular neuritis (p<0.001). Patients with Menière's disease, vestibular migraine, and psychiatric disorders showed normal parameters for vestibular testing but pathological values for psychometric measures. There was no correlation between pathological neurological and pathological psychometric parameters. High anxiety scores are not a result of vestibular deficits or dysfunction. Patients with Menière's disease and vestibular migraine but not vestibular deficits showed the highest psychiatric comorbidity. Thus the course of vertigo syndromes and the possibility of a pre-existing psychopathological personality should be considered pathogenic factors in any linkage between organic and psychometric vertigo syndromes.
BibTeX: @article{Best2006, author = {Best, C and Eckhardt-Henn, A and Diener, G and Bense, S and Breuer, P and Dieterich, M}, title = {Interaction of somatoform and vestibular disorders.}, journal = {Journal of neurology, neurosurgery, and psychiatry}, year = {2006}, volume = {77}, issue = {5}, pages = {658--664}, doi = {https://doi.org/10.1136/jnnp.2005.072934}, keywords = {Adult; Aged; Anxiety Disorders, diagnosis, psychology; Caloric Tests; Comorbidity; Depressive Disorder, diagnosis, psychology; Female; Humans; Kinesthesis; Male; Middle Aged; Migraine with Aura, diagnosis, psychology; Neurologic Examination; Patient Care Team; Personality Assessment; Prospective Studies; Reference Values; Reflex, Vestibulo-Ocular; Somatoform Disorders, diagnosis, psychology; Statistics as Topic; Tilt-Table Test; Vertigo, diagnosis, psychology; Vestibular Diseases, diagnosis, psychology; Vestibular Neuronitis, diagnosis, psychology}, pmid = {16614028} }
Singh, N.K. and Barman, A.	Inter-frequency amplitude ratio of oVEMP for differentiating Meniere's disease from BPPV: clinical validation using a double-blind approach. [Abstract] [BibTeX]	2018	International journal of audiology, pp. 1-8	article	DOI
Abstract: The study aimed at examining the usefulness of inter-frequency amplitude ratio (IFAR) of ocular vestibular evoked myogenic potential (oVEMP) in identifying Meniere's disease (MD) and differentiating it from benign paroxysmal positional vertigo (BPPV). A case-control design was used with a double blind approach. Phase 1 included 70 healthy individuals and 36 individuals each with MD and BPPV and Phase 2 included 20 individuals each with MD and BPPV. The age range of the participants in both phases was 15-50 years. All participants underwent oVEMP testing using 500 and 1000 Hz tone bursts and IFAR was obtained. The results in phase 1 revealed significantly higher IFARs in Meniere's disease than BPPV and healthy individuals (p < 0.001). An optimum criterion point of IFAR ≥1.11 for diagnosing MD was found which yielded 80% sensitivity and 98% specificity. The results in phase 2 demonstrated 85% correct identification of MD and 95% correct rejection of BPPV as non-MD. IFAR of oVEMP appears highly sensitive and specific parameter for identifying MD and a clinically valid tool for differentiating MD from BPPV.
BibTeX: @article{Singh2018, author = {Singh, Niraj Kumar and Barman, Animesh}, title = {Inter-frequency amplitude ratio of oVEMP for differentiating Meniere's disease from BPPV: clinical validation using a double-blind approach.}, journal = {International journal of audiology}, year = {2018}, pages = {1--8}, doi = {https://doi.org/10.1080/14992027.2018.1529440}, keywords = {BPPV; Frequency-amplitude ratio; Meniere’s disease; clinical validation; double-blind study; oVEMP}, pmid = {30382796} }
Piccirillo, E., De Stefano, A., Dispenza, F., Kulamarva, G., De Donato, G. and Sanna, M.	Intermediate nerve schwannoma: a rare tumour. [Abstract] [BibTeX]	2011	B-ENT Vol. 7(3), pp. 219-223	article
Abstract: The intermediate nerve (IN), also called the nerve of Wrisberg, is a relatively small nerve with a variable anatomical course. Currently, this nerve is not addressed well in the pertinent literature. Pre-operative diagnosis of IN tumours is clinically challenging due to the lack of related symptoms. Symptoms are typically caused by the functional deterioration of neighbouring anatomical structures. In this report, we describe a patient with a schwannoma that arose at the porus acusticus of the internal auditory canal; during surgery, this proved to originate from the IN. We discuss our findings in the context of previously reported cases of IN schwannomas and analyse the vague characteristics and symptoms of this rare tumour.
BibTeX: @article{Piccirillo2011, author = {Piccirillo, E and De Stefano, A and Dispenza, F and Kulamarva, G and De Donato, G and Sanna, M}, title = {Intermediate nerve schwannoma: a rare tumour.}, journal = {B-ENT}, year = {2011}, volume = {7}, issue = {3}, pages = {219--223}, keywords = {Adult; Benign Paroxysmal Positional Vertigo; Cranial Nerve Neoplasms, diagnosis, surgery; Diagnosis, Differential; Facial Nerve; Facial Nerve Diseases, diagnosis, surgery; Humans; Magnetic Resonance Imaging; Male; Neurilemmoma, diagnosis, surgery; Vertigo, diagnosis}, pmid = {22026146} }
Bergin, M., Bird, P. and Wright, A.	Internal carotid artery dissection following canalith repositioning procedure. [Abstract] [BibTeX]	2010	The Journal of laryngology and otology Vol. 124(5), pp. 575-576	article	DOI
Abstract: To highlight the possibility of internal carotid artery dissection following canalith repositioning procedures. A 52-year-old woman with right posterior canal benign paroxysmal positional vertigo sustained a right carotid artery dissection following a canalith repositioning procedure. The patient also had profound mixed hearing loss associated with otosclerosis, so underwent simultaneous cochlear implantation and occlusion of her posterior semicircular canal, following completion of anticoagulation therapy for her dissection. While internal carotid artery trauma is a rare adverse outcome following canalith repositioning procedures, clinicians should be aware of this possibility if patients report unusual symptoms following such procedures.
BibTeX: @article{Bergin2010, author = {Bergin, M and Bird, P and Wright, A}, title = {Internal carotid artery dissection following canalith repositioning procedure.}, journal = {The Journal of laryngology and otology}, year = {2010}, volume = {124}, issue = {5}, pages = {575--576}, doi = {https://doi.org/10.1017/S0022215109991356}, keywords = {Carotid Artery, Internal, Dissection, diagnosis, etiology; Female; Humans; Middle Aged; Otolithic Membrane; Physical Therapy Modalities, adverse effects; Posture; Semicircular Canals; Vertigo, rehabilitation}, pmid = {19785929} }
Dunniway, H.M. and Welling, D.B.	Intracranial tumors mimicking benign paroxysmal positional vertigo. [Abstract] [BibTeX]	1998	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 118(4), pp. 429-436	article	DOI
Abstract: Benign paroxysmal positional vertigo is a common type of vertigo seen by the otolaryngologist; however, intracranial tumors can mimic benign paroxysmal positional vertigo in their presentation. A review of patients seen in the Department of Otolaryngology at The Ohio State University between July 1992 and August 1996 identified five patients with intracranial pathologic conditions mimicking benign paroxysmal positional vertigo. These patients were first seen with episodic vertigo associated with positional change. Failure of the symptoms to respond to the particle repositioning maneuver or the finding of associated auditory or neurologic symptoms prompted further evaluation by magnetic resonance imaging of the brain, which revealed intracranial pathologic conditions including two meningiomas, a vestibular schwannoma, a glioma, and a lipoma. These findings suggest that patients seen with symptoms like those of benign paroxysmal positional vertigo who do not show improvement after undergoing the particle repositioning maneuver or those who describe associated auditory or neurologic symptoms should have magnetic resonance imaging done to rule out intracranial pathologic conditions. Additionally, benign paroxysmal positional vertigo and intracranial tumors may coexist.
BibTeX: @article{Dunniway1998, author = {Dunniway, H M and Welling, D B}, title = {Intracranial tumors mimicking benign paroxysmal positional vertigo.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {1998}, volume = {118}, issue = {4}, pages = {429--436}, doi = {https://doi.org/10.1177/019459989811800401}, keywords = {Adult; Aged; Brain, pathology; Brain Neoplasms, complications, diagnosis, surgery; Cerebellar Neoplasms, complications, diagnosis, surgery; Diagnosis, Differential; Female; Humans; Lipoma, complications, diagnosis, surgery; Magnetic Resonance Imaging; Meniere Disease, etiology, surgery; Meningeal Neoplasms, complications, diagnosis, surgery; Meningioma, complications, diagnosis, surgery; Middle Aged; Neurologic Examination; Neuroma, Acoustic, complications, diagnosis, surgery; Thalamic Diseases, complications, diagnosis, surgery}, pmid = {9560091} }
Kundaragi, N.G., Mudali, S., Karpagam, B. and Priya, R.	Intracranially protruded bilateral posterior and superior SCCs with multiple dehiscences in a patient with positional vertigo: CT and MR imaging findings and review of literature. [Abstract] [BibTeX]	2014	The Indian journal of radiology & imaging Vol. 24(4), pp. 406-409	article	DOI
Abstract: We report a rare case of intracranially protruded posterior and superior semicircular canals beyond the margins of temporal bone with bony roof dehiscence in bilateral posterior and left superior semicircular canals in a patient with benign paroxysmal positional vertigo (BPPV).
BibTeX: @article{Kundaragi2014, author = {Kundaragi, Nischal G and Mudali, Srinivasa and Karpagam, Bulabai and Priya, Rathna}, title = {Intracranially protruded bilateral posterior and superior SCCs with multiple dehiscences in a patient with positional vertigo: CT and MR imaging findings and review of literature.}, journal = {The Indian journal of radiology & imaging}, year = {2014}, volume = {24}, issue = {4}, pages = {406--409}, doi = {https://doi.org/10.4103/0971-3026.143904}, keywords = {Intracranial protrusion; magnetic resonance imaging and computed tomography; multiple dehiscences; semicircular canal}, pmid = {25489134} }
Gross, E.M., Ress, B.D., Viirre, E.S., Nelson, J.R. and Harris, J.P.	Intractable benign paroxysmal positional vertigo in patients with Meniere's disease. [Abstract] [BibTeX]	2000	The Laryngoscope Vol. 110(4), pp. 655-659	article	DOI
Abstract: To provide a detailed description of the coexistence of benign paroxysmal positional vertigo (BPPV) and Meniere's disease in individuals and to offer a possible mechanism that explains the findings in these patients. Retrospective. Chart review. Of 162 patients diagnosed with Meniere's disease between January 1998 and January 1999, 9 were found to have both "definite" Meniere's disease and "certain" BPPV. Meniere's symptoms preceded the onset of BPPV in all of our patients. Seven of the 9 patients were female. Except for one patient who experienced BPPV bilaterally, BPPV was limited to the same ear as the Meniere's disease. All patients presented with intractable BPPV that did not respond completely to otolith repositioning procedures. A detailed description of five patients is presented. Our data, in conjunction with that of others, suggest that Meniere's disease may predispose patients to intractable BPPV. Hydropically induced damage to the maculae of the utricle and saccule or partial obstruction of the membranous labyrinth may be possible mechanisms that explain the coexistence of Meniere's disease and BPPV.
BibTeX: @article{Gross2000, author = {Gross, E M and Ress, B D and Viirre, E S and Nelson, J R and Harris, J P}, title = {Intractable benign paroxysmal positional vertigo in patients with Meniere's disease.}, journal = {The Laryngoscope}, year = {2000}, volume = {110}, issue = {4}, pages = {655--659}, doi = {https://doi.org/10.1097/00005537-200004000-00022}, keywords = {Acoustic Maculae, physiopathology; Aged; Aged, 80 and over; Comorbidity; Diagnosis, Differential; Ear, Inner, physiopathology; Female; Humans; Male; Meniere Disease, diagnosis, physiopathology; Middle Aged; Retrospective Studies; Vertigo, diagnosis, physiopathology}, pmid = {10764014} }
Horii, A., Kitahara, T., Osaki, Y., Imai, T., Fukuda, K., Sakagami, M. and Inohara, H.	Intractable benign paroxysmal positioning vertigo: long-term follow-up and inner ear abnormality detected by three-dimensional magnetic resonance imaging. [Abstract] [BibTeX]	2010	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 31(2), pp. 250-255	article	DOI
Abstract: To investigate the occurrence rate, prognosis, and inner ear abnormality in intractable benign paroxysmal positioning vertigo (BPPV). A prospective study. Tertiary referral university hospital. Intractable BPPV was defined in case of either a persistent nystagmus or a frequent relapse each lasting more than 1 year after the initial diagnosis. T2-weighted 3-dimensional fast imaging employing steady-state acquisition sequences of magnetic resonance imaging (MRI) were reconstructed 3-dimensionally for 13 intractable BPPV patients and 14 control volunteers. Transition and relapse of nystagmus were monitored. Semicircular canals were evaluated for a stenosis or filling defect (obturation). Eighteen patients (4 with posterior canal type, 2 with horizontal canal type with geotropic nystagmus, and 12 with apogeotropic nystagmus) fulfilled the above criteria for intractability among 495 BPPV patients. The occurrence rate of intractable BPPV was 3.6%. Also, the rate of nystagmus transition was significantly higher in patients with geotropic nystagmus and the posterior canal type (100%) compared with those with apogeotropic nystagmus (33.3%). Of the 13 intractable BPPV patients who underwent MRI, 11 (84.6%) had a total of 23 canals with abnormal appearance (29.5%), showing a significantly higher incidence compared with controls. There was no correlation between the affected canal diagnosed by MRI and the type of nystagmus. The low incidence of nystagmus transition in patients with apogeotropic nystagmus suggests a difference in pathophysiology between apogeotropic nystagmus and other types of BPPV. Stenosis and filling defect (obturation) of canals on MRI, which would indicate an innate narrowing and/or an otoconial jam of the semicircular canal, may account for the intractability of BPPV.
BibTeX: @article{Horii2010, author = {Horii, Arata and Kitahara, Tadashi and Osaki, Yasuhiro and Imai, Takao and Fukuda, Kazuyasu and Sakagami, Masafumi and Inohara, Hidenori}, title = {Intractable benign paroxysmal positioning vertigo: long-term follow-up and inner ear abnormality detected by three-dimensional magnetic resonance imaging.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2010}, volume = {31}, issue = {2}, pages = {250--255}, doi = {https://doi.org/10.1097/MAO.0b013e3181cabd77}, keywords = {Ear, Inner, abnormalities, pathology; Follow-Up Studies; Humans; Image Processing, Computer-Assisted; Long-Term Care; Magnetic Resonance Imaging; Nystagmus, Pathologic, pathology; Prognosis; Semicircular Canals, abnormalities, pathology; Vertigo, diagnosis, pathology}, pmid = {20042906} }
Inamori, T., Machizuka, H., Kumoi, T. and Takayasu, Y.	Intravenous digital subtraction angiography for patients with positional nystagmus. [Abstract] [BibTeX]	1986	Auris, nasus, larynx Vol. 13 Suppl 2, pp. S113-S121	article
Abstract: Thirty cases of intractable positional vertigo were studied by means of digital subtraction angiography (DSA). Benign paroxysmal positional vertigo was not included. DSA allows real time digital subtraction of X-ray transmission data using an image intensifier and television system. Intravenous DSA (IV DSA) was used to compare blood vessel flow in the right and left vertebral arteries. Abnormal findings were noted in 27 patients, with 10 being affected on the left side, 7 on the right, and 10 bilaterally. Twenty-three patients had slight stenosis, and bending and kinking were observed in 17. DSA results were related to the 6 established types of positional nystagmus. DSA is, therefore, considered to be an important tool in the diagnosis and treatment of positional vertigo.
BibTeX: @article{Inamori1986, author = {Inamori, T and Machizuka, H and Kumoi, T and Takayasu, Y}, title = {Intravenous digital subtraction angiography for patients with positional nystagmus.}, journal = {Auris, nasus, larynx}, year = {1986}, volume = {13 Suppl 2}, pages = {S113--S121}, keywords = {Adult; Aged; Cerebral Angiography; Constriction, Pathologic, diagnostic imaging; Electronystagmography; Female; Humans; Male; Meniere Disease, diagnostic imaging; Middle Aged; Nystagmus, Pathologic, diagnostic imaging; Subtraction Technique; Vertebrobasilar Insufficiency, diagnostic imaging}, pmid = {3548681} }
De Clercq, H., Naude, A. and Bornman, J.	Investigating nystagmus in patients with traumatic brain injury: A systematic review (1996 - 2016). [Abstract] [BibTeX]	2017	South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde Vol. 107(11), pp. 957-964	article	DOI
Abstract: Traumatic brain injury (TBI) is a health and socioeconomic concern worldwide. In patients with TBI, post-traumatic balance problems are often the result of damage to the vestibular system. Nystagmus is common in these patients, and can provide insight into the damage that has resulted from the trauma. To present a systematic overview of published literature regarding nystagmus in patients with TBI. Nine databases and platforms were searched during October 2016 for articles published between 1996 and 2016. Studies of any research design and published in English that focused on nystagmus in patients with TBI were considered for inclusion. A total of 110 articles were screened once duplicates had been removed, and 29 full-text articles were assessed. Eleven articles were included in the quality appraisal phase (using the McMaster tool), after which 10 articles were included in this review. This review describes nystagmus in 713 patients, and all articles reviewed described the type of assessment method that was used. However, the results lacked comprehensive data regarding the assessment, measurement and description of nystagmus in TBI patients, or the possible link and relationship between nystagmus and TBI. This systematic review indicated that: (i) there is a growing body of evidence that benign paroxysmal positional vertigo should be considered during the medical examination of all patients suffering from head trauma; (ii) all patients with TBI should undergo visual (eye movement) and vestibular examination; and (iii) future studies should include quantitative measurements of eye movements and nystagmus.
BibTeX: @article{DeClercq2017, author = {De Clercq, H and Naude, A and Bornman, J}, title = {Investigating nystagmus in patients with traumatic brain injury: A systematic review (1996 - 2016).}, journal = {South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde}, year = {2017}, volume = {107}, issue = {11}, pages = {957--964}, doi = {https://doi.org/10.7196/SAMJ.2017.v107i11.12472}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis; Brain Injuries, Traumatic, complications, physiopathology; Diagnosis, Differential; Eye Movement Measurements; Humans; Nystagmus, Pathologic, diagnosis, etiology; Nystagmus, Physiologic, physiology; Vestibular Function Tests}, pmid = {29262937} }
Tsai, K.-L., Cheng, Y.-Y., Leu, H.-B., Lee, Y.-Y., Chen, T.-J., Liu, D.-H. and Kao, C.-L.	Investigating the role of Sirt1-modulated oxidative stress in relation to benign paroxysmal positional vertigo and Parkinson's disease. [Abstract] [BibTeX]	2015	Neurobiology of aging Vol. 36(9), pp. 2607-2616	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is one of the most frequently encountered primary complaints in dizziness clinics. The incidence of BPPV has been proven to increase with age. The relationship between BPPV and another neurodegenerative disease, Parkinson's disease (PD), has not been previously discussed. This study aimed to investigate the relationship of BPPV and PD with oxidative stress. A total of 30,811 subjects participated in our cohort study. The study cohort comprised 5057 BPPV patients and a comparison cohort of 25,754 nonBPPV patients. SIRT1 axis gene expression was investigated in BPPV patient blood samples and a PD cell model of 6-hydroxydopamine (6-OHDA)-treated PC-12 cells to elucidate the potential in vitro and in vivo mechanisms of degeneration in PD and BPPV. Our data suggest that BPPV patients with histories of head injuries show a significantly higher hazard to develop subsequent PD (hazard ratio, 3.942; confidence interval, 1.523-10.205, p = 0.005). We also observed that oxidative status is increased in blood samples from patients with BPPV. Our in vitro study suggests that SIRT1 function is inhibited by oxidative stress, which thereby promotes 6-hydroxydopamine-induced cell death. We conclude that BPPV is independently associated with an increased risk of PD. This finding may be attributed to oxidative stress-mediated inhibition of SIRT1 expression levels.
BibTeX: @article{Tsai2015, author = {Tsai, Kun-Ling and Cheng, Yuan-Yang and Leu, Hsin-Bang and Lee, Yi-Yen and Chen, Tzeng-Ji and Liu, Ding-Hao and Kao, Chung-Lan}, title = {Investigating the role of Sirt1-modulated oxidative stress in relation to benign paroxysmal positional vertigo and Parkinson's disease.}, journal = {Neurobiology of aging}, year = {2015}, volume = {36}, issue = {9}, pages = {2607--2616}, doi = {https://doi.org/10.1016/j.neurobiolaging.2015.05.012}, keywords = {Adrenergic Agents, pharmacology; Adult; Age Factors; Aged; Animals; Benign Paroxysmal Positional Vertigo, blood, epidemiology; Chromones, pharmacology; Cohort Studies; Female; Gene Expression Regulation, drug effects; Humans; Male; Membrane Potential, Mitochondrial, drug effects; Middle Aged; Nerve Growth Factor, pharmacology; Oxidative Stress, drug effects, genetics; Oxidopamine, pharmacology; PC12 Cells, drug effects; Parkinson Disease, blood, epidemiology; Proto-Oncogene Proteins c-bcl-2, metabolism; Rats; Reactive Oxygen Species, metabolism; Sirtuin 1, blood, genetics; Superoxide Dismutase, blood; Thiobarbituric Acid Reactive Substances, metabolism; Transcription Factors, genetics, metabolism; bcl-2-Associated X Protein, metabolism; Benign paroxysmal positional vertigo; Oxidative stress; Parkinson's disease; SIRT1}, pmid = {26130063} }
Inukai, K., Koizuka, I. and Takahashi, S.	Investigation into dizziness before and after Epley's maneuver for benign paroxysmal positional vertigo using stabilometry. [Abstract] [BibTeX]	2007	Auris, nasus, larynx Vol. 34(1), pp. 15-17	article	DOI
Abstract: To investigate the cause of dizziness after Epley's maneuver using stabilometry. Subjects were 35 patients with posterior canal type BPPV. First we performed stabilometry, next Epley's maneuver, then stabilometry was performed again. The enveloped area and the locus length per second of stabilometry were compared. Seventeen patients reported a feeling of dizziness after the treatment, whereas the other 18 patients did not. The patients were divided into two groups: 17 patients with dizziness (WD) and 18 patients without dizziness (WOD) after the treatment. In the WD group, the enveloped area (P=0.0495) and the locus length per second (P=0.0099) before Epley's maneuver were significantly lower than those after Epley's maneuver. In the WOD group, there was no significant difference in the stabilometry parameter between values obtained before and after Epley's maneuver. There were no significant differences found in either parameter between these two groups either before or after applying Epley's maneuver. Epley's maneuver is a treatment for the posterior semicircular canal. Malfunction of the otolith organ remains. It is considered that the cause of dizziness after Epley's maneuver comes from otolith dysfunction.
BibTeX: @article{Inukai2007, author = {Inukai, Kenya and Koizuka, Izumi and Takahashi, Sugata}, title = {Investigation into dizziness before and after Epley's maneuver for benign paroxysmal positional vertigo using stabilometry.}, journal = {Auris, nasus, larynx}, year = {2007}, volume = {34}, issue = {1}, pages = {15--17}, doi = {https://doi.org/10.1016/j.anl.2006.09.018}, keywords = {Adult; Aged; Aged, 80 and over; Dizziness, diagnosis, physiopathology; Female; Humans; Male; Middle Aged; Otolaryngology, methods; Otolithic Membrane, physiopathology; Posture; Severity of Illness Index; Time Factors; Vertigo, physiopathology, therapy}, pmid = {17118595} }
Eggers, S.D.Z., Staab, J.P., Neff, B.A., Goulson, A.M., Carlson, M.L. and Shepard, N.T.	Investigation of the coherence of definite and probable vestibular migraine as distinct clinical entities. [Abstract] [BibTeX]	2011	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 32(7), pp. 1144-1151	article	DOI
Abstract: To investigate the following: 1) associations between vestibular symptoms and migraine in a well-characterized cohort of tertiary neurotology patients, 2) effects of comorbidity on clinical presentations, and 3) validity of proposed definitions of definite (dVM) and probable vestibular migraine (pVM). Retrospective chart review. Tertiary neurotology center. All 228 subjects with headache were selected from a larger investigation of 410 patients with vestibular symptoms who underwent comprehensive medical, surgical, and behavioral neurotologic consultations. Subjects had at least one of 4 diagnoses: dVM/pVM, Ménière's disease, benign paroxysmal positional vertigo, or chronic subjective dizziness. Subjects were divided into migraine (n = 164) and nonmigraine headache (n = 64) groups by International Headache Society criteria, then subdivided by those with vestibular symptoms related or unrelated to headache. Subjects meeting proposed criteria for dVM (n = 46) and pVM (n = 42) were identified. Statistical analyses investigated discriminating features and cohesiveness in each group, with or without comorbidity. Characteristics of dVM and pVM. Migraine, particularly migraine with aura, was more often related to vestibular symptoms than nonmigrainous headache. dVM and pVM groups did not differ in demographics, clinical histories, examinations, or vestibular testing. Numerous differences existed between dVM/pVM subjects with and without comorbid Ménière's disease, benign paroxysmal positional vertigo, or chronic subjective dizziness. The pVM group contained 4 subtypes. These results support an association between vestibular symptoms and migraine but not proposed distinctions between dVM and pVM. pVM does not appear to be a coherent diagnostic entity. Comorbid conditions are important causes of vestibular symptoms in patients with migraine.
BibTeX: @article{Eggers2011, author = {Eggers, Scott D Z and Staab, Jeffrey P and Neff, Brian A and Goulson, Adam M and Carlson, Matthew L and Shepard, Neil T}, title = {Investigation of the coherence of definite and probable vestibular migraine as distinct clinical entities.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2011}, volume = {32}, issue = {7}, pages = {1144--1151}, doi = {https://doi.org/10.1097/MAO.0b013e31822a1c67}, keywords = {Adult; Aged; Dizziness, complications, diagnosis; Female; Humans; Male; Meniere Disease, complications, diagnosis; Middle Aged; Migraine Disorders, complications, diagnosis; Retrospective Studies; Vestibular Diseases, complications, diagnosis}, pmid = {21799457} }
Dlugaiczyk, J., Siebert, S., Hecker, D.J., Brase, C. and Schick, B.	Involvement of the anterior semicircular canal in posttraumatic benign paroxysmal positioning vertigo. [Abstract] [BibTeX]	2011	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 32(8), pp. 1285-1290	article	DOI
Abstract: To study the involvement of the different semicircular canals in posttraumatic benign paroxysmal positioning vertigo (BPPV) with special reference to the anterior canal (AC). Retrospective review. Tertiary referral center. Seventy-four BPPV patients. Neurotologic assessment with video-oculography; treatment of BPPV with the canalith repositioning procedure appropriate for the affected semicircular canal. Number of patients with AC, posterior canal (PC), horizontal canal (HC), and multiple-canal involvement in posttraumatic versus idiopathic BPPV. 85.1% of patients were classified as idiopathic BPPV, whereas 14.9% had a history of posttraumatic BPPV. The prevalence of AC BPPV was significantly higher in the posttraumatic group (27.3%) compared with that in the idiopathic group (3.2%; Fisher's exact test: p = 0.021). Multiple-canal (combined) BPPV was observed more frequently after head trauma (27.3%) compared with the idiopathic form of the disorder (1.6%; p = 0.009). In particular, the risk for combined AC/PC BPPV was greater in posttraumatic than idiopathic cases (odds ratio, 13.78; 95% confidence interval, 1.13-167.8). No significant differences were observed for the involvement of the PC and HC between the two groups. Two cases of combined AC/PC BPPV are presented with particular respect to the underlying trauma mechanism. Head trauma is a risk factor for AC and combined BPPV, in particular AC/PC BPPV. Involvement of the AC should especially be considered in patients who experienced head trauma resulting in a nonupright position of the body.
BibTeX: @article{Dlugaiczyk2011, author = {Dlugaiczyk, Julia and Siebert, Stefan and Hecker, Dietmar J and Brase, Christoph and Schick, Bernhard}, title = {Involvement of the anterior semicircular canal in posttraumatic benign paroxysmal positioning vertigo.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2011}, volume = {32}, issue = {8}, pages = {1285--1290}, doi = {https://doi.org/10.1097/MAO.0b013e31822e94d9}, keywords = {Adult; Benign Paroxysmal Positional Vertigo; Craniocerebral Trauma, complications, physiopathology; Female; Humans; Male; Middle Aged; Patient Positioning; Retrospective Studies; Semicircular Canals, physiopathology; Vertigo, etiology, physiopathology}, pmid = {21892120} }
Emami, S.F.	Is all human hearing cochlear? [Abstract] [BibTeX]	2013	TheScientificWorldJournal Vol. 2013, pp. 147160	article	DOI
Abstract: The objective of this cross-sectional study was to investigate the possibility that the saccule may contribute to human hearing. The forty participants included twenty healthy people and twenty other subjects selected from patients who presented with benign paroxysmal positional vertigo to Audiology Department of Hazrat Rasoul Akram hospital (Tehran, Iran). Assessments comprised of audiological evaluations, cervical vestibular evoked myogenic potentials (cVEMPs), recognition of spoken phonemes in white noise (Rsp in wn), and auditory brainstem response to 500 Hz tone burst (ABR(500 HZ)). Twenty affected ears with decreased vestibular excitability as detected by abnormal cVEMPs revealed decreased scores of Rsp in wn and abnormal findings of ABR(500 HZ). Both unaffected and normal ears had normal results. Multiple comparisons of mean values of cVEMPs and ABR(500 HZ) between three groups were significant (P < 0.05, ANOVA). The correlation between RSP in wn and p13 latencies was significant. The peak-to-peak amplitudes showed significant correlation to RSP in wn. The correlation between RSP in wn and the latencies of n23 was significant. In high-level of noisy competing situations, healthy human saccular sensation can mediate the detection of low frequencies and possibly help in cochlear hearing for frequency and intensity discrimination. So, all human hearing is not cochlear.
BibTeX: @article{Emami2013, author = {Emami, Seyede Faranak}, title = {Is all human hearing cochlear?}, journal = {TheScientificWorldJournal}, year = {2013}, volume = {2013}, pages = {147160}, doi = {https://doi.org/10.1155/2013/147160}, keywords = {Cochlea, physiopathology; Female; Hearing; Humans; Male; Vertigo, physiopathology; Vestibular Evoked Myogenic Potentials}, pmid = {24453793} }
Murofushi, T., Tsubota, M., Suizu, R. and Yoshimura, E.	Is Alteration of Tuning Property in Cervical Vestibular-Evoked Myogenic Potential Specific for Ménière's Disease? [Abstract] [BibTeX]	2017	Frontiers in neurology Vol. 8, pp. 193	article	DOI
Abstract: The aim of this study is to show sensitivity and specificity of cervical vestibular-evoked myogenic potential (cVEMP) tuning property test to Ménière's disease (MD) in comparison with healthy controls (HC) and patients with other vestibular diseases. Totally 92 subjects (50 women and 42 men, 20-77 years of age) were enrolled in this study. Subjects were composed of 38 definite unilateral MD patients, 11 unilateral benign paroxysmal positional vertigo patients, 14 vestibular migraine patients, 19 unilateral vestibular neuritis patients, and 10 HC. The subjects underwent cVEMP testing to 500 and 1,000 Hz short tone bursts (125 dBSPL). The corrected amplitudes of the first biphasic responses (p13-n23) (cVEMP) were measured. Then, a tuning property index (the 500-1,000 Hz cVEMP slope) was calculated. The area of under the ROC curve (AUC) was 0.75 in comparison with other vestibular disease patients, while AUC was 0.77 in comparison with other vestibular disease patients plus HC. The best cutoff point of the 500-1,000 Hz cVEMP slope was -19.9. Sensitivity of the tuning property test to MD was 0.74, while specificity was 0.76 to other vestibular disease patients. The tuning property test of cVEMP is useful as a screening test of MD.
BibTeX: @article{Murofushi2017, author = {Murofushi, Toshihisa and Tsubota, Masahito and Suizu, Ryota and Yoshimura, Eriko}, title = {Is Alteration of Tuning Property in Cervical Vestibular-Evoked Myogenic Potential Specific for Ménière's Disease?}, journal = {Frontiers in neurology}, year = {2017}, volume = {8}, pages = {193}, doi = {https://doi.org/10.3389/fneur.2017.00193}, keywords = {Ménière’s disease; endolymphatic hydrops; otolith organ; saccule; tuning; vertigo}, pmid = {28533763} }
Chan, T.P.	Is benign paroxysmal positional vertigo underdiagnosed in hospitalised patients? [Abstract] [BibTeX]	2008	Hong Kong medical journal = Xianggang yi xue za zhi Vol. 14(3), pp. 198-202	article
Abstract: To investigate the proportion of sufferers of benign paroxysmal positional vertigo among hospitalised patients in Hong Kong who complained of dizziness, and to determine the predictive values and likelihood ratios of classical presenting symptoms. Cross-sectional study. Convalescence/rehabilitation hospital, Hong Kong. A cohort of 88 newly admitted patients, who complained of dizziness or complained of having had dizziness in the 2 weeks prior to admission from September 2005 to February 2006. Presence of the pathognomonic nystagmus of benign paroxysmal positional vertigo. Five patients had benign paroxysmal positional vertigo, all with the posterior type. The frequency of its occurrence among patients complaining of dizziness was 6% (95% confidence interval, 1-11%), which was more than double the figure of 3% in our local convalescence/rehabilitation hospitals, though this difference was not statistically significant. Regarding the five identified patients, in two it involved the left ear, in two others the right ear, and in one it was bilateral. All four classical presenting symptoms had low positive predictive values, high negative predictive values, and small likelihood ratios. Benign paroxysmal positional vertigo in the setting of a convalescence/rehabilitation hospital in Hong Kong seems to be underdiagnosed. Small and insignificant likelihood ratios for the classical presenting symptoms preclude their use in making the diagnosis. However, absence of these symptoms in a clinical setting of low occurrence rate can be regarded as against the diagnosis.
BibTeX: @article{Chan2008, author = {Chan, T P}, title = {Is benign paroxysmal positional vertigo underdiagnosed in hospitalised patients?}, journal = {Hong Kong medical journal = Xianggang yi xue za zhi}, year = {2008}, volume = {14}, issue = {3}, pages = {198--202}, keywords = {Adult; Aged; Aged, 80 and over; Cross-Sectional Studies; Female; Hong Kong, epidemiology; Humans; Inpatients, statistics & numerical data; Logistic Models; Male; Middle Aged; Nystagmus, Pathologic, diagnosis, epidemiology; Statistics, Nonparametric; Vertigo, diagnosis, epidemiology}, pmid = {18525088} }
Batuecas-Caletrío, A., Martín-Sánchez, V., Cordero-Civantos, C., Guardado-Sánchez, L., Marcos, M.R., Fabián, A.H., Benito González, J.J. and Santa Cruz-Ruiz, S.	Is benign paroxysmal vertigo of childhood a migraine precursor? [Abstract] [BibTeX]	2013	European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society Vol. 17(4), pp. 397-400	article	DOI
Abstract: Benign Paroxysmal Vertigo of Childhood (BPVC) is a common cause of vertigo in children and it is characterized by recurrent attacks of vertigo without warning resolving spontaneously after minutes to hours. It has been considered the equivalent of migraine in childhood. Twenty-seven patients diagnosed with BPVC were recruited between 1991 and 1997 with a follow up of at least 15 years. The incidence of migraine, inner ear disorders and family medical history is analyzed. The average age for the onset of the attacks of BPVC was 3 years and 11 months, and for spontaneous resolution, it was around 5 years and 7 months. The average age for follow up was 18 years. Nine patients developed migraine during adulthood. Nineteen of them had a family history of migraine. We have observed that the prevalence of migraine in patients that had been diagnosed with BPVC is higher than in the general population, which leads us to propose BPVC as a precursor of migraine during childhood.
BibTeX: @article{Batuecas-Caletrio2013a, author = {Batuecas-Caletrío, Angel and Martín-Sánchez, Víctor and Cordero-Civantos, Cristina and Guardado-Sánchez, Luís and Marcos, María Rey and Fabián, Aranzazu Hernández and Benito González, José Javier and Santa Cruz-Ruiz, Santiago}, title = {Is benign paroxysmal vertigo of childhood a migraine precursor?}, journal = {European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society}, year = {2013}, volume = {17}, issue = {4}, pages = {397--400}, doi = {https://doi.org/10.1016/j.ejpn.2013.01.006}, keywords = {Benign Paroxysmal Positional Vertigo; Child; Child, Preschool; Disease Progression; Female; Humans; Infant; Longitudinal Studies; Male; Migraine Disorders, epidemiology, etiology; Time Factors; Vertigo, epidemiology, physiopathology}, pmid = {23434307} }
Lee, N.H. and Ban, J.H.	Is BPPV a Prognostic Factor in Idiopathic Sudden Sensory Hearing Loss? [Abstract] [BibTeX]	2010	Clinical and experimental otorhinolaryngology Vol. 3(4), pp. 199-202	article	DOI
Abstract: The prognostic significance of vertigo in patients with idiopathic sudden sensorineural hearing loss (SSNHL) remains a matter of debate because vertigo is associated with many different vestibular disorders. The purpose of this study is to determine the role of benign paroxysmal positional vertigo (BPPV) as a prognostic factor in patients with SSNHL. We conducted a retrospective study of 298 patients with SSNHL. Hearing outcomes were evaluated by assessments of pre-treatment hearing and hearing gain. Comparative multivariate analyses between prognostic factors and hearing outcome were conducted. Thirty-eight (12.7%) SSNHL patients were found to also have BPPV. BPPV showed significant negative prognostic factors in hearing outcome on multivariate analysis (odds ratio, 0.15). In comparison to average pure tone audiometry (PTA), patients diagnosed with SSNHL with BPPV exhibited poorer hearing in pre- and post-treatment PTA compared to SSNHL without BPPV. Old age (>60 years), pre-treatment hearing, and canal paresis were significant outcome predictors. BPPV in SSNHL patients, representing definitive vestibular damage, was closely related to poor prognosis.
BibTeX: @article{Lee2010, author = {Lee, No Hee and Ban, Jae Ho}, title = {Is BPPV a Prognostic Factor in Idiopathic Sudden Sensory Hearing Loss?}, journal = {Clinical and experimental otorhinolaryngology}, year = {2010}, volume = {3}, issue = {4}, pages = {199--202}, doi = {https://doi.org/10.3342/ceo.2010.3.4.199}, keywords = {Sudden hearing loss; Vertigo}, pmid = {21217960} }
Oliveira, A.K.d.S., Suzuki, F.A. and Boari, L.	Is it important to repeat the positioning maneuver after the treatment for benign paroxysmal positional vertigo? [Abstract] [BibTeX]	2015	Brazilian journal of otorhinolaryngology Vol. 81(2), pp. 197-201	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vestibular dysfunction. To assess whether the performance of the Dix-Hallpike maneuver after the Epley positioning maneuver has prognostic value in the evolution of unilateral ductolithiasis of posterior semicircular canal. A prospective cohort study in monitored patients at otoneurology ambulatory with a diagnosis of BPPV; they were submitted to the therapeutic maneuver and then to a retest in order to evaluate the treatment effectiveness; all cases were reassessed one week later and the retest prognostic value was evaluated. A sample of 64 patients which 47 belonging to negative retest group and 17 belonging to positive retest. Performed the maneuver in all patients, the retest presented 51.85% sensitivity, 91.89% specificity, 82.35% positive predictive value and 72.34% negative predictive value. The study shows that doing the retest after repositioning maneuver of particles in BPPV is effectual, since it has high specificity.
BibTeX: @article{Oliveira2015, author = {Oliveira, Alexandra Kolontai de Sousa and Suzuki, Fabio Akira and Boari, Leticia}, title = {Is it important to repeat the positioning maneuver after the treatment for benign paroxysmal positional vertigo?}, journal = {Brazilian journal of otorhinolaryngology}, year = {2015}, volume = {81}, issue = {2}, pages = {197--201}, doi = {https://doi.org/10.1016/j.bjorl.2014.06.002}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis, therapy; Diagnostic Techniques, Otological; Epidemiologic Methods; Female; Humans; Male; Middle Aged; Patient Positioning; Physical Therapy Modalities; Semicircular Canals, physiopathology; Treatment Outcome; Canais semicirculares; Resultado de tratamento; Semicircular canals; Treatment outcome; Vertigem; Vertigo}, pmid = {25636732} }
Ganança, F.F., Simas, R., Ganança, M.M., Korn, G.P. and Dorigueto, R.S.	Is it important to restrict head movement after Epley maneuver? [Abstract] [BibTeX]	2005	Brazilian journal of otorhinolaryngology Vol. 71(6), pp. 764-768	article
Abstract: The effectiveness of postmaneuver postural restrictions is controversial in patients with benign paroxysmal positional vertigo. To verify the role of postural restrictions in patients with benign paroxysmal positional vertigo of posterior canal, submitted to a single Epley maneuver. clinical prospective. Fifty eight patients with benign paroxysmal positional vertigo of posterior canal were randomly divided in two groups following the application of a unique Epley maneuver. The patients from group 1 were informed to restrict their head movements and to use a cervical collar and group 2 patients were not informed about these postmaneuver restrictions. The patients from both groups were reevaluated one week after Epley maneuver, regarding the presence of symptoms and positional nystagmus. One week after Epley maneuver 82.1% of the patients from group 1 and 73.3% from group 2 didn't present positional nystagmus (p=0.421). There was a clinical improvement in 96.0% of the patients from group 1 and in 94.0% from group 2 (p=0.781). The use of postural restrictions in patients with benign paroxysmal positional vertigo of posterior canal didn't interfere in their clinical evaluation, one week after a unique Epley maneuver.
BibTeX: @article{Gananca2005, author = {Ganança, Fernando Freitas and Simas, Ricardo and Ganança, Maurício M and Korn, Gustavo P and Dorigueto, Ricardo S}, title = {Is it important to restrict head movement after Epley maneuver?}, journal = {Brazilian journal of otorhinolaryngology}, year = {2005}, volume = {71}, issue = {6}, pages = {764--768}, keywords = {Adult; Aged; Aged, 80 and over; Female; Head Movements; Humans; Male; Middle Aged; Physical Therapy Modalities; Prospective Studies; Treatment Outcome; Vertigo, therapy}, pmid = {16878246} }
Gordon, C.R., Levite, R., Joffe, V. and Gadoth, N.	Is posttraumatic benign paroxysmal positional vertigo different from the idiopathic form? [Abstract] [BibTeX]	2004	Archives of neurology Vol. 61(10), pp. 1590-1593	article	DOI
Abstract: Although head trauma is considered a common cause of benign paroxysmal positional vertigo (BPPV), clinical presentation and outcome of traumatic BPPV (t-BPPV) have not been systematically evaluated. To compare the clinical presentation, patient's response to physical treatment, and outcome of patients with t-BPPV with those with the idiopathic form (i-BBPV). Tertiary referral neuro-otology outpatient clinic. We reviewed the clinical records of 247 consecutive patients with posterior canal BPPV during the years 1997 to 2000. All patients were diagnosed using the Dix-Hallpike test and treated using the particle repositioning maneuver. Patients with an onset of positional vertigo within 3 days of well-documented head trauma were included in the t-BPPV group. The outcome was compared with the outcome of 42 patients with i-BPPV who were similarly treated and followed up. Twenty-one (8.5%) of the 247 patients with BPPV fulfilled the diagnostic criteria for t-BPPV. The most common cause of head trauma was motor vehicle crash, documented in 57% of the cases; half of the patients additionally suffered from a whiplash injury. While the other causes were diverse, common falls were predominant. Only 2 of the patients involved in motor vehicle crashes experienced brief loss of consciousness. Sixty-seven percent of patients with t-BPPV required repeated physical treatments for complete resolution of signs and symptoms in comparison to 14% of patients with i-BPPV (P<.001). During a mean +/-SD follow-up of 21.7 +/- 9.7 months, 57% of t-BPPV patients and 19% of i-BPPV controls had recurrent attacks (P<.004). The nature and severity of the traumas causing t-BPPV are diverse, ranging from minor head injuries to more severe head and neck trauma with brief loss of consciousness. It appears that t-BPPV is more difficult to treat than i-BPPV, and also has a greater tendency to recur.
BibTeX: @article{Gordon2004, author = {Gordon, Carlos R and Levite, Ronen and Joffe, Vitaly and Gadoth, Natan}, title = {Is posttraumatic benign paroxysmal positional vertigo different from the idiopathic form?}, journal = {Archives of neurology}, year = {2004}, volume = {61}, issue = {10}, pages = {1590--1593}, doi = {https://doi.org/10.1001/archneur.61.10.1590}, keywords = {Adult; Aged; Aged, 80 and over; Craniocerebral Trauma, complications, rehabilitation; Eye Movements, physiology; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nystagmus, Physiologic, physiology; Reflex, Vestibulo-Ocular, physiology; Retrospective Studies; Saccades, physiology; Treatment Outcome; Vertigo, classification, diagnosis, etiology, rehabilitation}, pmid = {15477514} }
Kim, C.-H. and Hong, S.M.	Is the modified cupulolith repositioning maneuver effective for treatment of persistent geotropic direction-changing positional nystagmus? [Abstract] [BibTeX]	2018	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 275(7), pp. 1731-1736	article	DOI
Abstract: Clinicians sometimes see patients with relatively persistent geotropic direction-changing positional nystagmus (DCPN) as a variant of lateral semicircular canal-benign paroxysmal positional vertigo (LSCC-BPPV). Recently, the concept of a "light cupula" in the lateral semicircular canal, exhibiting persistent geotropic DCPN, has been introduced. However, the underlying pathogenesis of light cupula is not known. We investigated the efficacy of a modified cupulopathy repositioning maneuver (mCuRM), designed to reduce light debris attached to the cupula in patients with persistent geotropic DCPN. Retrospective cohort study. Participants included 65 patients with a persistent geotropic DCPN: 35 underwent treatment (mCuRM group), and 30 were followed-up but received no treatment (No CuRM group). We compared the therapeutic and survival rate of persistent geotropic DCPN between two groups. On Day 1, the persistent geotropic DCPN did not resolve in either group. On the first and second follow-up days, persistent geotropic DCPN was observed in 28 (80%) and 21 (60%) of patients, respectively, in the mCuRM group, and in 28 (93.3%) and 24 (80%) patients, respectively, in the no mCuRM group. The differences between groups were not statistically significant. Furthermore, no between-group differences were found in the time from diagnosis to resolution of nystagmus, or the time from symptom onset to resolution of nystagmus. Kaplan-Meier analysis of the time course of persistent geotropic DCPN resolution from the day of diagnosis and day of symptom onset revealed no significant differences between the groups. Our findings indicate that mCuRM had no therapeutic benefit for a persistent geotropic DCPN and suggest that the pathophysiology of persistent geotropic DCPN is less likely to be a light debris attached to the cupula.
BibTeX: @article{Kim2018c, author = {Kim, Chang-Hee and Hong, Seok Min}, title = {Is the modified cupulolith repositioning maneuver effective for treatment of persistent geotropic direction-changing positional nystagmus?}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2018}, volume = {275}, issue = {7}, pages = {1731--1736}, doi = {https://doi.org/10.1007/s00405-018-5006-4}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo, diagnosis, therapy; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, physiopathology, therapy; Nystagmus, Physiologic; Patient Positioning; Physical Therapy Modalities; Retrospective Studies; Semicircular Canals, physiopathology; Vestibular Function Tests; BPPV; Direction-changing positional nystagmus; Mechanism; Reposition maneuver}, pmid = {29804128} }
Yagi, T., Morishita, M., Koizumi, Y., Kokawa, M., Kamura, E. and Baba, S.	Is the pathology of horizontal canal benign paroxysmal positional vertigo really localized in the horizontal semicircular canal? [Abstract] [BibTeX]	2001	Acta oto-laryngologica Vol. 121(8), pp. 930-934	article
Abstract: In order to clarify the pathological localization of horizontal canal benign paroxysmal positional vertigo (HC-BPPV), we performed 3D analysis of positional nystagmus in 11 patients with HC-BPPV. In addition, these results were compared with 3D analysis data of pressure nystagmus in patients with HC fistula. 3D analysis of nystagmus was carried out using a video image analysis system. In seven patients with HC-BPPV, the velocity vectors were well aligned with the axes of the HC and in four patients they were not. In addition, the 3D velocity vectors of the slow phase of pressure nystagmus in all 11 subjects with HC fistula were closely aligned with the axes of the HC. The pathology of HC-BPPV in most patients with apogeotropic positional nystagmus has been considered to be localized in the HC. However, our results strongly suggest that the pathology of HC-BPPV with geotropic nystagmus is localized in the utricle. This is the first report concerning the pathological localization of HC-BPPV based on physiological evidence.
BibTeX: @article{Yagi2001, author = {Yagi, T and Morishita, M and Koizumi, Y and Kokawa, M and Kamura, E and Baba, S}, title = {Is the pathology of horizontal canal benign paroxysmal positional vertigo really localized in the horizontal semicircular canal?}, journal = {Acta oto-laryngologica}, year = {2001}, volume = {121}, issue = {8}, pages = {930--934}, keywords = {Female; Humans; Male; Nystagmus, Pathologic, complications, diagnosis; Semicircular Canals, pathology; Terminology as Topic; Vertigo, complications, diagnosis}, pmid = {11813897} }
Schultz, A.R., Neves-Souza, R.D., Costa, V.d.S.P., Meneses-Barriviera, C.L., Franco, P.P.R. and Marchiori, L.L.d.M.	Is There a Possible Association between Dietary Habits and Benign Paroxysmal Positional Vertigo in the Elderly? The Importance of Diet and Counseling. [Abstract] [BibTeX]	2015	International archives of otorhinolaryngology Vol. 19(4), pp. 293-297	article	DOI
Abstract: Introduction Poor diet habits and inadequate intake of nutrients are a concern in the elderly. Nutritional education with guidance may improve the results of the treatment of vertigo. Objective Evaluate the presence of benign paroxysmal positional vertigo (BPPV) associated with feeding habits. Methods Cross-sectional study with elderly people living independently. We evaluated nutritional habits through the method of dietary 24-hour recall and manipulation of Dix-Hallpike. Results Based on a sample of 487 individuals, 117 had BPPV. Among the 117 elderly patients with BPPV, 37 (31.62%) had inadequate feeding. From those 370 individuals without BPPV, 97 (26.21%) had inappropriate feeding. No significant association between nutritional habits and BPPV in the total population was observed (p = 0.3064). However, there was significant relation between BPPV and inadequate carbohydrate intake (p = 0.0419) and insufficient fiber intake (p = 0.03), and the diet of these subjects was rich in polyunsaturated fatty acids (p = 0.0084). Conclusion These data correlate with the dyslipidemia and hypertriglyceridemia status, making it extremely important to reduce the intake of fats and carbohydrates and increase the fiber intake to stabilize triglycerides and thus minimize harmful effects on the inner ear. Food readjustment is suggested in patients with BPPV, along with the work of a multidisciplinary team to improve the quality of the elderly.
BibTeX: @article{Schultz2015, author = {Schultz, Adriane Rocha and Neves-Souza, Rejane Dias and Costa, Viviane de Souza Pinho and Meneses-Barriviera, Caroline Luiz and Franco, Pricila Perini Rigotti and Marchiori, Luciana Lozza de Moraes}, title = {Is There a Possible Association between Dietary Habits and Benign Paroxysmal Positional Vertigo in the Elderly? The Importance of Diet and Counseling.}, journal = {International archives of otorhinolaryngology}, year = {2015}, volume = {19}, issue = {4}, pages = {293--297}, doi = {https://doi.org/10.1055/s-0035-1551551}, keywords = {aging; dizziness; nutrition}, pmid = {26491473} }
Ziavra, N.V. and Bronstein, A.M.	Is uric acid implicated in benign paroxysmal positional vertigo? [BibTeX]	2004	Journal of neurology Vol. 251(1), pp. 115	article	DOI
BibTeX: @article{Ziavra2004, author = {Ziavra, Nausica V and Bronstein, Adolfo M}, title = {Is uric acid implicated in benign paroxysmal positional vertigo?}, journal = {Journal of neurology}, year = {2004}, volume = {251}, issue = {1}, pages = {115}, doi = {https://doi.org/10.1007/s00415-004-0277-7}, keywords = {Adult; Aged; Case-Control Studies; Female; Humans; Male; Middle Aged; Neurologic Examination; Uric Acid, blood; Vertigo, blood}, pmid = {14999502} }
Hillier, S. and McDonnell, M.	Is vestibular rehabilitation effective in improving dizziness and function after unilateral peripheral vestibular hypofunction? An abridged version of a Cochrane Review. [Abstract] [BibTeX]	2016	European journal of physical and rehabilitation medicine Vol. 52(4), pp. 541-556	article
Abstract: Unilateral peripheral vestibular dysfunction (UPVD) is characterized by complaints of dizziness, gaze disturbances and balance impairment. Current management includes medication, physical man oeuvres and exercise regimes, the latter known collectively as vestibular rehabilitation. The aim was to assess the effectiveness of vestibular rehabilitation in people with symptomatic UVPD. A systematic review was conducted for the population of adults diagnosed with symptomatic UPVD, living in the community. We searched all relevant databases and trials registers to identify randomized controlled trials comparing vestibular rehabilitation versus control (e.g. placebo), other treatment (non-vestibular rehabilitation, e.g. pharmacological) or another form of vestibular rehabilitation. We considered possible effectiveness in the domains of symptoms (dizziness) or function (activities, quality of life) and where possible combined results in meta-analyses to provide overall estimates of effect. We included 39 studies involving 2441 participants with UPVD in the review. Individual and pooled analyses of the primary outcome (frequency of dizziness) showed a statistically significant effect in favor of vestibular rehabilitation over control or no intervention (odds ratio (OR) 2.67, 95% confidence interval (CI) 1.85 to 3.86). Secondary outcomes measures related to levels of activity or participation showed a strong trend towards significant differences between the groups (standardized mean difference -0.83, 95% CI -1.02 to -0.64). However when movement-based vestibular rehabilitation was compared to physical maneuvers for benign paroxysmal positional vertigo (BPPV), where the latter was shown to be superior in cure rate in the short term (OR 0.19, 95% CI 0.07 to 0.49). There were no reported adverse effects and risk of bias was generally low across the studies. There is moderate to strong evidence that vestibular rehabilitation is a safe, effective management for UPVD. For the specific diagnostic group of BPPV, physical (repositioning) maneuvers are more effective in the short term than exercise-based vestibular rehabilitation; although a combination of the two is effective for longer-term functional recovery. There is insufficient evidence to discriminate between differing forms of vestibular rehabilitation.
BibTeX: @article{Hillier2016, author = {Hillier, Susan and McDonnell, Michelle}, title = {Is vestibular rehabilitation effective in improving dizziness and function after unilateral peripheral vestibular hypofunction? An abridged version of a Cochrane Review.}, journal = {European journal of physical and rehabilitation medicine}, year = {2016}, volume = {52}, issue = {4}, pages = {541--556}, keywords = {Dizziness, diagnosis, rehabilitation; Evidence-Based Medicine; Exercise Therapy, methods; Female; Humans; Male; Patient Positioning; Postural Balance; Quality of Life; Randomized Controlled Trials as Topic; Treatment Outcome; Vestibular Diseases, diagnosis, rehabilitation}, pmid = {27406654} }
Castellucci, A., Malara, P., Brandolini, C., Del Vecchio, V., Giordano, D., Ghidini, A., Ferri, G.G. and Pirodda, A.	Isolated horizontal canal hypofunction differentiating a canalith jam from an acute peripheral vestibular loss. [Abstract] [BibTeX]	2018	American journal of otolaryngology	article	DOI
Abstract: To describe a unique case of acute vertigo presenting with spontaneous horizontal nystagmus (SHN) and a clinical picture consistent with right acute peripheral vestibular loss (APVL) in which an isolated hypofunction of a horizontal semicircular canal (HSC) permitted to detect a spontaneous canalith jam and treat the patient accordingly. Case report and literature review. A 74-year old woman presented with acute vertigo, left-beating SHN and a clinical picture consistent with right APVL. Nevertheless, vestibular evoked myogenic potentials were normal with symmetrical amplitudes and the video head impulse test (vHIT) revealed an isolated hypofunction of the right HSC. After repeated head shakings, the supine roll test evoked bilaterally a positioning paroxysmal geotropic horizontal nystagmus suggesting benign paroxysmal positional vertigo involving the non-ampullated arm of the right HSC. vHIT and caloric testing confirmed restitution of HSC function after repositioning maneuvers. In case of acute vertigo with SHN, a complete functional assessment of vestibular receptors and afferents should always be given in order to avoid misdiagnosis. Canalith jam should be considered in case of spontaneous nystagmus and isolated canal hypofunction.
BibTeX: @article{Castellucci2018, author = {Castellucci, Andrea and Malara, Pasquale and Brandolini, Cristina and Del Vecchio, Valeria and Giordano, Davide and Ghidini, Angelo and Ferri, Gian Gaetano and Pirodda, Antonio}, title = {Isolated horizontal canal hypofunction differentiating a canalith jam from an acute peripheral vestibular loss.}, journal = {American journal of otolaryngology}, year = {2018}, doi = {https://doi.org/10.1016/j.amjoto.2018.12.005}, keywords = {Acute peripheral vestibular loss; Benign paroxysmal positional vertigo; Caloric test; Canalith jam; Horizontal semicircular canal; Video head impulse test}, pmid = {30665622} }
Messina, A., Casani, A.P., Manfrin, M. and Guidetti, G.	Italian survey on benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2017	Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale Vol. 37(4), pp. 328-335	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most common type of peripheral vertigo. BPPV often relapses after the first episode, with a recurrence rate between 15% and 50%. To date both the aetiopathogenetic processes that lead to otoconia detachment and the factors that make BPPV a relapsing disease are still unclear, but recent epidemiological studies have shown a possible association with cardiovascular risk factors. The aim of the present study (Sesto Senso Survey) was to evaluate in the Italian population through an observational survey, the main demographic and clinical characteristics of patients with BPPV (first episode or recurrent) with particular focus on the potential cardiovascular risk factors. The survey was conducted in 158 vestibology centres across Italy on 2,682 patients (mean age 59.3 ± 15.0 years; 39.1% males and 60.9% females) suffering from BPPV, from January 2013 to December 2014. The results showed a high prevalence of cardiovascular risk factors such as high blood pressure (55.8%), hypercholesterolaemia (38.6%) and diabetes (17.7%), as well as a family history of cardiovascular disease (49.4%). A high percentage of patients also had hearing loss (42.9%), tinnitus (41.2%), or both (26.8%). The presence of hypertension, dyslipidaemia and pre-existing cardiovascular comorbidities were significantly related to recurrent BPPV episodes (OR range between 1.84 and 2.31). In addition, the association with diabetes and thyroid/autoimmune disease (OR range between 1.73 and 1.89) was relevant. The survey results confirm the significant association between cardiovascular comorbidities and recurrent BPPV and identify them as a potential important risk factor for recurrence of BPPV in the Italian population, paving the way for the evaluation of new therapeutic strategies in the treatment of this disease.
BibTeX: @article{Messina2017, author = {Messina, A and Casani, A P and Manfrin, M and Guidetti, G}, title = {Italian survey on benign paroxysmal positional vertigo.}, journal = {Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale}, year = {2017}, volume = {37}, issue = {4}, pages = {328--335}, doi = {https://doi.org/10.14639/0392-100X-1121}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, complications, diagnosis, epidemiology; Cardiovascular Diseases, complications; Female; Health Surveys; Humans; Italy, epidemiology; Male; Middle Aged; Records; Young Adult; Benign paroxysmal positional vertigo; Cardiovascular diseases; Risk factors; Therapy}, pmid = {28872163} }
Anthony, P.F.	Laser applications in inner ear surgery. [Abstract] [BibTeX]	1996	Otolaryngologic clinics of North America Vol. 29(6), pp. 1031-1048	article
Abstract: Argon and carbon dioxide lasers can cause heat shrinkage of the membranous labyrinth without injury to hearing. The argon laser can penetrate the membranous labyrinth and cause destruction of targeted vestibula special sensory epithelium also without injury to hearing. Consequently, these lasers have been used successfully in two treatment techniques for benign paroxysmal positional vertigo, which are discussed in detail. The early techniques for laser assisted resection of the pars superior portion of the inner ear with hearing preservation are discussed.
BibTeX: @article{Anthony1996, author = {Anthony, P F}, title = {Laser applications in inner ear surgery.}, journal = {Otolaryngologic clinics of North America}, year = {1996}, volume = {29}, issue = {6}, pages = {1031--1048}, keywords = {Animals; Argon; Carbon Dioxide; Ear, Inner, surgery; Epithelium, surgery; Hearing; Hot Temperature; Humans; Labyrinth Diseases, surgery; Laser Therapy; Posture; Vertigo, surgery; Vestibule, Labyrinth, surgery}, pmid = {8890133} }
Nomura, Y. and Kobayashi, H.	Laser irradiation of the semicircular canal: occlusion of the canal or duct. [Abstract] [BibTeX]	2012	Acta oto-laryngologica Vol. 132(1), pp. 106-111	article	DOI
Abstract: The aim of this study was to evaluate the effects of argon laser irradiation of the semicircular canals using computed tomography (CT) images and to examine the basis for laser treatment for benign paroxysmal positional vertigo (BPPV). CT images of the posterior canal were evaluated postoperatively in a patient with intractable BPPV, in whom the unilateral posterior and lateral semicircular canals were irradiated with an argon laser. In addition, bootstrap analysis of 20 patients with normal CT findings of the temporal bone was performed and previous experimentally obtained histologic findings were compared. Cross-sections of the posterior canals of 20 patients were found to show no difference in size between the right and left sides. The laser-irradiated posterior canal became narrower than that on the non-irradiated healthy side in our patient. There was a discrepancy between the CT images and experimentally obtained histologic findings that showed complete occlusion of the canal. CT images of a patient with severe vertigo demonstrated that argon laser irradiation to the blue-lined semicircular canals did not occlude the canal of the corresponding areas, while the canal of the guinea pig histologically showed complete obstruction with new bone after irradiation with the same energy (1.5 W, 0.5 s, spot size: around 200 μm in diameter). The patient has been free from vertigo for 16 years. Marked constriction of the semicircular duct corresponding to the irradiated area appeared to be effective in treating intractable BPPV.
BibTeX: @article{Nomura2012, author = {Nomura, Yasuya and Kobayashi, Hitome}, title = {Laser irradiation of the semicircular canal: occlusion of the canal or duct.}, journal = {Acta oto-laryngologica}, year = {2012}, volume = {132}, issue = {1}, pages = {106--111}, doi = {https://doi.org/10.3109/00016489.2011.622292}, keywords = {Aged; Benign Paroxysmal Positional Vertigo; Female; Follow-Up Studies; Humans; Lasers, Gas, therapeutic use; Low-Level Light Therapy, methods; Semicircular Canals, diagnostic imaging, radiation effects; Tomography, X-Ray Computed; Vertigo, diagnostic imaging, radiotherapy}, pmid = {22053860} }
Dan-Goor, E., Dangoor, J.Y. and Samra, M.	Lateral canal benign paroxysmal positional vertigo and decompression illness. [BibTeX]	2013	The American journal of emergency medicine Vol. 31(2), pp. 451.e1-451.e2	article	DOI
BibTeX: @article{Dan-Goor2013, author = {Dan-Goor, Eric and Dangoor, Joseph Yoav and Samra, Monica}, title = {Lateral canal benign paroxysmal positional vertigo and decompression illness.}, journal = {The American journal of emergency medicine}, year = {2013}, volume = {31}, issue = {2}, pages = {451.e1--451.e2}, doi = {https://doi.org/10.1016/j.ajem.2012.06.022}, keywords = {Adult; Benign Paroxysmal Positional Vertigo; Decompression Sickness, complications; Diving, injuries; Female; Humans; Vertigo, diagnosis, etiology}, pmid = {22944556} }
Asprella-Libonati, G.	Lateral canal BPPV with Pseudo-Spontaneous Nystagmus masquerading as vestibular neuritis in acute vertigo: a series of 273 cases. [Abstract] [BibTeX]	2014	Journal of vestibular research : equilibrium & orientation Vol. 24(5-6), pp. 343-349	article	DOI
Abstract: To investigate the incidence of Lateral Semicircular Canal BPPV (LSC BPPV) with Pseudo-Spontaneous Nystagmus in patients preliminarily diagnosed for vestibular neuritis in the Emergency Department (ED). Retrospective study of 273 patients with acute vertigo and persistent horizontal nystagmus in upright position (male 110, female 163, 14-93 years old) observed over four years. All the patients were checked for any nystagmus modification by performing the Head Pitch Test (HPT) in the upright position. The HPT modified the beating direction of the persistent horizontal nystagmus in 56 of the 273 examined patients. The positioning tests subsequently confirmed the diagnosis of LSC BPPV in all those 56 patients. There were 37 geotropic variants and 19 apogeotropic variants and all of them were successfully treated by performing liberatory manoeuvres in the course of the same session. Performing the HPT in the upright position helps to differentiate a direction fixed nystagmus from a direction changing one, and in so doing, to make the differential diagnosis between vestibular neuritis and LSC BPPV, achieving the goal of successfully treating LSC BPPV in the first session.
BibTeX: @article{Asprella-Libonati2014, author = {Asprella-Libonati, Giacinto}, title = {Lateral canal BPPV with Pseudo-Spontaneous Nystagmus masquerading as vestibular neuritis in acute vertigo: a series of 273 cases.}, journal = {Journal of vestibular research : equilibrium & orientation}, year = {2014}, volume = {24}, issue = {5-6}, pages = {343--349}, doi = {https://doi.org/10.3233/VES-140532}, keywords = {Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, complications, diagnosis, epidemiology; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, complications, diagnosis, epidemiology; Patient Positioning; Retrospective Studies; Vertigo, complications, diagnosis, epidemiology; Vestibular Neuronitis, complications, diagnosis, epidemiology; Young Adult; BPPV; Vestibular neuritis; positional nystagmus; pseudo-spontaneous nystagmus; spontaneous nystagmus}, pmid = {25564076} }
Nuti, D., Mandalà, M. and Salerni, L.	Lateral canal paroxysmal positional vertigo revisited. [Abstract] [BibTeX]	2009	Annals of the New York Academy of Sciences Vol. 1164, pp. 316-323	article	DOI
Abstract: The first reports of an involvement of the lateral canal (LC) in paroxysmal positional vertigo (PPV), were published in 1985, by Luciano Cipparrone et al., from Italy and Joseph McClure from Canada. The increasing interest of otolaryngologists and neurologists has led to a progressive advance in the knowledge of this labyrinthine disorder regarding its epidemiological, physiopathological, clinical, and therapeutic aspects. According to the most recent data, LC-benign PPV accounts for 17% of all PPV patients, regardless of gender and between the two labyrinths. The LC-PPV syndrome is characterized by intense positional vertigo and direction-changing geotropic horizontal nystagmus, both caused by rotation of the head in the supine position. Less frequently, it presents with apogeotropic nystagmus. In some patients nystagmus is also detectable in the sitting position, mimicking a spontaneous nystagmus. In most cases nystagmus is caused by displaced otoconia floating in the semicircular canal. The pathological side, which must be identified for successful treatment, is usually indicated by nystagmus intensity: the more intense positional nystagmus beats toward the affected ear. In a few cases, where there is no difference in nystgmus intensity, other indicators are necessary to determine the pathological side. Vestibular neuritis and posterior fossa lesions should be considered in the differential diagnosis. Treatment of LC-PPV relies on some physical maneuvers, the objective of which is to allow the otoconial debris to exit from the LC by centrifugal inertia and/or by gravitation.
BibTeX: @article{Nuti2009, author = {Nuti, Daniele and Mandalà, Marco and Salerni, Lorenzo}, title = {Lateral canal paroxysmal positional vertigo revisited.}, journal = {Annals of the New York Academy of Sciences}, year = {2009}, volume = {1164}, pages = {316--323}, doi = {https://doi.org/10.1111/j.1749-6632.2008.03720.x}, keywords = {Head Movements; Humans; Nystagmus, Pathologic; Vertigo, diagnosis, physiopathology}, pmid = {19645918} }
Asprella-Libonati, G.	Lateral semicircular canal benign paroxysmal positional vertigo diagnostic signs. [BibTeX]	2010	Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale Vol. 30(4), pp. 222	article
BibTeX: @article{Asprella-Libonati2010, author = {Asprella-Libonati, G}, title = {Lateral semicircular canal benign paroxysmal positional vertigo diagnostic signs.}, journal = {Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale}, year = {2010}, volume = {30}, issue = {4}, pages = {222}, keywords = {Benign Paroxysmal Positional Vertigo; Humans; Patient Positioning; Terminology as Topic; Vertigo, diagnosis}, pmid = {21253290} }
Kim, C.-H., Kim, Y.G., Shin, J.E., Yang, Y.S. and Im, D.	Lateralization of horizontal semicircular canal canalolithiasis and cupulopathy using bow and lean test and head-roll test. [Abstract] [BibTeX]	2016	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 273(10), pp. 3003-3009	article	DOI
Abstract: Accurate lateralization is important to improve treatment outcomes in horizontal semicircular canal (HSCC) benign paroxysmal positional vertigo (BPPV). To determine the involved side in HSCC-BPPV, the intensity of nystagmus has been compared in a head-roll test (HRT) and the direction of nystagmus was evaluated in a bow and lean test (BLT). The aim of this study is to compare the results of a BLT with those of a HRT for lateralization of HSCC-canalolithiasis and cupulopathy (heavy cupula and light cupula), and evaluate treatment outcomes in patients with HSCC-canalolithiasis. We conducted retrospective case reviews in 66 patients with HSCC-canalolithiasis and 63 patients with HSCC-cupulopathy. The affected side was identified as the direction of bowing nystagmus on BLT in 55 % (36 of 66) of patients with canalolithiasis, which was concordant with the HRT result in 67 % (24 of 36) of cases (concordant group). Lateralization was determined by comparison of nystagmus intensity during HRT in 30 patients who did not show bowing or leaning nystagmus. The remission rate after the first treatment was 71 % (17 of 24) in the concordant group and 45 % (5 of 11) in the discordant group. Both bowing and leaning nystagmus were observed in all patients with cupulopathy, and the side of the null plane was identified as the affected side. In conclusion, bowing and/or leaning nystagmus were observed in only 55 % of patients with HSCC-canalolithiasis, and the first treatment based on the result of BLT alone was effective in only 45 % of the patients in whom the BLT and HRT were discordant, which may suggest that the usefulness of BLT in lateralizing the HSCC-canalolithiasis may be limited.
BibTeX: @article{Kim2016, author = {Kim, Chang-Hee and Kim, Yong Gyu and Shin, Jung Eun and Yang, Young Soo and Im, Donghyuk}, title = {Lateralization of horizontal semicircular canal canalolithiasis and cupulopathy using bow and lean test and head-roll test.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2016}, volume = {273}, issue = {10}, pages = {3003--3009}, doi = {https://doi.org/10.1007/s00405-016-3894-8}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, diagnosis, physiopathology; Female; Head Movements, physiology; Humans; Male; Middle Aged; Nystagmus, Pathologic, diagnosis, etiology, physiopathology; Posture, physiology; Retrospective Studies; Semicircular Canals, physiopathology; Treatment Outcome; Young Adult; Benign paroxysmal positional vertigo; Bow and lean test; Canalolithiasis; Cupulopathy; Head-roll test; Horizontal semicircular canal}, pmid = {26758464} }
Kisilevsky, V., Bailie, N.A., Dutt, S.N. and Rutka, J.A.	Lessons learned from the surgical management of benign paroxysmal positional vertigo: the University Health Network experience with posterior semicircular canal occlusion surgery (1988-2006). [Abstract] [BibTeX]	2009	Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale Vol. 38(2), pp. 212-221	article
Abstract: To assess the long-term efficacy and safety of posterior semicircular canal (PSCC) occlusion for intractable and incapacitating benign paroxysmal positional vertigo (BPPV) and identify lessons that may be learned from our experience. Retrospective review. Tertiary referral centre. Clinical records and results of audiometric and vestibular testing were reviewed on a series of patients who underwent occlusion of the PSCC for intractable BPPV between 1988 and 2006. Postoperative neurotologic examination, audiometry, and vestibular testing were assessed. Thirty-two PSCC occlusion procedures were performed (24 females, 8 males; mean age 46 years). The average follow-up was 63 months. All patients had complete resolution of their PSCC positional vertigo, which has been maintained long term. Thirteen patients (40%) have experienced other forms of dizziness postoperatively (contralateral BPPV in four, continued Meniere disease attacks in three, ipsilateral lateral or superior canal BPPV in two, otolithic symptoms in two, continued oscillopsia in one, and subsequent cerebellar degeneration in one). Postoperative audiometry demonstrated an average reduction in pure-tone threshold of 6.1, 6.3, and 6.9 dB at 0.5 to 3, 4, and 8 kHz, respectively. Five patients had a mild to moderate reduction in caloric activity in the operated ear postoperatively. Two patients with Meniere disease had a significant postoperative caloric reduction. No patient had postoperative facial weakness. PSCC occlusion is a safe and highly effective treatment for intractable BPPV. However, other forms of vertigo may persist or arise subsequently in approximately 40% of cases. Patients with Meniere disease may be susceptible to increased caloric reduction postoperatively.
BibTeX: @article{Kisilevsky2009, author = {Kisilevsky, Vitaly and Bailie, Neil A and Dutt, Sunil N and Rutka, John A}, title = {Lessons learned from the surgical management of benign paroxysmal positional vertigo: the University Health Network experience with posterior semicircular canal occlusion surgery (1988-2006).}, journal = {Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale}, year = {2009}, volume = {38}, issue = {2}, pages = {212--221}, keywords = {Adult; Audiometry, Pure-Tone; Caloric Tests; Cerebellum, physiopathology; Electronystagmography; Facial Paralysis, etiology; Female; Hearing Loss, Sensorineural, diagnosis; Humans; Male; Meniere Disease, diagnosis, physiopathology, surgery; Middle Aged; Nerve Degeneration, physiopathology; Otologic Surgical Procedures, methods; Patient Satisfaction; Postoperative Complications; Retrospective Studies; Semicircular Canals, physiopathology, surgery; Severity of Illness Index; Vertigo, diagnosis, physiopathology, surgery; Vestibular Function Tests; Young Adult}, pmid = {19442371} }
Tirelli, G., Boscolo Nata, F., Gardenal, N., Ghirardo, G. and Tofanelli, M.	Liberatory vertigo: a new prognostic factor for repositioning maneuvers. [Abstract] [BibTeX]	2016	The American journal of emergency medicine Vol. 34(8), pp. 1548-1551	article	DOI
Abstract: This study suggests the new concept of liberatory vertigo to facilitate emergency department treatment of benign paroxysmal positional vertigo. The present prospective nonrandomized study enrolled 535 patients with typical forms of positional vertigo, who were treated following clinical practice guidelines. We observed the onset of liberatory vertigo during the maneuver as a prognostic factor, and we tested the correlation between that symptom and therapeutic effectiveness. A subjective evaluation of vertigo was made by way of a questionnaire. Data analysis was performed that made use of statistical software. Complete recovery occurred in 287 patients (76.5%) with posterior semicircular canal positional vertigo and in 67 patients (80%) with horizontal semicircular canal positional vertigo; liberatory vertigo occurred in 195 (67.9%) and 59 (88%) of those cases, respectively. Differences in terms of recovery probability resulted regardless of the canal involved. Positive predictive value ranged from 93% to 97%. In our sample, liberatory vertigo could predict the effectiveness of the maneuver regardless of the canal involved.
BibTeX: @article{Tirelli2016, author = {Tirelli, Giancarlo and Boscolo Nata, Francesca and Gardenal, Nicoletta and Ghirardo, Guido and Tofanelli, Margherita}, title = {Liberatory vertigo: a new prognostic factor for repositioning maneuvers.}, journal = {The American journal of emergency medicine}, year = {2016}, volume = {34}, issue = {8}, pages = {1548--1551}, doi = {https://doi.org/10.1016/j.ajem.2016.05.044}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis, therapy; Female; Humans; Male; Middle Aged; Non-Randomized Controlled Trials as Topic; Patient Positioning, methods; Posture; Prognosis; Prospective Studies}, pmid = {27241562} }
Monzani, D., Genovese, E., Rovatti, V., Malagoli, M.L., Rigatelli, M. and Guidetti, G.	Life events and benign paroxysmal positional vertigo: a case-controlled study. [Abstract] [BibTeX]	2006	Acta oto-laryngologica Vol. 126(9), pp. 987-992	article	DOI
Abstract: Within the poorly understood mechanisms implicated in the aetiology of benign paroxysmal positional vertigo (BPPV), the results of this trial provide clinical evidence of a potential role of emotional stress connected to adverse life events as a trigger of otoconial dysfunction. High levels of anxiety, depression and somatization were recorded and considered psychogenic precursors of BPPV, thus emphasizing the role of psychological distress in precipitating peripheral vestibular disorders. Therefore, appraisal of life stress and psychological attitudes may have potential implications in the clinical assessment of this labyrinthine vertigo and its frequent relapses. BPPV is one of the most common peripheral vestibular disorders, and although it has been the subject of several studies and debates, its aetiology still remains unknown in most cases. Because it has been shown that emotional stress is related to the onset or worsening of other inner ear dysfunctions such as Ménière's disease and sudden hearing loss, this study investigated the hypothesis that life events, mood and psychological attitudes may have a causal relationship with BPPV. Fifty patients (40 females and 10 men; mean age 43.5+/-10.1 years, range 30-65 years) were recruited and compared with 50 healthy volunteers matched for sex, age and socio-demographic variables. Patients were selected among dizzy patients who were referred to the ENT Clinic of the University of Modena and Reggio Emilia from the emergency unit with a primary diagnosis of 'positional vertigo' and enrolled in the study only if they had a paroxysmal positional nystagmus as diagnosed by Dix-Hallpike and Semont's manoeuvres. Patients with a history of recurrent vertigo and additional otoneurological diseases were excluded. The Paykel Life Events Scale, Spielberger State-Trait Anxiety Inventory, Symptom Check List-90 Revisited and Hamilton Depression Scale were the psychometric questionnaires used to complete the audiological and vestibular examinations. Patients with BPPV reported significantly more life events than control subjects in the year preceding the onset of vertigo (p<0.005). Negative life events, objective negative impact and a poor degree of control were also significantly more frequent in patients compared with controls (p<0.005). There were no significant differences between groups concerning positive life events (p>0.05). Psychometric questionnaires recorded significantly higher levels of anxiety, depression and somatization in the pathological sample (p<0.005), as well as an increased obsessive-compulsive attitude (p<0.05).
BibTeX: @article{Monzani2006, author = {Monzani, Daniele and Genovese, Elisabetta and Rovatti, Virginia and Malagoli, Maria Ludovica and Rigatelli, Marco and Guidetti, Giorgio}, title = {Life events and benign paroxysmal positional vertigo: a case-controlled study.}, journal = {Acta oto-laryngologica}, year = {2006}, volume = {126}, issue = {9}, pages = {987--992}, doi = {https://doi.org/10.1080/00016480500546383}, keywords = {Adult; Aged; Anxiety, psychology; Case-Control Studies; Compulsive Behavior, psychology; Depression, psychology; Female; Humans; Male; Middle Aged; Obsessive Behavior, psychology; Psychiatric Status Rating Scales; Psychophysiologic Disorders, psychology; Stress, Psychological, psychology; Surveys and Questionnaires; Vertigo, psychology}, pmid = {16864499} }
Imai, T., Matsuda, K., Takeda, N., Uno, A., Kitahara, T., Horii, A., Nishiike, S. and Inohara, H.	Light cupula: the pathophysiological basis of persistent geotropic positional nystagmus. [Abstract] [BibTeX]	2015	BMJ open Vol. 5(1), pp. e006607	article	DOI
Abstract: To clarify the pathophysiological basis of persistent geotropic positional nystagmus (PGN) in patients with the horizontal canal type of benign paroxysmal positional vertigo (H-BPPV), the time constant (TC) of nystagmus and the relationship between its slow phase eye velocity (SPV) and the angle of head rotation in supine were defined. Geotropic or apogeotropic positional nystagmus was recorded by video-oculography and analysed three-dimensionally. Geotropic positional nystagmuses in patients with H-BPPV were classified as transient geotropic positional nystagmus with a TC of ≤35 s or PGN with a TC of >35 s. Alternatively, the TC of persistent apogeotropic positional nystagmus (AN) in patients with H-BPPV was >35 s. The direction of the SPV of patients with PGN was opposite to that of patients with AN at each head position across the range of neutral head positions. The relationship between the SPV of patients with PGN and the angle of head rotation was linearly symmetrical against that of patients with AN with respect to a line drawn on the neutral head position. Since its TC was >35 s, it is suggested that PGN is induced by cupula deviation in response to gravity at each head position. It is also suggested that the direction of cupula deviation in patients with PGN is opposite to that of patients with AN across the neutral head positional range with no nystagmus where the long axis of cupula is in alignment with the axis of gravity. Since the pathophysiological basis of AN is considered a heavy cupula, it is suggested that PGN is conversely induced by a light cupula.
BibTeX: @article{Imai2015, author = {Imai, Takao and Matsuda, Kazunori and Takeda, Noriaki and Uno, Atsuhiko and Kitahara, Tadashi and Horii, Arata and Nishiike, Suetaka and Inohara, Hidenori}, title = {Light cupula: the pathophysiological basis of persistent geotropic positional nystagmus.}, journal = {BMJ open}, year = {2015}, volume = {5}, issue = {1}, pages = {e006607}, doi = {https://doi.org/10.1136/bmjopen-2014-006607}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, complications, physiopathology; Female; Head Movements; Humans; Male; Middle Aged; Nystagmus, Pathologic, complications, physiopathology; Nystagmus, Physiologic, physiology; Supine Position}, pmid = {25586370} }
Arthur, J.C., Kortte, K.B., Shelhamer, M. and Schubert, M.C.	Linear path integration deficits in patients with abnormal vestibular afference. [Abstract] [BibTeX]	2012	Seeing and perceiving Vol. 25(2), pp. 155-178	article	DOI
Abstract: Effective navigation requires the ability to keep track of one's location and maintain orientation during linear and angular displacements. Path integration is the process of updating the representation of body position by integrating internally-generated self-motion signals over time (e.g., walking in the dark). One major source of input to path integration is vestibular afference. We tested patients with reduced vestibular function (unilateral vestibular hypofunction, UVH), patients with aberrant vestibular function (benign paroxysmal positional vertigo, BPPV), and healthy participants (controls) on two linear path integration tasks: experimenter-guided walking and target-directed walking. The experimenter-guided walking task revealed a systematic underestimation of self-motion signals in UVH patients compared to the other groups. However, we did not find any difference in the distance walked between the UVH group and the control group for the target-directed walking task. Results from neuropsychological testing and clinical balance measures suggest that the errors in experimenter-guided walking were not attributable to cognitive and/or balance impairments. We conclude that impairment in linear path integration in UVH patients stem from deficits in self-motion perception. Importantly, our results also suggest that patients with a UVH deficit do not lose their ability to walk accurately without vision to a memorized target location.
BibTeX: @article{Arthur2012, author = {Arthur, Joeanna C and Kortte, Kathleen B and Shelhamer, Mark and Schubert, Michael C}, title = {Linear path integration deficits in patients with abnormal vestibular afference.}, journal = {Seeing and perceiving}, year = {2012}, volume = {25}, issue = {2}, pages = {155--178}, doi = {https://doi.org/10.1163/187847612X629928}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo; Female; Humans; Locomotion, physiology; Male; Middle Aged; Orientation, physiology; Psychomotor Performance; Reflex, Vestibulo-Ocular; Space Perception, physiology; Vertigo, physiopathology; Vestibular Diseases, physiopathology; Walking, physiology}, pmid = {22726251} }
Rashad, U.M.	Long-term follow up after Epley's manoeuvre in patients with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2009	The Journal of laryngology and otology Vol. 123(1), pp. 69-74	article	DOI
Abstract: To assess the long-term efficacy of Epley's manoeuvre performed to treat benign paroxysmal positional vertigo. Two hundred and sixty-nine patients suffering benign paroxysmal positional vertigo were offered Epley's manoeuvre. After five years, follow up was arranged. One hundred and three patients attended for follow up (58 women and 45 men; age range 19-65 years). As mentioned 269 patients were offered the EM and 103 of them were available for follow up. Prior to initial Epley's manoeuvre treatment, these patients' duration of benign paroxysmal positional vertigo had ranged from four to 96 weeks. Five years after treatment of benign paroxysmal positional vertigo with Epley's manoeuvre, 65 per cent of patients reported no further attacks. Kaplan-Meier testing showed that the time to recurrence was significantly longer in patients aged less than 40 years, those with a duration of attacks of less than three years prior to initial Epley's manoeuvre treatment, and those suffering less than six exacerbations prior to initial Epley's manoeuvre treatment. Gender had no effect on time to recurrence. Duration of illness before receiving Epley's manoeuvre was the only independent predictor of recurrence. Epley's manoeuvre remains an effective modality for treatment of benign paroxysmal positional vertigo. A patient age of less than 40 years and duration of attacks of less than three years are good prognostic factors. Exacerbation number and gender do not affect the probability of benign paroxysmal positional vertigo recurrence after five years; however, these factors do affect the duration of time free from the condition.
BibTeX: @article{Rashad2009, author = {Rashad, U M}, title = {Long-term follow up after Epley's manoeuvre in patients with benign paroxysmal positional vertigo.}, journal = {The Journal of laryngology and otology}, year = {2009}, volume = {123}, issue = {1}, pages = {69--74}, doi = {https://doi.org/10.1017/S0022215108002430}, keywords = {Adult; Age Factors; Aged; Female; Follow-Up Studies; Humans; Male; Middle Aged; Otolithic Membrane, pathology; Physical Therapy Modalities; Recurrence; Rotation; Semicircular Canals, pathology; Statistics as Topic; Time Factors; Treatment Outcome; Vertigo, therapy; Vestibule, Labyrinth; Young Adult}, pmid = {18492305} }
Kansu, L., Avci, S., Yilmaz, I. and Ozluoglu, L.N.	Long-term follow-up of patients with posterior canal benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2010	Acta oto-laryngologica Vol. 130(9), pp. 1009-1012	article	DOI
Abstract: Recurrence of posterior canal benign paroxysmal positional vertigo (PC-BPPV) developed in one-third of patients when followed for an average of 5 years from diagnosis. History of head trauma and Ménière's disease contributed significantly to recurrence (p < 0.05). History of head trauma as an etiologic cause was more frequent in patients with recurrence of PC-BPPV. To estimate recurrence in the long-term follow-up of patients with PC-BPPV after successful canalith repositioning maneuvers, and to determine which factors contribute to recurrence. The charts of 118 patients with PC-BPPV were reviewed. Data of patients were recorded from the initial evaluation and treatment. Follow-up was performed at mean of 64 +/- 7.7 months after the initial phase. The Dix-Hallpike maneuver was performed for diagnosis, and all patients were treated by the canalith repositioning maneuver, which was repeated every 3 days until the patients were symptom-free or results of the Dix-Hallpike maneuver were negative. At diagnosis, the most common etiology was idiopathic in 55 patients (46.6%). Recurrence occurred in 39 of 118 patients (33.1%). Recurrence occurred within the first 2 years in 21 of the 39 patients (53.8%). History of head trauma was a more frequent finding in patients who developed recurrence (12 of 39, 30.8%).
BibTeX: @article{Kansu2010, author = {Kansu, Leyla and Avci, Suat and Yilmaz, Ismail and Ozluoglu, Levent N}, title = {Long-term follow-up of patients with posterior canal benign paroxysmal positional vertigo.}, journal = {Acta oto-laryngologica}, year = {2010}, volume = {130}, issue = {9}, pages = {1009--1012}, doi = {https://doi.org/10.3109/00016481003629333}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Female; Follow-Up Studies; Humans; Male; Middle Aged; Recurrence; Retrospective Studies; Turkey, epidemiology; Vertigo, epidemiology, therapy; Young Adult}, pmid = {20297928} }
Lopez-Escamez, J.A., Gamiz, M.J., Fernandez-Perez, A. and Gomez-Fiñana, M.	Long-term outcome and health-related quality of life in benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2005	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 262(6), pp. 507-511	article	DOI
Abstract: A prospective cohort study was designed to evaluate the long-term outcome and health-related quality of life (HRQoL) in patients with posterior canal benign paroxysmal positional vertigo (PC-BPPV) treated by the particle repositioning maneuver (PRM) in the outpatient clinic of a general community hospital. Fifty individuals with PC-BPPV were included, and 45 (90%) completed the study. The diagnosis was based on the history of short episodes of vertigo and a positional nystagmus during the Dix-Hallpike test (DHT). All patients were treated by a single PRM, and relapses were evaluated by DHT at 30, 180 and 360 days post-treatment; a new PRM was performed if the DHT was positive. The main outcome measures were: percentage of patients with a negative DHT after treatment, scores obtained on the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and the Dizziness Handicap Inventory Short Form (DHI-S) before and 30, 180 and 360 days post-treatment. The DHT was found negative in 80% (40/50) of individuals at 30 days. Ten, seven and five patients presented a positive DHT at 30, 180 and 360 days, respectively. Persistent BPPV was observed in 5% (2/50) of patients at 360 days, despite repeated PRM. Relapses (DH+ after successful PRM) were observed in 7.5% (3/50) at 180 days and 360 days. Both questionnaires showed a reliability Cronbach's alpha >0.7. The average standardized score for each SF-36 scale was compared with the reference population normative data, showing differences with norms for all scales except for vitality. After PRM, patients improved their scores with both instruments, indicating a restoration of HRQoL at 30 days. Physical dimension scores of the SF-36 improved from day 30 to 360. DHI-S scores were statistically better after PRM (P < 0.001). Our results show that the effectiveness of PRM is 88% after 1 year of follow-up. Patients with BPPV experienced a decrease in HRQoL, which was restored after PRM. Although relapses were observed in 7.5% of individuals, they did not affect HRQoL.
BibTeX: @article{Lopez-Escamez2005a, author = {Lopez-Escamez, Jose A and Gamiz, Maria J and Fernandez-Perez, Antonio and Gomez-Fiñana, Manuel}, title = {Long-term outcome and health-related quality of life in benign paroxysmal positional vertigo.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2005}, volume = {262}, issue = {6}, pages = {507--511}, doi = {https://doi.org/10.1007/s00405-004-0841-x}, keywords = {Cohort Studies; Female; Follow-Up Studies; Humans; Male; Middle Aged; Posture; Prospective Studies; Quality of Life; Semicircular Canals, physiopathology; Severity of Illness Index; Surveys and Questionnaires; Treatment Outcome; Vertigo, psychology, therapy}, pmid = {15942805} }
Sakaida, M., Takeuchi, K., Ishinaga, H., Adachi, M. and Majima, Y.	Long-term outcome of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2003	Neurology Vol. 60(9), pp. 1532-1534	article
Abstract: To clarify long-term outcome of benign paroxysmal positional vertigo (BPPV), 50 patients were followed up for a mean of 52 months. Overall recurrence rate by Kaplan-Meier estimation was 37% at 60 months. The patients with horizontal canal BPPV (n = 19) had a significantly higher recurrence rate (50%) at 60 months than those with posterior canal BPPV (n = 28; 26%). There was no significant association between recurrence rates and sex or age.
BibTeX: @article{Sakaida2003, author = {Sakaida, M and Takeuchi, K and Ishinaga, H and Adachi, M and Majima, Y}, title = {Long-term outcome of benign paroxysmal positional vertigo.}, journal = {Neurology}, year = {2003}, volume = {60}, issue = {9}, pages = {1532--1534}, keywords = {Adult; Aged; Disease Progression; Female; Follow-Up Studies; Head Movements; Humans; Life Tables; Male; Middle Aged; Nystagmus, Pathologic, epidemiology, etiology, physiopathology, therapy; Physical Therapy Modalities; Prospective Studies; Recurrence; Semicircular Canals, physiopathology; Treatment Outcome; Vertigo, epidemiology, etiology, physiopathology, therapy}, pmid = {12743247} }
Giacomini, P.G., Alessandrini, M. and Magrini, A.	Long-term postural abnormalities in benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2002	ORL; journal for oto-rhino-laryngology and its related specialties Vol. 64(4), pp. 237-241	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is a disorder in which patients suffer from acute rotatory vertigo due to the presence of free otoconial debris migrating into one or more semicircular canals during head movements and resulting in abnormal stimulation of the ampullary crest. A prolonged loss of equilibrium of unclear origin is also present. Static posturography is a useful tool for the study of postural control systems and their role in these abnormalities. The aim of the present study was to evaluate the frequency of body sway and long-term instability of BPPV patients by posturography frequency analysis. Twenty patients with canalithiasis of the posterior semicircular canal and 20 normal controls were subjected to static posturography. Informed consent was obtained from all subjects. Patients were tested 1 h after diagnosis, and 3 days and 12 weeks after the characteristic Epley repositioning maneuver. Patients with BPPV showed significantly increased body sway both on lateral (X) and anteroposterior (Y) planes compared to normal subjects. Corporal oscillation with a broad-frequency spectrum was observed in both closed and open eye tests. The repositioning maneuver decreased the X plane body sway, while the anteroposterior sway was unchanged. Twelve weeks after treatment, a normalization of the anteroposterior sway was observed. Results of this study suggest that the long-term postural disturbance associated with BPPV differs from the acute disequilibrium that subsides after canalith repositioning: the former is a sagittal plane/broad spectrum body sway, while the latter is primarily a frontal plane/low frequency sway. The Epley maneuver was shown to reduce frontal sway, a postural abnormality that might therefore be linked to posterior semicircular canal function. Conversely, the observed sagittal body sway was only partially relieved by the restoration of canal function, and therefore, may be more related to the chronic dizziness observed in these patients.
BibTeX: @article{Giacomini2002, author = {Giacomini, Pier Giorgio and Alessandrini, Marco and Magrini, Antonio}, title = {Long-term postural abnormalities in benign paroxysmal positional vertigo.}, journal = {ORL; journal for oto-rhino-laryngology and its related specialties}, year = {2002}, volume = {64}, issue = {4}, pages = {237--241}, doi = {https://doi.org/10.1159/000064130}, keywords = {Adult; Case-Control Studies; Female; Humans; Male; Middle Aged; Nystagmus, Physiologic, physiology; Posture, physiology; Semicircular Canals, physiopathology; Signal Processing, Computer-Assisted; Vertigo, physiopathology}, pmid = {12232467} }
Walsh, R.M., Bath, A.P., Cullen, J.R. and Rutka, J.A.	Long-term results of posterior semicircular canal occlusion for intractable benign paroxysmal positional vertigo. [Abstract] [BibTeX]	1999	Clinical otolaryngology and allied sciences Vol. 24(4), pp. 316-323	article
Abstract: Benign paroxysmal positional vertigo (BPPV) is a common condition which is usually managed conservatively, surgical intervention being recommended only for those small number of patients in whom it becomes persistent and incapacitating. The results of surgery in 13 patients who underwent posterior semicircular canal occlusion for intractable (> 12 months duration) and incapacitating BPPV are presented with special emphasis on their long-term follow-up. The mean follow-up was 66 months (range, 29-119 months). All patients reported complete and immediate resolution of their positional vertigo, which has been maintained in the long term. Most patients, however, reported some postoperative transient unsteadiness which lasted up to 4 weeks. All patients developed a transient mild conductive hearing loss secondary to a middle ear collection, which usually resolved within 4 weeks. Five patients developed a transient mild high frequency sensorineural hearing loss which resolved in all cases within 6 months. There were no reports of sensorineural hearing loss nor tinnitus in the long term. All patients believed that the operation was beneficial and would undergo it again. Our findings indicate that posterior semicircular canal occlusion is an effective and safe operation in the long term and is the procedure of choice for intractable and incapacitating BPPV rather than singular neurectomy.
BibTeX: @article{Walsh1999, author = {Walsh, R M and Bath, A P and Cullen, J R and Rutka, J A}, title = {Long-term results of posterior semicircular canal occlusion for intractable benign paroxysmal positional vertigo.}, journal = {Clinical otolaryngology and allied sciences}, year = {1999}, volume = {24}, issue = {4}, pages = {316--323}, keywords = {Adult; Aged; Female; Follow-Up Studies; Hearing Loss, Sensorineural, etiology; Humans; Male; Middle Aged; Patient Satisfaction; Postoperative Complications; Semicircular Canals, surgery; Vertigo, surgery}, pmid = {10472467} }
Han, W., Fan, Z., Zhou, M., Guo, X., Yan, W., Lu, X., Li, L., Gu, C., Chen, C. and Wu, Y.	Low 25-hydroxyvitamin D levels in postmenopausal female patients with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2018	Acta oto-laryngologica Vol. 138(5), pp. 443-446	article	DOI
Abstract: Several studies have reported the association of benign paroxysmal positional vertigo (BPPV) with vitamin D deficiency. This study aimed to evaluate serum 25-hydroxy vitamin D (25 (OH) D) levels in native Chinese postmenopausal women with de novo idiopathic BPPV and to investigate the possible relationship between the occurrence of BPPV and low 25 (OH) D levels. This retrospective study comprised of 85 postmenopausal women with de novo idiopathic BPPV and 80 age-matched healthy controls. All subjects had bone mineral density (BMD) and serum 25 (OH) D levels measurements recorded, and the results were compared. The prevalence of reduced BMD (T score <-1.0) was significantly higher in female patients with BPPV than in healthy controls (71.8% vs. 51.2%, p = .004). The mean serum 25 (OH) D levels were also significantly lower in female patients with BPPV than in healthy controls (19.1 ± 5.2 vs. 22.5 ± 5.8, p < .001). The regression analyses demonstrated that vitamin D deficiency was associated with BPPV with an odds ratio of 2.1 (95% confidence interval = 1.1-3.1, p = .031). Our study suggests that low 25 (OH) D may be a risk factor for BPPV in postmenopausal women.
BibTeX: @article{Han2018, author = {Han, Weiwei and Fan, Zhenyi and Zhou, Min and Guo, Xu and Yan, Wang and Lu, Xiaoxiong and Li, Li and Gu, Chengyao and Chen, Caijing and Wu, Yunqin}, title = {Low 25-hydroxyvitamin D levels in postmenopausal female patients with benign paroxysmal positional vertigo.}, journal = {Acta oto-laryngologica}, year = {2018}, volume = {138}, issue = {5}, pages = {443--446}, doi = {https://doi.org/10.1080/00016489.2017.1416168}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, blood, etiology; Bone Density; Female; Humans; Logistic Models; Middle Aged; Postmenopause, blood; Retrospective Studies; Vitamin D, analogs & derivatives, blood; Vitamin D Deficiency, complications; 25-hydroxy vitamin D; Occurrence; benign paroxysmal positional vertigo; osteopenia; osteoporosis}, pmid = {29272984} }
Talaat, H.S., Abuhadied, G., Talaat, A.S. and Abdelaal, M.S.S.	Low bone mineral density and vitamin D deficiency in patients with benign positional paroxysmal vertigo. [Abstract] [BibTeX]	2015	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 272(9), pp. 2249-2253	article	DOI
Abstract: Several studies indicated the association between benign paroxysmal positional vertigo (BPPV) with osteoporosis and vitamin D deficiency implying that abnormal calcium metabolism may underlie BPPV. The aim of the present study is to confirm the correlation between BPPV and both decrease in bone mineral density (BMD) and vitamin D deficiency. The study group included 80 patients with idiopathic BPPV (52 females, 28 males), with age range 31-71 years (47.6 ± 9.1). The patients were divided into two groups; recurrent BPPV group including 36 subjects and non-recurrent group including 44 subjects. The control group included 100 healthy volunteers with age and gender distribution similar to the study group. All the subjects in the study were examined using Dual-energy X-ray absorptiometry to assess BMD, and serum 25-hydroxyvitamin D for vitamin D assessment. The accepted normal levels were T-score > -1, and 25-hydroxyvitamin D > 30 ng/ml. Twenty-six (26 %) subjects showed abnormal T-score in the control group; 26 (59 %) in the non-recurrent BPPV and 22 (61 %) in the recurrent BPPV group. Chi square test showed significant difference between the control group and both BPPV groups. The control group had significantly higher 25-hydroxyvitamin D levels than the BPPV subgroups (p < 0.05). Moreover, the 25-hydroxyvitamin D was significantly lower in the recurrent BPPV than it was in the non-recurrent subgroup (p < 0.05). The results of the current study associate between reduced BMD and development/recurrence of BPPV. Moreover, low levels of vitamin D were related to development of BPPV while very low levels were associated with recurrence of BPPV. The co-occurrence of two morbidities is not by itself supportive of a relationship, but the cumulating studies correlating between BPPV and both vitamin D deficiency and low BMD indicate the investigation and treatment of those disorders in cases with recurrent BPPV.
BibTeX: @article{Talaat2015, author = {Talaat, Hossam Sanyelbhaa and Abuhadied, Ghada and Talaat, Ahmed Sanyelbhaa and Abdelaal, Mohamed Samer S}, title = {Low bone mineral density and vitamin D deficiency in patients with benign positional paroxysmal vertigo.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2015}, volume = {272}, issue = {9}, pages = {2249--2253}, doi = {https://doi.org/10.1007/s00405-014-3175-3}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo, complications; Bone Diseases, Metabolic, complications; Case-Control Studies; Cohort Studies; Female; Humans; Male; Middle Aged; Recurrence; Vitamin D, analogs & derivatives, blood; Vitamin D Deficiency, complications}, pmid = {24973969} }
Oh, J.-H., Song, S.-K., Lee, J.S., Choi, J.C., Kang, S.-Y. and Kang, J.-H.	Lying-down nystagmus and head-bending nystagmus in horizontal semicircular canal benign paroxysmal positional vertigo: are they useful for lateralization? [Abstract] [BibTeX]	2014	BMC ophthalmology Vol. 14, pp. 136	article	DOI
Abstract: Lateralization of horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV) is very important for successful repositioning. The directions of lying-down nystagmus (LDN) and head-bending nystagmus (HBN) have been used as ancillary findings to identify the affected sites. This retrospective study was performed to evaluate the lateralizing values of LDN and HBN using clinical and laboratory findings for lateralizing probabilities in patients with HSC-BPPV. For 50 HSC-BPPV patients with asymmetric direction-changing horizontal nystagmus (DCHN) during the head-rolling test (HRT) using Frenzel goggles, the directions of LDN and HBN were evaluated and compared to those determined by video-oculography. Directional LDN was defined as the contralesional direction of nystagmus in geotropic types and the ipsilesional direction in apogeotropic types. Directional HBN was defined as the opposite direction relative to directional LDN. We also analyzed LDN and HBN in 14 patients with a history of ipsilesional peripheral vestibulopathy, caloric abnormality or conversion from other types of BPPV (such as probable localized HSC-BPPV, pro-BPPV). LDN and HBN were seen in 68% (34/50) and 76% (38/50) of patients, respectively. Of these, 19 (55.9%), and 28 (73.7%) patients showed directional LDN and HBN, respectively. The proportion of patients with directional LDN and HBN was much smaller among the pro-BPPV patients (4/12 for LDN, 3/10 for HBN). LDN and HBN did not seem to predict lateralization in patients with HSC-BPPV. To improve the prediction of lateralization of HSC-BPPV, it is necessary to modify the maneuvers used to elicit LDN or HBN, especially in cases of symmetric DCHN during HRT.
BibTeX: @article{Oh2014, author = {Oh, Jung-Hwan and Song, Sook-Keun and Lee, Jung Seok and Choi, Jay Chol and Kang, Sa-Yoon and Kang, Ji-Hoon}, title = {Lying-down nystagmus and head-bending nystagmus in horizontal semicircular canal benign paroxysmal positional vertigo: are they useful for lateralization?}, journal = {BMC ophthalmology}, year = {2014}, volume = {14}, pages = {136}, doi = {https://doi.org/10.1186/1471-2415-14-136}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, physiopathology; Caloric Tests; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, physiopathology; Nystagmus, Physiologic, physiology; Posture, physiology; Retrospective Studies; Semicircular Canals, physiopathology}, pmid = {25413310} }
Cha, W.W., Song, K., Yu, I.K., Choi, M.S., Chang, D.S., Cho, C.-S. and Lee, H.Y.	Magnetic resonance imaging predicts chronic dizziness after benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2017	American journal of otolaryngology Vol. 38(4), pp. 428-432	article	DOI
Abstract: We aimed to evaluate the clinical implications of magnetic resonance imaging (MRI) findings in patients with benign paroxysmal positional vertigo (BPPV). A total of 120 patients diagnosed with BPPV completed MRI at the emergency room between December 2012 and June 2015 and met our criteria for inclusion in this study. Epidemiologic characteristics, the results of audio-vestibular testing, and MRI findings were retrospectively analyzed. The most common findings were white matter hyperintensities (70.0%), sinusitis (34.2%), and brain atrophy (25.0%). There were no significant differences in MRI findings or epidemiologic characteristics according to BPPV subtype (p>0.05). A multiple regression analysis revealed that BPPV recurrence (odds ratio, 6.88; 95% confidence interval, 1.67-34.48; p=0.009) and brain atrophy (odds ratio, 4.39; 95% confidence interval, 1.11-21.28; p=0.036) were positively associated with dizziness lasting longer than 3months. Brain atrophy was independently associated with long-lasting dizziness after BPPV. Although the mechanism is unclear, brain atrophy may have relevance to otoneurotologic disease-related changes in brain structure.
BibTeX: @article{Cha2017, author = {Cha, Wang Woon and Song, Kudamo and Yu, In Kyu and Choi, Myoung Su and Chang, Dong Sik and Cho, Chin-Saeng and Lee, Ho Yun}, title = {Magnetic resonance imaging predicts chronic dizziness after benign paroxysmal positional vertigo.}, journal = {American journal of otolaryngology}, year = {2017}, volume = {38}, issue = {4}, pages = {428--432}, doi = {https://doi.org/10.1016/j.amjoto.2017.04.001}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo, complications, diagnostic imaging; Brain, diagnostic imaging, pathology; Chronic Disease; Dizziness, etiology; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Recurrence; Retrospective Studies; Risk Factors; Time Factors}, pmid = {28390809} }
De Stefano, A., Kulamarva, G. and Dispenza, F.	Malignant paroxysmal positional vertigo. [Abstract] [BibTeX]	2012	Auris, nasus, larynx Vol. 39(4), pp. 378-382	article	DOI
Abstract: An insidious percentage of paroxysmal positional vertigo appears to be intractable with canalith repositioning maneuver and also is not self-limiting. This type of positional vertigo is sustained by the action of intracranial tumors that mimics the clinical aspects of benign paroxysmal positional vertigo.Aim of this study is to clarify the features of these forms of positional vertigo, which we indicate as malignant paroxysmal positional vertigo. We retrospectively reviewed the clinical records of all the patients who presented with vertigo spells and were managed at our tertiary care referral centre over a three years period. Two hundred and eleven patients with diagnosis of positional paroxysmal vertigo were included in the final study. Seven patients were affected by intracranial tumors causing a positional vertigo and were classified as malignant paroxysmal positional vertigo patients after radiological and histological diagnosis. These patients were affected by an internal auditory canal mass alone or with extension in the cerebello pontine angle that mimicked a benign positional vertigo. We can conclude that the clinician should keep in mind the differentiation between benign positional vertigo and malignant positional vertigo. When the patients with positional vertigo presents a strange behaviour of symptoms, nystagmus or response to the canalith repositioning maneuver a radiological investigation must be undertaken in every doubtful case.
BibTeX: @article{DeStefano2012, author = {De Stefano, Alessandro and Kulamarva, Gautham and Dispenza, Francesco}, title = {Malignant paroxysmal positional vertigo.}, journal = {Auris, nasus, larynx}, year = {2012}, volume = {39}, issue = {4}, pages = {378--382}, doi = {https://doi.org/10.1016/j.anl.2011.07.008}, keywords = {Benign Paroxysmal Positional Vertigo; Brain Neoplasms, complications, diagnosis; Diagnosis, Differential; Humans; Meningeal Neoplasms, complications, diagnosis; Meningioma, complications, diagnosis; Neuroma, Acoustic, complications, diagnosis; Retrospective Studies; Vertigo, diagnosis, etiology}, pmid = {21880445} }
Deans, M.R., Peterson, J.M. and Wong, G.W.	Mammalian Otolin: a multimeric glycoprotein specific to the inner ear that interacts with otoconial matrix protein Otoconin-90 and Cerebellin-1. [Abstract] [BibTeX]	2010	PloS one Vol. 5(9), pp. e12765	article	DOI
Abstract: The mammalian otoconial membrane is a dense extracellular matrix containing bio-mineralized otoconia. This structure provides the mechanical stimulus necessary for hair cells of the vestibular maculae to respond to linear accelerations and gravity. In teleosts, Otolin is required for the proper anchoring of otolith crystals to the sensory maculae. Otoconia detachment and subsequent entrapment in the semicircular canals can result in benign paroxysmal positional vertigo (BPPV), a common form of vertigo for which the molecular basis is unknown. Several cDNAs encoding protein components of the mammalian otoconia and otoconial membrane have recently been identified, and mutations in these genes result in abnormal otoconia formation and balance deficits. Here we describe the cloning and characterization of mammalian Otolin, a protein constituent of otoconia and the otoconial membrane. Otolin is a secreted glycoprotein of ∼70 kDa, with a C-terminal globular domain that is homologous to the immune complement C1q, and contains extensive posttranslational modifications including hydroxylated prolines and glycosylated lysines. Like all C1q/TNF family members, Otolin multimerizes into higher order oligomeric complexes. The expression of otolin mRNA is restricted to the inner ear, and immunohistochemical analysis identified Otolin protein in support cells of the vestibular maculae and semi-circular canal cristae. Additionally, Otolin forms protein complexes with Cerebellin-1 and Otoconin-90, two protein constituents of the otoconia, when expressed in vitro. Otolin was also found in subsets of support cells and non-sensory cells of the cochlea, suggesting that Otolin is also a component of the tectorial membrane. Given the importance of Otolin in lower organisms, the molecular cloning and biochemical characterization of the mammalian Otolin protein may lead to a better understanding of otoconial development and vestibular dysfunction.
BibTeX: @article{Deans2010, author = {Deans, Michael R and Peterson, Jonathan M and Wong, G William}, title = {Mammalian Otolin: a multimeric glycoprotein specific to the inner ear that interacts with otoconial matrix protein Otoconin-90 and Cerebellin-1.}, journal = {PloS one}, year = {2010}, volume = {5}, issue = {9}, pages = {e12765}, doi = {https://doi.org/10.1371/journal.pone.0012765}, keywords = {Amino Acid Sequence; Animals; Cloning, Molecular; Ear, Inner, chemistry, metabolism; Extracellular Matrix Proteins, chemistry, genetics, metabolism; Gene Expression Regulation; HEK293 Cells; Humans; Mammals, genetics, metabolism; Mice, genetics, metabolism; Molecular Sequence Data; Nerve Tissue Proteins, genetics, metabolism; Oncorhynchus keta; Protein Binding; Protein Multimerization; Protein Precursors, genetics, metabolism; Sequence Alignment}, pmid = {20856818} }
Brandt, T.	Man in motion. Historical and clinical aspects of vestibular function. A review. [Abstract] [BibTeX]	1991	Brain : a journal of neurology Vol. 114 ( Pt 5), pp. 2159-2174	article
Abstract: This is a review of selected aspects of the history of the vestibular system (J. E. Purkyne, E. Mach, A. Crum-Brown) and of our current understanding of vestibular malfunction in clinical vertigo syndromes. Evidence is presented for a preliminary classification of central vestibular brainstem syndromes according to the three major planes of action of the vestibulo-ocular reflex (VOR): (1) disorders of the VOR in the horizontal (yaw) plane (horizontal nystagmus, pseudo 'vestibular neuritis'); (2) disorders of the VOR in the sagittal (pitch) plane (downbeat nystagmus; upbeat nystagmus); (3) disorders of the VOR in the frontal (roll) plane (ocular tilt reaction; lateropulsion). The pathophysiology of peripheral vestibular disorders is discussed: a specific gravity differential between the cupula fluid and the endolymph (buoyancy mechanism) causes vertigo in benign paroxysmal positioning vertigo and positional alcohol nystagmus. Vestibular neuritis is probably a partial unilateral vestibular paralysis due to viral infection of the superior division of the nerve trunk. The common post-traumatic vertigo is explained by otolith dysfunction secondary to dislodged otoconia resulting in unequal loads on the macula beds and a tonus imbalance between the two otoliths.
BibTeX: @article{Brandt1991, author = {Brandt, T}, title = {Man in motion. Historical and clinical aspects of vestibular function. A review.}, journal = {Brain : a journal of neurology}, year = {1991}, volume = {114 ( Pt 5)}, pages = {2159--2174}, keywords = {Brain Diseases, physiopathology; Humans; Motion Perception, physiology; Neuritis, physiopathology; Reflex, Vestibulo-Ocular; Syndrome; Vertigo, physiopathology; Vestibular Diseases, physiopathology; Vestibular Nerve, physiopathology; Vestibule, Labyrinth, physiology; Vision, Ocular}, pmid = {1933240} }
Song, C.I., Kang, B.C., Yoo, M.H., Chung, J.W., Yoon, T.H. and Park, H.J.	Management of 210 patients with benign paroxysmal positional vertigo: AMC protocol and outcomes. [Abstract] [BibTeX]	2015	Acta oto-laryngologica Vol. 135(5), pp. 422-428	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) could be treated with specific maneuvers for the involved canals. Management on a daily basis gave earlier relief than weekly treatment, especially in apogeotropic BPPV. Apogeotropic and multi-canal BPPVs were related to the increased numbers of follow-ups and trauma was related to the increased recurrence. We aimed to report the short-term outcomes of our protocol for BPPV and evaluate the factors influencing the results and recurrence. In 210 BPPV patients, posterior semicircular canal (PSCC), geotropic and apogeotropic lateral canal BPPVs were treated with the Epley maneuver, barbecue maneuver, and barbecue maneuver after head-shaking. The total number of follow-ups needed to have no provoked nystagmus, success rates at 1 week and 1 month, and factors for repeated maneuvers or recurrence were identified. Apogeotropic and multi-canal BPPV needed more follow-ups than PSCC BPPV. Multi-canal BPPV showed a significantly lower 1-week success rate than other types. Anterior and multi-canal BPPV showed significantly lower 1-month success rates than other types. The 1-week success rates for PSCC and geotropic and apogeotropic BPPV in patients followed up on a daily basis were higher than those in patients with weekly follow-up and the difference was significant only in apogeotropic BPPV. The overall 1-year recurrence rate was 16% and higher recurrence rate was related to trauma.
BibTeX: @article{Song2015, author = {Song, Chan Il and Kang, Byung Chul and Yoo, Myung Hoon and Chung, Jong Woo and Yoon, Tae Hyun and Park, Hong Ju}, title = {Management of 210 patients with benign paroxysmal positional vertigo: AMC protocol and outcomes.}, journal = {Acta oto-laryngologica}, year = {2015}, volume = {135}, issue = {5}, pages = {422--428}, doi = {https://doi.org/10.3109/00016489.2014.993089}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis, physiopathology, therapy; Follow-Up Studies; Head Movements, physiology; Humans; Otolithic Membrane, physiopathology; Physical Therapy Modalities; Recurrence; Republic of Korea; Retreatment; Retrospective Studies; Semicircular Canals, physiopathology; Epley maneuver; barbecue maneuver; head-shaking; semicircular canal}, pmid = {25678222} }
Diaz, D.S.	Management of athletes with postconcussion syndrome. [Abstract] [BibTeX]	2014	Seminars in speech and language Vol. 35(3), pp. 204-210	article	DOI
Abstract: Rehabilitation for athletes with postconcussion syndrome requires emphasis on both cognitive and physical rest with a gradual return to activity and sports. As the athlete becomes more active, the rehabilitation and sport professional should pay close attention to symptoms of concussion, like headache, dizziness, nausea, and difficulty concentrating. The Zurich Consensus Statement on Concussion in Sport provides a systematic approach to increasing the intensity of physical activity while attending to postconcussion symptoms. During the incident that led to a concussion, the injured athlete may have incurred injuries to the vestibular and balance system, which are not directly related to concussion. These conditions are best addressed by professionals with specific training in vestibular rehabilitation, most commonly physical therapists. Benign paroxysmal positional vertigo is a condition in which otoconia particles in the inner ear dislodge into the semicircular canals, resulting in severe vertigo and imbalance. This condition frequently resolves with a few sessions with a vestibular therapist and a home exercise program. In conditions like gaze instability, motion sensitivity, impaired postural control, and cervicogenic dizziness, improvement is more gradual and requires longer follow-up with a physical therapist. In all of these conditions, it is important to consider that the patient with postconcussion syndrome will likely recover more slowly than others and should be monitored for symptoms of postconcussion syndrome throughout intervention.
BibTeX: @article{Diaz2014, author = {Diaz, Deborah S}, title = {Management of athletes with postconcussion syndrome.}, journal = {Seminars in speech and language}, year = {2014}, volume = {35}, issue = {3}, pages = {204--210}, doi = {https://doi.org/10.1055/s-0034-1384682}, keywords = {Athletic Injuries, diagnosis, physiopathology, rehabilitation; Humans; Neuropsychological Tests; Post-Concussion Syndrome, diagnosis, physiopathology, rehabilitation}, pmid = {25116214} }
Riggio, F., Francesco, R., Dispenza, F., Francesco, D., Gallina, S., Salvatore, G., Kulamarva, G., Gautham, K., Gargano, R., Rosalia, G., Speciale, R. and Riccardo, S.	Management of benign paroxysmal positional vertigo of lateral semicircular canal by Gufoni's manoeuvre. [Abstract] [BibTeX]	2009	American journal of otolaryngology Vol. 30(2), pp. 106-111	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) of lateral semicircular canal (LSC) is one of the rarer forms of BPPV as compared to posterior semicircular canal BPPV. Various particle repositioning manoeuvres have been described in the literature as a mode of treating this condition. Evaluation and discussion of the procedure of the Gufoni's manoeuvre and its advantages in the treatment of BPPV of LSC. Prospective study of 58 patients affected by LSC BPPV who were office-treated with Gufoni's manoeuvre. Seventy-nine percent of the patients so treated had complete resolution of symptoms, and 6.9% did not show any improvement in their symptoms. The remaining 13.8% had a conversion into posterior semicircular canal BPPV during treatment and were successfully treated with Epley's or Semont's manoeuvre. Gufoni's manoeuvre is effective in treating patients suffering from BPPV of LSC; it is simple to perform; there are not many movements to execute, it needs low time of positioning, and positions are comfortable to the patient.
BibTeX: @article{Riggio2009, author = {Riggio, Francesco and Francesco, Riggio and Dispenza, Francesco and Francesco, Dispenza and Gallina, Salvatore and Salvatore, Gallina and Kulamarva, Gautham and Gautham, Kulamarva and Gargano, Rosalia and Rosalia, Gargano and Speciale, Riccardo and Riccardo, Speciale}, title = {Management of benign paroxysmal positional vertigo of lateral semicircular canal by Gufoni's manoeuvre.}, journal = {American journal of otolaryngology}, year = {2009}, volume = {30}, issue = {2}, pages = {106--111}, doi = {https://doi.org/10.1016/j.amjoto.2008.03.001}, keywords = {Adult; Aged; Aged, 80 and over; Ambulatory Care; Female; Follow-Up Studies; Humans; Male; Middle Aged; Musculoskeletal Manipulations, methods; Office Visits; Prospective Studies; Semicircular Canals; Treatment Outcome; Vertigo, diagnosis, etiology, therapy}, pmid = {19239952} }
Burmeister, D.B., Sacco, R. and Rupp, V.	Management of benign paroxysmal positional vertigo with the canalith repositioning maneuver in the emergency department setting. [Abstract] [BibTeX]	2010	The Journal of the American Osteopathic Association Vol. 110(10), pp. 602-604	article
Abstract: Vertigo is a common clinical manifestation in the emergency department (ED). It is important for physicians to determine if the peripheral cause of vertigo is benign paroxysmal positional vertigo (BPPV), a disorder accounting for 20% of all vertigo cases. However, the Dix-Hallpike test--the standard for BPPV diagnosis--is not common in the ED setting. If no central origin of the vertigo is determined, patients in the ED are typically treated with benzodiazepine, antihistamine, or anticholinergic agents. Studies have shown that these pharmaceutical treatment options may not be the best for patients with BPPV. The authors describe a case of a 38-year-old woman who presented to the ED with complaints of severe, sudden-onset vertigo. The patient's BPPV was diagnosed by means of a Dix-Hallpike test and the patient was acutely treated in the ED with physical therapy using the canalith repositioning maneuver.
BibTeX: @article{Burmeister2010, author = {Burmeister, David B and Sacco, Regina and Rupp, Valerie}, title = {Management of benign paroxysmal positional vertigo with the canalith repositioning maneuver in the emergency department setting.}, journal = {The Journal of the American Osteopathic Association}, year = {2010}, volume = {110}, issue = {10}, pages = {602--604}, keywords = {Adult; Benign Paroxysmal Positional Vertigo; Emergency Service, Hospital; Female; Humans; Manipulation, Osteopathic, methods; Physical Therapy Modalities; Vertigo, therapy}, pmid = {21068225} }
Kaur, J. and Shamanna, K.	Management of Benign Paroxysmal Positional Vertigo: A Comparative Study between Epleys Manouvre and Betahistine. [Abstract] [BibTeX]	2017	The international tinnitus journal Vol. 21(1), pp. 30-34	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder, accounting for 20% of all vertigo cases. Idiopathic BPPV is most common between the ages of 50 and 70, although the condition is found in all age groups. This study was conducted in our institute on 90 patients who presented to the outpatient department with history of vertigo and were diagnosed with BPPV via a positive Dix Hallpike test. Patients were randomnly placed in three groups of 30 each. Patients in Group A were treated with Epleys manoeuvre alone, in Group B were treated with Epleys Manouvre followed by oral Betahistine and patients in Group C were treated with Betahistine alone. All the patients were followed up after 1 week and 4 weeks following treatment. In our study we found that patients responded better when they were treated with Epleys Manouvre with Betahistine with less relapse and recurrence. Treatment with Epleys manouvre resulted in early improvement of symptoms. It was found in our study that Betahistine as a sole modality of treatment of vertigo in BPPV can be preferred in patients who are unfit to undergo canal repositioning manouvres.
BibTeX: @article{Kaur2017, author = {Kaur, Japneet and Shamanna, Karthik}, title = {Management of Benign Paroxysmal Positional Vertigo: A Comparative Study between Epleys Manouvre and Betahistine.}, journal = {The international tinnitus journal}, year = {2017}, volume = {21}, issue = {1}, pages = {30--34}, doi = {https://doi.org/10.5935/0946-5448.20170007}, keywords = {benign paroxysmal positional vertigo; betahistine; dizziness}, pmid = {28723599} }
Sacco, R.R., Burmeister, D.B., Rupp, V.A. and Greenberg, M.R.	Management of benign paroxysmal positional vertigo: a randomized controlled trial. [Abstract] [BibTeX]	2014	The Journal of emergency medicine Vol. 46(4), pp. 575-581	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is a common presenting problem. Our aim was to compare the efficacy of vestibular rehabilitation (maneuver) vs. conventional therapy (medications) in patients presenting to the emergency department (ED) with BPPV. This was a prospective, single-blinded physician, randomized pilot study comparing two groups of patients who presented to the ED with a diagnosis of BPPV at a Level 1 trauma center with an annual census of approximately 75,000. The first group received standard medications and the second group received a canalith repositioning maneuver. The Dizziness Handicap Inventory was used to measure symptom resolution. Twenty-six patients were randomized; 11 to the standard treatment arm and 15 to the interventional arm. Mean age ± standard deviation of subjects randomized to receive maneuver and medication were 59 ± 12.6 years and 64 ± 11.2 years, respectively. There was no significant difference in mean ages between the two treatment arms (p = 0.310). Two hours after treatment, the symptoms between the groups showed no difference in measures of nausea (p = 0.548) or dizziness (p = 0.659). Both groups reported a high level of satisfaction, measured on a 0-10 scale. Satisfaction in subjects randomized to receive maneuver and medication was 9 ± 1.5 and 9 ± 1.0, respectively; there was no significant difference in satisfaction between the two arms (p = 0.889). Length of stay during the ED visit did not differ between the treatment groups (p = 0.873). None of the patients returned to an ED for similar symptoms. This pilot study shows promise, and would suggest that there is no difference in symptomatic resolution, ED length of stay, or patient satisfaction between standard medical care and canalith repositioning maneuver. Physicians should consider the canalith repositioning maneuver as a treatment option.
BibTeX: @article{Sacco2014, author = {Sacco, Regina R and Burmeister, David B and Rupp, Valerie A and Greenberg, Marna Rayl}, title = {Management of benign paroxysmal positional vertigo: a randomized controlled trial.}, journal = {The Journal of emergency medicine}, year = {2014}, volume = {46}, issue = {4}, pages = {575--581}, doi = {https://doi.org/10.1016/j.jemermed.2013.08.116}, keywords = {Aged; Benign Paroxysmal Positional Vertigo, complications, therapy; Dizziness, etiology; Female; Head; Humans; Length of Stay; Male; Middle Aged; Nausea, etiology; Patient Positioning; Patient Satisfaction; Pilot Projects; Posture; Prospective Studies; Single-Blind Method; Torso; Trauma Centers; ED; benign paroxysmal positional vertigo; vestibular rehabilitation}, pmid = {24462034} }
	Management of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2009	Drug and therapeutics bulletin Vol. 47(6), pp. 62-66	article	DOI
Abstract: In vertigo, people experience an illusion of movement of the environment about them, or of themselves with respect to the environment. Vertigo usually originates in the peripheral nervous system (e.g. due to a disorder of the inner ear) but can, rarely, have a CNS origin (e.g. an intracranial tumour or brainstem lesion). It is commonly due to a peripheral disorder known as 'benign paroxysmal positional vertigo' (BPPV). Here we discuss BPPV and the management of patients with the condition, including diagnostic and therapeutic manoeuvres.
BibTeX: @article{2009,, title = {Management of benign paroxysmal positional vertigo.}, journal = {Drug and therapeutics bulletin}, year = {2009}, volume = {47}, issue = {6}, pages = {62--66}, doi = {https://doi.org/10.1136/dtb.2009.05.0020}, keywords = {Diagnosis, Differential; Exercise Therapy, methods; Humans; Physical Examination, methods; Treatment Outcome; Vertigo, diagnosis, therapy; Vestibular Function Tests, methods}, pmid = {19494342} }
Girardi, M. and Konrad, H.R.	Management of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	1996	ORL-head and neck nursing : official journal of the Society of Otorhinolaryngology and Head-Neck Nurses Vol. 14(2), pp. 25-30	article
Abstract: Benign paroxysmal positional vertigo (BPPV) is one of the most common balance disorders of the peripheral vestibular system. Diagnosis is made from patient history and the manifestation of specific symptoms. Treatment differs for the individual patient and may include pharmacological, surgical, dietary, and/or therapeutic modalities. Various versions of Modified Liberatory Maneuvers (MLM), and other, similar rehabilitation therapy treatments have been shown to be very effective in the management of the BPPV patient.
BibTeX: @article{Girardi1996, author = {Girardi, M and Konrad, H R}, title = {Management of benign paroxysmal positional vertigo.}, journal = {ORL-head and neck nursing : official journal of the Society of Otorhinolaryngology and Head-Neck Nurses}, year = {1996}, volume = {14}, issue = {2}, pages = {25--30}, keywords = {Diagnosis, Differential; Humans; Treatment Outcome; Vertigo, diagnosis, etiology, therapy}, pmid = {8788363} }
Kaplan, D.M., Nash, M., Niv, A. and Kraus, M.	Management of bilateral benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2005	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 133(5), pp. 769-773	article	DOI
Abstract: To describe a series of patients with bilateral benign paroxysmal positional vertigo (BiBPPV), with respect to demographics, management, and outcome. All patients who were identified and treated for BiBPPV in a previous 36-month period with a minimal follow-up period of 6 months were included. Patients were treated with Epley's maneuver (EM) on the side that was more symptomatic and that had a greater velocity and amplitude of tortional nystagmus. Patients were re-treated according to symptoms and findings on follow-up visits. Ten patients were identified with BiBPPV. Most patients complained of nonlocalized positional vertigo and unsteadiness. Four were males and 6 were females, and the mean age was 54 years. There was a positive history of recent head trauma in 4 of the patients. All patients recovered after performing a mean of 2.6 EMs during a 3-month period. One patient experienced unilateral recurrence and was re-treated successfully. BiBPPV has typical characteristics and can be managed successfully with EM, performed on the more symptomatic side, followed by repeated treatments as needed. C.
BibTeX: @article{Kaplan2005, author = {Kaplan, Daniel M and Nash, Michel and Niv, Alexander and Kraus, Mordechai}, title = {Management of bilateral benign paroxysmal positional vertigo.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2005}, volume = {133}, issue = {5}, pages = {769--773}, doi = {https://doi.org/10.1016/j.otohns.2005.07.017}, keywords = {Adult; Aged; Cohort Studies; Electronystagmography, methods; Female; Follow-Up Studies; Head Movements; Humans; Male; Middle Aged; Otolaryngology, methods; Patient Satisfaction; Retrospective Studies; Risk Assessment; Severity of Illness Index; Treatment Outcome; Vertigo, diagnosis, epidemiology, therapy; Vestibular Function Tests}, pmid = {16274807} }
Cvorovic, L., Ljiljana, C., Jovanovic, M.B., Markovic, M., Milutinovic, Z. and Strbac, M.	Management of complication from temporal bone fractures. [Abstract] [BibTeX]	2012	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 269(2), pp. 399-403	article	DOI
Abstract: The objective of the study is to review clinical findings and outcomes in patients with temporal bone fractures, and to show an incidence and management of complications. It is the retrospective clinical study and the study took place at tertiary referral center. Fifty-two patients with temporal bone fractures. Data were collected from patients' charts and clinical review. Patients were classified into five groups according to the CT scan. The primary endpoint of study was to show management of possible complication from temporal bone fractures and to analyze association with intracranial injuries. The second endpoint was to show incompleteness of traditionally classification of fracture type. Of the 52 patients with 54 fractures, 27 (50%) had longitudinal fractures, 4 (7.4%) had transverse fractures, 17 (31.5%) had temporal squama-mastoid fractures, 4 (7.4%) had mixed fractures and 2 (3.7%) had isolated meatal fracture. Fifty-eight percent of patients had at least one intracranial pathologic finding, of which 11% had two or more. Persistent conductive hearing loss was noted in 8 of 16 affected patients. The facial paralysis occurred in seven patients. One patient had benign paroxysmal positional vertigo developed 3 weeks after injury. In conclusion, rarely temporal bone fractures are isolated injures. The squama-mastoid fracture in most cases associated with intracranial injuries. Coordination between the neurosurgeon and otologist is essential in the care of such patients. Further large studies will be done to give a more complete classification of temporal bone fractures which will include all fracture patterns and predict clinical outcome.
BibTeX: @article{Cvorovic2012, author = {Cvorovic, Ljiljana and Ljiljana, Cvorovic and Jovanovic, Milan B and Markovic, Marko and Milutinovic, Zoran and Strbac, M}, title = {Management of complication from temporal bone fractures.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2012}, volume = {269}, issue = {2}, pages = {399--403}, doi = {https://doi.org/10.1007/s00405-011-1641-8}, keywords = {Audiometry; Brain Injuries, diagnosis, etiology, therapy; Cooperative Behavior; Electromyography; Electronystagmography; Facial Paralysis, diagnosis, etiology; Hearing Loss, Conductive, diagnosis, etiology; Humans; Interdisciplinary Communication; Mastoid, injuries; Patient Care Team; Prognosis; Retrospective Studies; Skull Fractures, complications, therapy; Temporal Bone, injuries; Tomography, X-Ray Computed; Vertigo, diagnosis, etiology}, pmid = {21607577} }
Hankey, G.J.	Management of the first-time transient ischaemic attack. [Abstract] [BibTeX]	2001	Emergency medicine (Fremantle, W.A.) Vol. 13(1), pp. 70-81	article
Abstract: The assessment and management of patients with a suspected transient ischaemic attack of the brain or eye is a daily task in busy emergency departments. They are common, affecting about 50 per 100,000 population each year. Conditions which mimic a transient ischaemic attack are even more common (e.g. migraine aura, partial seizures, benign paroxysmal positional vertigo, hysteria). This comprehensive review outlines an approach to the management of this complex and challenging problem.
BibTeX: @article{Hankey2001, author = {Hankey, G J}, title = {Management of the first-time transient ischaemic attack.}, journal = {Emergency medicine (Fremantle, W.A.)}, year = {2001}, volume = {13}, issue = {1}, pages = {70--81}, keywords = {Diagnosis, Differential; Embolism, Cholesterol, complications, prevention & control; Humans; Ischemic Attack, Transient, diagnosis, etiology, therapy; Medical History Taking; Physical Examination; Recurrence; Thromboembolism, complications, prevention & control}, pmid = {11476418} }
Bronstein, A.M. and Lempert, T.	Management of the patient with chronic dizziness. [Abstract] [BibTeX]	2010	Restorative neurology and neuroscience Vol. 28(1), pp. 83-90	article	DOI
Abstract: In this review we present a pragmatic approach to the patient with chronic vestibular symptoms. Even in the chronic patient a retrospective diagnosis should be attempted, in order to establish how the patient reached the current situation. Simple questions are likely to establish if the chronic dizzy symptoms started as benign paroxysmal positional vertigo (BPPV), vestibular neuritis, vestibular migraine, Meniere's disease or as a brainstem stroke. Then it is important to establish if the original symptoms are still present, in which case they need to be treated (e.g. repositioning maenouvres for BPPV, migraine prophylaxis) or if you are only dealing with chronic dizzy symptoms. In addition the doctor or physiotherapist needs to establish if the process of central vestibular compensation has been impeded due to additional clinical problems, e.g. visual problems (squints, cataract operation), proprioceptive deficit (neuropathy due to diabetes or alcohol), additional neurological or orthopaedic problems, lack of mobility or confidence, such as fear of falling or psychological disorders. A general neurological examination should also be conducted, amongst other reasons to make sure your patient's ;chronic dizziness' is not due to a neurological gait disorder. Treatment of the syndrome of chronic dizziness is multidisciplinary but rehabilitation and simple counselling should be available to all patients. In contrast, vestibular suppressants or tranquilisers should be reduced or, if possible, stopped.
BibTeX: @article{Bronstein2010, author = {Bronstein, A M and Lempert, Th}, title = {Management of the patient with chronic dizziness.}, journal = {Restorative neurology and neuroscience}, year = {2010}, volume = {28}, issue = {1}, pages = {83--90}, doi = {https://doi.org/10.3233/RNN-2010-0530}, keywords = {Brain Stem Infarctions, complications, diagnosis; Chronic Disease, rehabilitation, therapy; Diagnosis, Differential; Dizziness, diagnosis, etiology, therapy; Gait Disorders, Neurologic, complications, diagnosis; Humans; Meniere Disease, diagnosis; Migraine Disorders, diagnosis; Neurologic Examination, methods, standards; Somatosensory Disorders, complications, diagnosis; Vestibular Diseases, diagnosis, physiopathology, therapy}, pmid = {20086285} }
Teixeira, L.J. and Machado, J.N.P.	Maneuvers for the treatment of benign positional paroxysmal vertigo: a systematic review. [Abstract] [BibTeX]	2006	Brazilian journal of otorhinolaryngology Vol. 72(1), pp. 130-139	article
Abstract: Benign Paroxysmal Positional Vertigo (BPPV) is one of the most frequent diseases of the vestibular system and it is characterized by episodes of recurrent vertigo triggered by head movements or position changes. There are several approaches for treatment, but efficacy is still being discussed. To asses the effectiveness of the specific maneuvers available to the treatment of BPPV. An electronic search at the main databases, including MEDLINE, LILACS, PEDro, Cochrane Collaborations Database was performed, and we selected only randomized clinical trials studying adults with diagnosis of BPPV confirmed by the Dix-Hallpike test. The trials should have included physical maneuvers such as Epley and Semont. The main outcome was Dix-Hallpike negative test and the changes to subjective complaints. The trials were assessed using Jadad's scale and only studies with quality scores equal or above 3 were pooled on a meta-analyses to assess their effectiveness. We found five controlled clinical trials phase I comparing the Epley's maneuver with controls or placebo. The meta-analysis showed positive evidence of Epley's maneuver to the posterior semicircular canal (effect size = 0.11 [CI 95% 0.05, 0.26] of objective improvement [Dix-Halpike] within one week, 0.24 [CI 95% 0.13, 0.45] within one month and 0.16 [CI 95% 0.08, 0.33] of improvement reported by the patients within one week. There are no studies about the efficacy of Semont's maneuver. There is scientific evidence showing good efficacy of Epley's maneuver in the treatment.
BibTeX: @article{Teixeira2006, author = {Teixeira, Lázaro Juliano and Machado, João Natel Pollonio}, title = {Maneuvers for the treatment of benign positional paroxysmal vertigo: a systematic review.}, journal = {Brazilian journal of otorhinolaryngology}, year = {2006}, volume = {72}, issue = {1}, pages = {130--139}, keywords = {Humans; Kinesiology, Applied; Physical Therapy Modalities; Randomized Controlled Trials as Topic; Treatment Outcome; Vertigo, drug therapy, rehabilitation}, pmid = {16917565} }
Li, J.C.	Mastoid oscillation: a critical factor for success in canalith repositioning procedure. [Abstract] [BibTeX]	1995	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 112(6), pp. 670-675	article	DOI
Abstract: The canalith repositioning procedure has recently gained controversial recognition as a treatment for benign paroxysmal positional vertigo. Some authors contend that the canalith repositioning maneuver is no more effective than no treatment at all. Unfortunately, its technique has not been uniformly applied and its outcomes have not been uniformly assessed. I have found the use of mastoid oscillation to be critical in the success of this procedure. Another important factor is the time interval between diagnosis and relief of symptoms. Because it is well known that benign paroxysmal positional vertigo can spontaneously resolve after many months, the time frame for comparison should be short. A 1-week time interval was chosen for study purposes. Sixty patients were randomly assigned to three initial groups. The control group (n = 23) was not given any treatment. A second group (n = 27) was given treatment with the canalith repositioning maneuver with mastoid vibration. A third group (n = 10) was assigned to receive the canalith repositioning maneuver without mastoid vibration. Resolution was defined as no symptoms and negative Dix-Hallpike test results. The results showed that none of the control group's symptoms resolved completely in 1 week. Although 60% of those who received the canalith repositioning maneuver without mastoid vibration felt improved, none was free of nystagmus. An overwhelming 92% of those who received the canalith repositioning maneuver with mastoid vibration felt improved, and 70% were free of rotatory nystagmus after only one treatment. A review of all patients diagnosed with benign paroxysmal positional vertigo and treated with the canalith repositioning maneuver with mastoid vibration was also undertaken. In a series of 67 patients with a minimum of four weeks of follow-up, only two have not responded to the canalith repositioning maneuver, yielding a 97% rate of symptom control.
BibTeX: @article{Li1995, author = {Li, J C}, title = {Mastoid oscillation: a critical factor for success in canalith repositioning procedure.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {1995}, volume = {112}, issue = {6}, pages = {670--675}, doi = {https://doi.org/10.1016/S0194-59989570174-5}, keywords = {Humans; Mastoid; Nystagmus, Physiologic; Otolithic Membrane, physiopathology; Physical Therapy Modalities; Posture; Vertigo, therapy; Vibration, therapeutic use}, pmid = {7777350} }
Sanderson, J., Oman, C.M. and Harris, L.R.	Measurement of oscillopsia induced by vestibular Coriolis stimulation. [Abstract] [BibTeX]	2007	Journal of vestibular research : equilibrium & orientation Vol. 17(5-6), pp. 289-299	article
Abstract: We demonstrate a new method for measuring the time constant of head-movement-contingent oscillopsia (HMCO) produced by vestibular Coriolis stimulation. Subjects briskly rotated their heads around pitch or roll axes whilst seated on a platform rotating at constant velocity. This induced a cross-coupled vestibular Coriolis illusion. Simultaneous with the head movement, a visual display consisting of either a moving field of white dots on a black background or superimposed on a subject-stationary horizon, or a complete virtual room with conventional furnishings appeared. The scene's motion was driven by a simplified computer model of the Coriolis illusion. Subjects either nulled (if visual motion was against the illusory body rotation) or matched (if motion was in the same direction as the illusory motion) the sensation with the exponentially slowing scene motion, by indicating whether its decline was too fast or too slow. The model time constant was approximated using a staircase technique. Time constants comparable to that of the Coriolis vestibular ocular reflex were obtained. Time constants could be significantly reduced by adding subject-stationary visual elements. This technique for measuring oscillopsia might be used to quantify adaptation to artificial gravity environments. In principle more complex models can be used, and applied to other types of oscillopsia such as are experienced by BPPV patients or by astronauts returning to Earth.
BibTeX: @article{Sanderson2007, author = {Sanderson, Jeffrey and Oman, Charles M and Harris, Laurence R}, title = {Measurement of oscillopsia induced by vestibular Coriolis stimulation.}, journal = {Journal of vestibular research : equilibrium & orientation}, year = {2007}, volume = {17}, issue = {5-6}, pages = {289--299}, keywords = {Adaptation, Physiological; Adult; Coriolis Force; Female; Head Movements, physiology; Humans; Male; Motion Perception, physiology; Rotation; Space Motion Sickness, etiology; Vestibule, Labyrinth, physiology}, pmid = {18626139} }
Antonelli, P.J., Lundy, L.B., Kartush, J.M., Burgio, D.L. and Graham, M.D.	Mechanical versus CO2 laser occlusion of the posterior semicircular canal in humans. [Abstract] [BibTeX]	1996	The American journal of otology Vol. 17(3), pp. 416-420	article
Abstract: The purpose of this study was to compare the effectiveness of mechanical and laser-assisted posterior semicircular canal occlusion (PCO) for the treatment of intractable benign paroxysmal positional vertigo (BPPV). Twelve consecutive patients with intractable BPPV underwent PCO by three surgeons, six with mechanical PCO and six with CO2 laser-assisted PCO. PCO eliminated positional vertigo in all patients treated with the laser and five of six patients treated without the laser. Dysequilibrium was present in all patients immediately postoperatively. This resolved in all patients treated with the CO2 laser but in only two of six patients treated without the laser (p = 0.03). Patients were hospitalized for dysequilibrium for an average of 5.2 and 2.8 days for the mechanical and laser-assisted groups, respectively. Preoperative and postoperative hearing was not significantly different between the groups. No clinically significant postoperative hearing loss was encountered in either group. These results suggest that PCO is an effective treatment for intractable BPPV. The incidence of dysequilibrium that persists following PCO may be reduced by using the CO2 laser to seal the membranous canal prior to occluding the bony canal.
BibTeX: @article{Antonelli1996, author = {Antonelli, P J and Lundy, L B and Kartush, J M and Burgio, D L and Graham, M D}, title = {Mechanical versus CO2 laser occlusion of the posterior semicircular canal in humans.}, journal = {The American journal of otology}, year = {1996}, volume = {17}, issue = {3}, pages = {416--420}, keywords = {Adult; Aged; Carbon Dioxide; Female; Humans; Laser Therapy; Male; Middle Aged; Retrospective Studies; Semicircular Canals, physiopathology, surgery}, pmid = {8817019} }
Honrubia, V. and House, M.G.	Mechanism of posterior semicircular canal stimulation in patients with benign paroxysmal positional vertigo. [BibTeX]	2001	Annals of the New York Academy of Sciences Vol. 942, pp. 469	article
BibTeX: @article{Honrubia2001, author = {Honrubia, V and House, M G}, title = {Mechanism of posterior semicircular canal stimulation in patients with benign paroxysmal positional vertigo.}, journal = {Annals of the New York Academy of Sciences}, year = {2001}, volume = {942}, pages = {469}, keywords = {Eye Movements; Head Movements; Humans; Reference Values; Reflex, Vestibulo-Ocular; Semicircular Canals, physiology; Vertigo, physiopathology}, pmid = {11710488} }
Honrubia, V. and House, M.	Mechanism of posterior semicircular canal stimulation in patients with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2001	Acta oto-laryngologica Vol. 121(2), pp. 234-240	article
Abstract: A quantitative study of the stimuli and vestibulo-ocular response associated with benign paroxysmal positional vertigo (BPPV) was made to test and further develop the canalithiasis theory of BPPV. The angular velocities of the head in the planes of the semicircular canals during the Dix-Hallpike test were measured in four healthy subjects using electromagnetic sensors to record the position of the head in a six degrees of freedom paradigm. Next, the nystagmus reactions in seven patients diagnosed with idiopathic BPPV were recorded with video-oculography. The characteristics of the vestibulo-ocular reflex (VOR) response were analyzed using three-dimensional vector techniques. The angular velocity of the head was primarily, but not exclusively, in the plane of the posterior semicircular canal (PSC) in question. Both the anterior and horizontal canals were also stimulated by a lesser degree. The duration of the motion stimulus in the PSC was < 1.3 s with peak angular velocities of 150 deg/s. The eye response in BPPV patients began 4 s after the test and had a duration of 15-20 s. Peak slow-component eye velocities of about 42 deg/s were reached 3-5 s after onset of nystagmus. The motion of the eye, as predicted by the cupulolithiasis theory, is disconjugated and has torsional, vertical, and horizontal components. In the eye ipsilateral to the tested ear it is primarily torsional (0.80, 0.54, 0.16) and in the contralateral eye it is mainly vertical (0.57, 0.73, 0.08). These results suggest that particles, initially resting on the floor of the cupula dome in the PSC, are perturbed by the Dix-Hallpike test and disperse freely into the endolymph where they are propelled by gravity into the canal lumen. This creates abnormal pressure on the cupula and the specific VOR activation of the ipsilateral superior oblique and the contralateral inferior rectus muscles, whose force vectors are indistinguishable from the measured eye motion vectors. The estimated pressure exerted on the crista is approximately 10(-2) dyn/cm2.
BibTeX: @article{Honrubia2001a, author = {Honrubia, V and House, M}, title = {Mechanism of posterior semicircular canal stimulation in patients with benign paroxysmal positional vertigo.}, journal = {Acta oto-laryngologica}, year = {2001}, volume = {121}, issue = {2}, pages = {234--240}, keywords = {Adult; Calcinosis, physiopathology; Electronystagmography; Female; Functional Laterality, physiology; Head Movements, physiology; Humans; Male; Meniere Disease, physiopathology; Oculomotor Muscles, physiopathology; Orientation, physiology; Reference Values; Reflex, Vestibulo-Ocular, physiology; Semicircular Canals, physiopathology; Vestibular Function Tests; Vestibular Nerve, physiopathology}, pmid = {11349786} }
Yang, L., Xu, Y., Zhang, Y., Vijayakumar, S., Jones, S.M. and Lundberg, Y.Y.W.	Mechanism Underlying the Effects of Estrogen Deficiency on Otoconia. [Abstract] [BibTeX]	2018	Journal of the Association for Research in Otolaryngology : JARO Vol. 19(4), pp. 353-362	article	DOI
Abstract: Otoconia-related vertigo and balance deficits, particularly benign paroxysmal positional vertigo (BPPV), are common. Our recent studies in humans show that, while BPPV prevalence greatly increases with age in both genders, peri-menopausal women are especially susceptible. In the present study, we show that bilateral ovariectomized (OVX) mice have significant balance behavioral deficits, and that estrogen deficiency compromises otoconia maintenance and anchoring by reducing the expression of otoconial component and anchoring proteins. There is ectopic debris formation in the ampulla under estrogen deficiency due to aberrant matrix protein expression. Furthermore, phytoestrogen is effective in rescuing the otoconia abnormalities. By comparing the expression levels of known estrogen receptor (Esr) subtypes, and by examining the otoconia phenotypes of null mice for selected receptors, we postulate that Esr2 may be critical in mediating the effects of estrogen in otoconia maintenance.
BibTeX: @article{Yang2018, author = {Yang, Liping and Xu, Yinfang and Zhang, Yan and Vijayakumar, Sarath and Jones, Sherri M and Lundberg, Yunxia Yesha Wang}, title = {Mechanism Underlying the Effects of Estrogen Deficiency on Otoconia.}, journal = {Journal of the Association for Research in Otolaryngology : JARO}, year = {2018}, volume = {19}, issue = {4}, pages = {353--362}, doi = {https://doi.org/10.1007/s10162-018-0666-8}, keywords = {BPPV; estrogen deficiency; estrogen receptor; menopause; otoconia; phytoestrogen}, pmid = {29687165} }
Meurer, W.J., Low, P.A. and Staab, J.P.	Medical and Psychiatric Causes of Episodic Vestibular Symptoms. [Abstract] [BibTeX]	2015	Neurologic clinics Vol. 33(3), pp. 643-59, ix	article	DOI
Abstract: Dizziness and vertigo are among the most common presenting patient complaints in ambulatory settings. Specific vestibular causes are often not immediately identifiable. The first task of the clinician is to attempt to rule in specific vestibular disorders, such as benign paroxysmal positional vertigo through physical examination, diagnostic testing, and history taking. A large proportion of patients with dizziness and vertigo will not be easily classified or confirmed as having a specific vestibular cause. As with any undifferentiated patient, the focus in this setting is to attempt to exclude serious or threatening causes.
BibTeX: @article{Meurer2015, author = {Meurer, William J and Low, Phillip A and Staab, Jeffrey P}, title = {Medical and Psychiatric Causes of Episodic Vestibular Symptoms.}, journal = {Neurologic clinics}, year = {2015}, volume = {33}, issue = {3}, pages = {643--59, ix}, doi = {https://doi.org/10.1016/j.ncl.2015.04.007}, keywords = {Aged; Dizziness, diagnosis, etiology; Female; Humans; Male; Vertigo, diagnosis, etiology; Vestibular Diseases, diagnosis, etiology; Dizziness; Episodic vestibular symptoms; Medication adverse effects; Orthostasis; Panic disorders; Syncope; Vertigo}, pmid = {26231277} }
Hamid, M.	Medical management of common peripheral vestibular diseases. [Abstract] [BibTeX]	2010	Current opinion in otolaryngology & head and neck surgery Vol. 18(5), pp. 407-412	article	DOI
Abstract: Review of office-based medical management options for common vestibular diseases. Basic science studies have defined the ionic homeostasis of the inner ear stria vascularis as a central principle in the understanding of inner ear disorders. New molecular channels for water homeostasis have been identified in the inner ear structures. Office-based history, neurotological physical examination and judicial use of audiovestibular testing have increased our ability to manage vestibular patients more cost-effectively. Clinical studies supported the use of gentamicin and steroids intratympanic perfusion of the inner ear to augment traditional treatments of common vestibular disorders. The molecular biology and ionic transport between the stria vascularis and endolymph provided further understanding to the pathology and treatment of inner ear disorders. The history, physical examination and judicial use of laboratory tests are very critical and cost-effective in managing patients with vestibular diseases. Treatments such as inner ear perfusion with gentamicin and steroids have helped control and stabilize vertigo and hearing loss in Meniere's disease. Canalith repositioning treatments and home-based vestibular rehabilitation have improved our abilities to effectively manage patients with benign paroxysmal positional vertigo, uncompensated peripheral vestibular loss and multisensory deficit and age-related balance disorders.
BibTeX: @article{Hamid2010, author = {Hamid, Mohamed}, title = {Medical management of common peripheral vestibular diseases.}, journal = {Current opinion in otolaryngology & head and neck surgery}, year = {2010}, volume = {18}, issue = {5}, pages = {407--412}, doi = {https://doi.org/10.1097/MOO.0b013e32833e587a}, keywords = {Humans; Meniere Disease, diagnosis, physiopathology, therapy; Vertigo, diagnosis, physiopathology, therapy; Vestibular Diseases, diagnosis, physiopathology, therapy; Vestibular Neuronitis, diagnosis, physiopathology, therapy}, pmid = {20827085} }
Ehrhardt, D. and Eggenberger, E.	Medical treatment of acquired nystagmus. [Abstract] [BibTeX]	2012	Current opinion in ophthalmology Vol. 23(6), pp. 510-516	article	DOI
Abstract: This article synthesises recent findings and addresses relevant anatomy, pathophysiologic considerations, and current treatment options for common forms of acquired nystagmus including vestibular and gaze holding dysfunction. Some forms of nystagmus have relatively specific treatments, such as baclofen for periodic alternating nystagmus, and repositioning for benign paroxysmal positional vertigo. Recent studies have brought changes to many of the treatments of nystagmus variants. Additionally, other recent advances in nystagmus treatment, like the usage of 4-aminopyridine, have added potent medications to the physician's armamentarium. Nystagmus is a commonly encountered entity in clinical practice. However, evidence supported treatments are scarce. Medical treatment of nystagmus is difficult, with often limited and variable response to pharmacologic therapies. This mandates a continued re-evaluation of patients and creation of an individualized approach to this common clinical problem.
BibTeX: @article{Ehrhardt2012, author = {Ehrhardt, David and Eggenberger, Eric}, title = {Medical treatment of acquired nystagmus.}, journal = {Current opinion in ophthalmology}, year = {2012}, volume = {23}, issue = {6}, pages = {510--516}, doi = {https://doi.org/10.1097/ICU.0b013e328358ba6e}, keywords = {4-Aminopyridine, therapeutic use; Baclofen, therapeutic use; GABA-B Receptor Agonists, therapeutic use; Humans; Nystagmus, Pathologic, drug therapy, physiopathology; Potassium Channel Blockers, therapeutic use}, pmid = {23014266} }
Golding, J.F. and Patel, M.	Meniere's, migraine, and motion sickness. [Abstract] [BibTeX]	2017	Acta oto-laryngologica Vol. 137(5), pp. 495-502	article	DOI
Abstract: Elevated Motion Sickness Susceptibility (MSS) in Meniere?s disease (MD) is likely to be a consequence of the onset of MD and not migraine per se. Pathologies of the vestibular system influence MSS. Bilateral vestibular deficits lower MSS, vestibular neuritis or benign paroxysmal positional vertigo have little overall effect, whereas vestibular migraine elevates MSS. However, less is known about MSS in MD, a condition in which many patients experience vestibular loss and migraine symptoms. The authors conducted an online survey that posed diagnostic and disease questions before addressing frequency of headaches, migraines, visual display dizziness (VDD), syncope, social life, and work impact of dizziness (SWID4) and motion sickness susceptibility (MSSQ). The two groups were: diagnosed MD individuals with hearing loss (n = 751) and non-MD individuals in the control group (n = 400). The MD group showed significantly elevated MSS, more headache and migraine, increased VDD, higher SWID4 scores, and increased syncope. MSS was higher in MD than controls only after the development of MD, but not before, nor in childhood. Although elevated in MD compared with controls, MSS was lower than migraine patients from past data. Multivariate analysis revealed VDD, SWID4, and MSS in adulthood as the strongest predictors of MD, but not headache nor migraine.
BibTeX: @article{Golding2017, author = {Golding, John F and Patel, Mitesh}, title = {Meniere's, migraine, and motion sickness.}, journal = {Acta oto-laryngologica}, year = {2017}, volume = {137}, issue = {5}, pages = {495--502}, doi = {https://doi.org/10.1080/00016489.2016.1255775}, keywords = {Adult; Case-Control Studies; Female; Humans; Male; Meniere Disease, complications, epidemiology; Middle Aged; Migraine Disorders, complications; Motion Sickness, etiology; Surveys and Questionnaires; United Kingdom, epidemiology; Meniere’s disease; Motion sickness; headache; migraine; vestibular}, pmid = {27918236} }
De Stefano, A., Dispenza, F., Di Trapani, G. and Kulamarva, G.	Meningioma of the cerebellopontine angle mimicking benign paroxysmal positional vertigo. [BibTeX]	2008	Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale Vol. 37(2), pp. E46-E48	article
BibTeX: @article{DeStefano2008, author = {De Stefano, Alessandro and Dispenza, Francesco and Di Trapani, Giuseppe and Kulamarva, Gautham}, title = {Meningioma of the cerebellopontine angle mimicking benign paroxysmal positional vertigo.}, journal = {Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale}, year = {2008}, volume = {37}, issue = {2}, pages = {E46--E48}, keywords = {Cerebellopontine Angle; Contrast Media, administration & dosage; Diagnosis, Differential; Gadolinium; Humans; Magnetic Resonance Imaging; Male; Meningeal Neoplasms, diagnosis, surgery; Meningioma, diagnosis, surgery; Middle Aged; Vertigo, etiology}, pmid = {19137657} }
Ogun, O.A., Büki, B., Cohn, E.S., Janky, K.L. and Lundberg, Y.W.	Menopause and benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2014	Menopause (New York, N.Y.) Vol. 21(8), pp. 886-889	article	DOI
Abstract: This study was designed to examine the age and sex distribution and the effects of menopause in a large cohort of participants diagnosed with benign paroxysmal positional vertigo (BPPV). We analyzed 1,377 BPPV patients and surveyed 935 women from this group-all diagnosed at the Boys Town National Research Hospital in the last decade. A detailed age and sex distribution analysis of BPPV onset showed that aging had a profound impact on BPPV occurrence in both sexes, and that perimenopausal women were especially susceptible to BPPV (3.2:1 female-to-male ratio). The latter is a novel finding and was confirmed by a direct survey of female BPPV patients (168 participated). In addition, there was a pronounced female preponderance (6.8:1 female-to-male ratio) in BPPV in the teenage group despite its low prevalence in this age group. Data suggest that hormonal fluctuations (especially during menopause) may increase the tendency to develop BPPV.
BibTeX: @article{Ogun2014a, author = {Ogun, Oluwaseye Ayoola and Büki, Bela and Cohn, Edward S and Janky, Kristen L and Lundberg, Yunxia Wang}, title = {Menopause and benign paroxysmal positional vertigo.}, journal = {Menopause (New York, N.Y.)}, year = {2014}, volume = {21}, issue = {8}, pages = {886--889}, doi = {https://doi.org/10.1097/GME.0000000000000190}, keywords = {Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, complications, epidemiology; Child; Child, Preschool; Cohort Studies; Female; Humans; Infant; Male; Menopause; Middle Aged; Nebraska, epidemiology; Sex Factors}, pmid = {24496089} }
Di Fabio, R.P.	Meta-analysis of the sensitivity and specificity of platform posturography. [Abstract] [BibTeX]	1996	Archives of otolaryngology--head & neck surgery Vol. 122(2), pp. 150-156	article
Abstract: To compare the sensitivity and specificity of platform posturography with other vestibular tests for patients with peripheral vestibular deficits (PVD), Meniere's disease, benign paroxysmal positional vertigo (BPPV), and central nervous system-vestibular impairment (CNS). A computed search was conducted using the Index Medicus database (1966-1994) and Current Contents Science Editions. Studies were selected for analysis if the article addressed the sensitivity and/or specificity of platform posturography, compared posturography with another objective test of vestibular function, identified the basis for abnormal test results, and reported the data with sufficient detail to calculate an effect size from a 2 x 2 contingency table. A count of the normal and abnormal test results for posturography and the criterion standard were retrieved from each article, analyzed using a chi 2 statistic, and converted to an effect size. A positive effect size indicated that posturography identified abnormalities in patients who had normal tests on the criterion standard. Sensitivity and specificity of posturography were about 50%. The overall effect size was small (0.13) but positive. The diagnostic category had a significant influence on the predictive value of abnormal results (73% for Meniere's disease and BPPV, compared with 41% for PVD, and 44% for mixed CNS and PVD (F2,12 = 5.26, P = .02) and on the magnitude of the effect size (0.41 for mixed CNS and PVD compared with 0.22 for Meniere's disease and BPPV, and -0.10 for PVD (F2,12 = 13.95, P = .001). Platform posturography provides a measurable supplement to the standard vestibular examination. The enhancement was most notable when the target population included patients with CNS deficits.
BibTeX: @article{DiFabio1996, author = {Di Fabio, R P}, title = {Meta-analysis of the sensitivity and specificity of platform posturography.}, journal = {Archives of otolaryngology--head & neck surgery}, year = {1996}, volume = {122}, issue = {2}, pages = {150--156}, keywords = {Abstracting and Indexing as Topic; Analysis of Variance; Effect Modifier, Epidemiologic; Humans; Postural Balance; Posture; Reproducibility of Results; Research Design; Sensitivity and Specificity; Vestibular Diseases, diagnosis, physiopathology; Vestibular Function Tests, methods, standards}, pmid = {8630208} }
Teixido, M., Baker, A. and Isildak, H.	Migraine and benign paroxysmal positional vertigo: a single-institution review. [Abstract] [BibTeX]	2017	The Journal of laryngology and otology Vol. 131(6), pp. 508-513	article	DOI
Abstract: Benign paroxysmal positional vertigo and migraine-associated dizziness are common. The prevalence of benign paroxysmal positional vertigo seems to be higher in patients with migraine-associated dizziness than in those without migraine. A database of 508 patients seen at the primary author's balance clinic was analysed to determine the prevalence of migraine, as defined by International Headache Society criteria, in patients with benign paroxysmal positional vertigo. The percentage of patients with dizziness or vertigo who met criteria for migraine was 33.7 per cent, with a prevalence of benign paroxysmal positional vertigo of 42.3 per cent. When excluding patients with migrainous vertigo, patients with migraine frequently had benign paroxysmal positional vertigo (66.7 per cent vs 55.8 per cent), although this finding was not statistically significant. The results for the entire sample suggest that, after excluding patients with migrainous vertigo, patients with migraine seem more likely to have benign paroxysmal positional vertigo; however, this association was not significant, probably because of the small sample size.
BibTeX: @article{Teixido2017, author = {Teixido, M and Baker, A and Isildak, H}, title = {Migraine and benign paroxysmal positional vertigo: a single-institution review.}, journal = {The Journal of laryngology and otology}, year = {2017}, volume = {131}, issue = {6}, pages = {508--513}, doi = {https://doi.org/10.1017/S0022215117000536}, keywords = {Adult; Aged; Analysis of Variance; Benign Paroxysmal Positional Vertigo, epidemiology, etiology; Chi-Square Distribution; Databases, Factual; Dizziness, complications, epidemiology; Female; Humans; Logistic Models; Male; Middle Aged; Migraine Disorders, complications, epidemiology; Prevalence; Benign Paroxysmal Positional Vertigo; Electronystagmography; Labyrinth; Migraine; Otoconia; Phonophobia; Photophobia; Prevalence; Scotoma; Vestibular Diseases}, pmid = {28249625} }
Uneri, A.	Migraine and benign paroxysmal positional vertigo: an outcome study of 476 patients. [Abstract] [BibTeX]	2004	Ear, nose, & throat journal Vol. 83(12), pp. 814-815	article
Abstract: To investigate whether migraine is more common in patients with benign paroxysmal positional vertigo (BPPV) than in the general population, the author conducted a retrospective study of 476 patients with BPPV seen over 12 years at a tertiary referral center. Records of patients with a confirmed diagnosis of BPPV followed for 1 to 7 years were reviewed. The typical history of BPPV and the characteristic torsional positional nystagmus were identified in all patients. A modified Epley maneuver was performed for all patients with posterior semicircular canal BPPV, with a 98% success rate. The survey consisted of detailed patient questionnaires and vestibular tests. Migraine and motion sickness were three times more common in patients with BPPV than in the general population. A family history of migraine (58.4%) and vertigo (44.9%) was also more common in patients than in a control group.
BibTeX: @article{Uneri2004, author = {Uneri, Alev}, title = {Migraine and benign paroxysmal positional vertigo: an outcome study of 476 patients.}, journal = {Ear, nose, & throat journal}, year = {2004}, volume = {83}, issue = {12}, pages = {814--815}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Case-Control Studies; Child; Female; Health Surveys; Humans; Male; Middle Aged; Migraine Disorders, complications, epidemiology; Nystagmus, Physiologic; Outcome Assessment (Health Care); Retrospective Studies; Risk Factors; Surveys and Questionnaires; Turkey, epidemiology; Vertigo, epidemiology, etiology}, pmid = {15724736} }
Gelfand, A.A.	Migraine and childhood periodic syndromes in children and adolescents. [Abstract] [BibTeX]	2013	Current opinion in neurology Vol. 26(3), pp. 262-268	article	DOI
Abstract: This review covers recent advances in our understanding of migraine and childhood periodic syndromes in children and adolescents, as well as the treatment of these disorders. The childhood periodic syndromes include benign paroxysmal torticollis, benign paroxysmal vertigo, abdominal migraine, and cyclic vomiting syndrome. Recent research suggests infant colic may also fit into this category. Migraine headache is common in children and adolescents, and chronic migraine effects 0.8-1.8% of adolescents and 0.6% of children. Two triptans are now FDA-approved for the acute treatment of migraine in pediatric patients. For preventive therapy, a number of medications have been studied and a major national trial is ongoing. Childhood periodic syndromes are thought to be early life expressions of those genes that later in life are expressed as migraine headache. Future research into mechanisms of identifying children with these disorders prior to extensive and often invasive testing would be of benefit to these families and children. Migraine-specific therapies are now approved for the acute treatment of migraine in pediatric patients. Preventive migraine therapy is indicated in appropriate patients, although which medications are most effective in children is an area of active research.
BibTeX: @article{Gelfand2013, author = {Gelfand, Amy A}, title = {Migraine and childhood periodic syndromes in children and adolescents.}, journal = {Current opinion in neurology}, year = {2013}, volume = {26}, issue = {3}, pages = {262--268}, doi = {https://doi.org/10.1097/WCO.0b013e32836085c7}, keywords = {Adolescent; Benign Paroxysmal Positional Vertigo; Child; Diagnosis, Differential; Humans; Migraine Disorders, diagnosis, drug therapy; Torticollis, diagnosis, drug therapy; Tryptamines, therapeutic use; Vertigo, diagnosis, drug therapy; Vomiting, diagnosis, drug therapy}, pmid = {23549418} }
Bisdorff, A.	Migraine and dizziness. [Abstract] [BibTeX]	2014	Current opinion in neurology Vol. 27(1), pp. 105-110	article	DOI
Abstract: Awareness of the importance of migraine in patients with symptoms of vestibular dysfunction is increasing. This article gives an overview of the multiple facets of the link between migraine and vestibular dysfunction. The vestibular and the headache community have published a consensual definition of vestibular migraine, which is an important step to promote research on the topic and the awareness of clinicians. Vestibular migraine is considered the most common cause of spontaneous recurrent vertigo. So far, the evidence for vestibular migraine has been mainly epidemiological, but the recent follow-up of a cohort over 9 years could show the robustness of the diagnosis over time.Additionally, migraine and vestibular dysfunction have multiple potential interactions and links through a range of comorbidities such as Menière's disease, benign paroxysmal positional vertigo, anxiety and motion sickness, which go beyond the diagnostic entity of vestibular migraine. The further refinement and wider acceptance of the diagnostic entity of vestibular migraine is an important development as it is one the most common vestibular disorders. But the relationship between migraine and vestibular dysfunction is complex and has many aspects beyond vestibular migraine.
BibTeX: @article{Bisdorff2014, author = {Bisdorff, Alexandre}, title = {Migraine and dizziness.}, journal = {Current opinion in neurology}, year = {2014}, volume = {27}, issue = {1}, pages = {105--110}, doi = {https://doi.org/10.1097/WCO.0000000000000061}, keywords = {Dizziness, complications, epidemiology; Humans; Migraine Disorders, complications, epidemiology; Vestibular Diseases, complications, epidemiology}, pmid = {24316729} }
Cha, Y.-H. and Baloh, R.W.	Migraine associated vertigo. [Abstract] [BibTeX]	2007	Journal of clinical neurology (Seoul, Korea) Vol. 3(3), pp. 121-126	article	DOI
Abstract: The interrelations of migraine and vertigo are complex, eluding a simple localization either centrally or peripherally. Spontaneous episodic vertigo, benign paroxysmal positional vertigo, and Meniere's disease all occur more frequently in patients with migraine than in those without. Family studies support a hereditary predisposition to migraine associated vertigo. In this review, we discuss definitions, epidemiology, associated syndromes, neurootological abnormalities, genetics and treatment for patients with migraine and vertigo.
BibTeX: @article{Cha2007, author = {Cha, Yoon-Hee and Baloh, Robert W}, title = {Migraine associated vertigo.}, journal = {Journal of clinical neurology (Seoul, Korea)}, year = {2007}, volume = {3}, issue = {3}, pages = {121--126}, doi = {https://doi.org/10.3988/jcn.2007.3.3.121}, keywords = {BPPV; Benign recurrent vertigo; Dizziness; Meniere's disease; Migraine; Motion sickness; Vertigo}, pmid = {19513278} }
Teixeira, K.C.S., Montenegro, M.A. and Guerreiro, M.M.	Migraine equivalents in childhood. [Abstract] [BibTeX]	2014	Journal of child neurology Vol. 29(10), pp. 1366-1369	article	DOI
Abstract: Migraine equivalents are a group of periodic and paroxysmal neurologic diseases. Because headache is not a prominent symptom, the diagnosis might be challenging. The objective of the study was to evaluate the frequency and outcome of migraine equivalents. This was a retrospective study. We included benign paroxysmal torticollis of infancy, benign paroxysmal vertigo of infancy, abdominal migraine, cyclic vomiting, aura without migraine, and confusional migraine. We evaluated the frequency of events, treatment, and outcome. Out of 674 children with headache, 38 (5.6%) presented with migraine equivalents. Twenty-one were boys and the mean age was 6.1 years. Fifteen had abdominal migraine, 12 benign paroxysmal vertigo, 5 confusional migraine, 3 aura without migraine, 2 paroxysmal torticollis, and 1 cyclic vomiting. Prophylactic treatment was introduced in 23 patients; 4 lost follow-up and 19 had significant improvement. We conclude that the correct diagnosis of migraine equivalents enables an effective treatment with an excellent outcome.
BibTeX: @article{Teixeira2014, author = {Teixeira, Karine C S and Montenegro, Maria Augusta and Guerreiro, Marilisa M}, title = {Migraine equivalents in childhood.}, journal = {Journal of child neurology}, year = {2014}, volume = {29}, issue = {10}, pages = {1366--1369}, doi = {https://doi.org/10.1177/0883073813504459}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis, drug therapy, epidemiology; Child; Child, Preschool; Female; Follow-Up Studies; Headache, diagnosis, drug therapy, epidemiology; Humans; Infant; Male; Migraine Disorders, diagnosis, drug therapy, epidemiology; Retrospective Studies; Torticollis, diagnosis, drug therapy, epidemiology; Vomiting, diagnosis, drug therapy, epidemiology; benign paroxysmal vertigo; childhood; confusional migraine; headache; migraine equivalent}, pmid = {24092892} }
Chu, C.-H., Liu, C.-J., Lin, L.-Y., Chen, T.-J. and Wang, S.-J.	Migraine is associated with an increased risk for benign paroxysmal positional vertigo: a nationwide population-based study. [Abstract] [BibTeX]	2015	The journal of headache and pain Vol. 16, pp. 62	article	DOI
Abstract: There is evidence suggesting that migraine may be associated with vertigo. The aim of this study was to assess the risk of benign paroxysmal positional vertigo (BPPV), the most common form of vertigo, in patients with migraine using a population-based dataset. The National Health Insurance Research Database in Taiwan was searched for migraine patients and was also used to select an age- and sex-matched cohort of subjects without migraine. The analyses included 8266 migraine patients and 8266 controls. The incidence rates of BPPV in the two cohorts were compared. Cox proportional hazard models were used to identify risk factors for BPPV in migraine patients. In the migraine cohort, 1.11% of the patients developed BPPV compared to 0.5% of the controls. The incidence rate ratio was 2.03 (95% CI 1.41-2.97; p <0.001). Cox proportional hazards analysis showed that age ≥40 years (HR 2.20; 95% CI 1.40-3.45; p = 0.001), coronary artery disease (HR 4.62; 95% CI 1.12-19.01; p = 0.034), and the number of outpatient department visits to neurologists because of migraine (HR 2.93; 95% CI 2.50-3.44; p >0.001) were associated with an increased risk for BPPV. The results showed that patients with migraine had a 2.03-fold increased risk of developing BPPV compared with age- and sex-matched controls. Although BPPV may not be a common condition in migraine patients, migraine sufferers with vestibular symptoms should alert physicians to the possibility of BPPV, particularly if patients are aged ≥40 years, have a history of coronary artery disease, or have frequent visits to neurologists clinics because of migraine.
BibTeX: @article{Chu2015, author = {Chu, Chia-Huei and Liu, Chia-Jen and Lin, Liang-Yu and Chen, Tzeng-Ji and Wang, Shuu-Jiun}, title = {Migraine is associated with an increased risk for benign paroxysmal positional vertigo: a nationwide population-based study.}, journal = {The journal of headache and pain}, year = {2015}, volume = {16}, pages = {62}, doi = {https://doi.org/10.1186/s10194-015-0547-z}, keywords = {Adult; Benign Paroxysmal Positional Vertigo, epidemiology; Comorbidity; Databases, Factual; Female; Humans; Incidence; Male; Middle Aged; Migraine Disorders, epidemiology; Risk; Taiwan, epidemiology}, pmid = {26141381} }
Winner, P.	Migraine-related symptoms in childhood. [Abstract] [BibTeX]	2013	Current pain and headache reports Vol. 17(8), pp. 339	article	DOI
Abstract: Periodic disorders of childhood often represent precursors of migraine. As we advance our knowledge of migraine and its complicated phenotypic presentation in childhood, we have noted the similarities in overlapping symptoms of children presenting with childhood periodic syndromes. There is often a positive family history of migraine in children that present with periodic syndromes. There is a known transformation of periodic syndromes from childhood into adult migraine with and without aura phenotype. There has been an evolution of our understanding of what was initially referred to as periodic symptoms of childhood and more recently been called childhood periodic syndromes and is now evolving into the terminology of episodic symptoms that are associated with migraine. International classification of headache disorders has been instrumental in the evolution of the classification of headache and children adults. The most recent classification utilizes and replaces the periodic symptom terminology with episodic symptoms that will no longer be limited to just childhood. This article will address the evolution of our understanding of the diagnostic criteria, pathophysiology and management of the episodic syndromes that may be associated with migraine.
BibTeX: @article{Winner2013, author = {Winner, Paul}, title = {Migraine-related symptoms in childhood.}, journal = {Current pain and headache reports}, year = {2013}, volume = {17}, issue = {8}, pages = {339}, doi = {https://doi.org/10.1007/s11916-013-0339-6}, keywords = {Age of Onset; Benign Paroxysmal Positional Vertigo; Child; Epilepsy; Female; Gastrointestinal Diseases, diagnosis, epidemiology, physiopathology; Headache Disorders, diagnosis, epidemiology, physiopathology; Humans; International Classification of Diseases; Male; Migraine Disorders, diagnosis, epidemiology, physiopathology; Syndrome; Torticollis, diagnosis, epidemiology, physiopathology; United States, epidemiology; Vertigo, diagnosis, epidemiology, physiopathology; Vomiting, diagnosis, epidemiology, physiopathology}, pmid = {23961555} }
von Brevern, M., Radtke, A., Clarke, A.H. and Lempert, T.	Migrainous vertigo presenting as episodic positional vertigo. [Abstract] [BibTeX]	2004	Neurology Vol. 62(3), pp. 469-472	article
Abstract: Migraine can cause vestibular symptoms including positional vertigo. Of 362 consecutive patients presenting with positional vertigo, 10 with migrainous vertigo mimicking benign paroxysmal positional vertigo (BPPV) were identified. The following factors help to distinguish migrainous positional vertigo from BPPV: short-duration symptomatic episodes and frequent recurrences, manifestation early in life, migrainous symptoms during episodes with positional vertigo, and atypical positional nystagmus.
BibTeX: @article{Brevern2004c, author = {von Brevern, Michael and Radtke, Andrea and Clarke, Andrew H and Lempert, Thomas}, title = {Migrainous vertigo presenting as episodic positional vertigo.}, journal = {Neurology}, year = {2004}, volume = {62}, issue = {3}, pages = {469--472}, keywords = {Age of Onset; Aged; Female; Humans; Male; Middle Aged; Migraine without Aura, complications; Nystagmus, Physiologic; Retrospective Studies; Vertigo, diagnosis, etiology; Vestibular Neuronitis, diagnosis}, pmid = {14872034} }
Trombelli, L., Franceschetti, G., Stacchi, C., Minenna, L., Riccardi, O., Di Raimondo, R., Rizzi, A. and Farina, R.	Minimally invasive transcrestal sinus floor elevation with deproteinized bovine bone or β-tricalcium phosphate: a multicenter, double-blind, randomized, controlled clinical trial. [Abstract] [BibTeX]	2014	Journal of clinical periodontology Vol. 41(3), pp. 311-319	article	DOI
Abstract: To evaluate the outcomes of transcrestal sinus floor elevation (tSFE) performed with a minimally invasive procedure (Smart Lift technique) combined with the additional use of deproteinized bovine bone mineral (DBBM) or β-tricalcium phosphate (β-TCP). In a multicenter randomized controlled trial, 38 sites in 38 patients were treated with the Smart Lift technique in association with DBBM (n = 19) or β-TCP (n = 19). The extent of the sinus lift (SL) and the height of the graft apical to the implant apex (aGH) were assessed on periapical radiographs taken immediately after surgery and at 6 months following surgery. (i) Substantial aGH and SL were observed immediately after surgery and at 6 months, with no significant differences between DBBM and β-TCP groups; (ii) a significant graft remodelling was observed from post-surgery to 6-months in the β-TCP group and (iii) limited incidence of complications as well as limited post-operative pain and discomfort were associated with the use of both graft materials. The Smart Lift technique in conjunction with the additional use of either DBBM or β-TCP may provide a substantial elevation of the maxillary sinus floor along with limited post-surgical complications and post-operative pain/discomfort.
BibTeX: @article{Trombelli2014, author = {Trombelli, Leonardo and Franceschetti, Giovanni and Stacchi, Claudio and Minenna, Luigi and Riccardi, Orio and Di Raimondo, Rosario and Rizzi, Alessandro and Farina, Roberto}, title = {Minimally invasive transcrestal sinus floor elevation with deproteinized bovine bone or β-tricalcium phosphate: a multicenter, double-blind, randomized, controlled clinical trial.}, journal = {Journal of clinical periodontology}, year = {2014}, volume = {41}, issue = {3}, pages = {311--319}, doi = {https://doi.org/10.1111/jcpe.12210}, keywords = {Adult; Animals; Benign Paroxysmal Positional Vertigo, etiology; Biocompatible Materials, therapeutic use; Bone Substitutes, therapeutic use; Calcium Phosphates, therapeutic use; Cattle; Dental Implantation, Endosseous, methods; Dental Implants; Double-Blind Method; Female; Follow-Up Studies; Humans; Intraoperative Complications; Male; Middle Aged; Minimally Invasive Surgical Procedures, methods; Nasal Mucosa, injuries; Operative Time; Pain, Postoperative, etiology; Postoperative Complications; Radiography, Bitewing; Sinus Floor Augmentation, instrumentation, methods; Treatment Outcome; beta tricalcium phosphate; bone regeneration; dental implants; heterologous; maxillary sinus; minimally invasive; outcome assessment; surgical procedures; transplantation}, pmid = {24325663} }
Lance, S. and Mossman, S.S.	Misleading signs in acute vertigo. [Abstract] [BibTeX]	2018	Practical neurology Vol. 18(2), pp. 162-165	article	DOI
Abstract: The acute vestibular syndrome is common and usually has a benign cause. Sometimes, however, even experienced neurologists can find it difficult to determine the cause clinically. Furthermore, neuroimaging is known to be insensitive.We describe two cases of acute vestibular syndrome where conflicting clinical findings contributed to a delay in making the correct diagnosis. The first patient with symptomatic vertigo had signs consistent with horizontal benign paroxysmal positional vertigo but also had an abnormal horizontal head impulse test, superficially suggesting acute vestibular neuritis but later accounted for by the finding of a vestibular schwannoma (acoustic neuroma). The second patient also had an abnormal horizontal head impulse test, with skew deviation suggesting stroke as the cause. However, later assessment identified that a long-standing fourth nerve palsy was the true cause for her apparent skew. We discuss potential errors that can arise when assessing such patients and highlight ways to avoid them.
BibTeX: @article{Lance2018, author = {Lance, Sean and Mossman, Stuart Scott}, title = {Misleading signs in acute vertigo.}, journal = {Practical neurology}, year = {2018}, volume = {18}, issue = {2}, pages = {162--165}, doi = {https://doi.org/10.1136/practneurol-2017-001749}, keywords = {Aged; Diagnosis, Differential; Female; Head Impulse Test; Humans; Stroke, diagnosis; Vertigo, etiology; Vestibular Neuronitis, complications, diagnosis; confirmation bias; head impulse test; skew deviation; vertigo; video oculography}, pmid = {29208731} }
Otsuka, K., Suzuki, M. and Furuya, M.	Model experiment of benign paroxysmal positional vertigo mechanism using the whole membranous labyrinth. [Abstract] [BibTeX]	2003	Acta oto-laryngologica Vol. 123(4), pp. 515-518	article
Abstract: Whole membranous labyrinths of bullfrogs were used in order to replicate the human vestibule. The posterior semicircular canals (PSCs) were exposed, leaving the remaining membranous labyrinth encapsulated in the otic capsule. Vibration was applied to the surface of the bony capsule using a conventional surgical drill in order to dislodge the otoconia from the utricle. The position of the preparation was controlled so that the dislodged otoconia were attached to the cupular surface. This was regarded as a cupulolithiasis model. The action potentials changed instantaneously according to the gravitational force on the cupula. When the otoconia were dislodged and held within the PSC lumen, the position of the whole preparation was changed so that the otoconia moved back and forth within the canal lumen. This is a model of canalolithiasis. The action potentials changed in combination with the otoconial movement after a latent period. Both cupulolithiasis and canalolithasis are potentially valid mechanisms of benign paroxysmal positional vertigo (BPPV). However, canalolithiasis is the most likely mechanism of BPPV, which is usually characterized by nystagmus of short duration and long latency. A vibratory stimulus was able to detach the otoconia from the utricle, suggesting that mechanical insult could be a possible etiology of BPPV.
BibTeX: @article{Otsuka2003, author = {Otsuka, Koji and Suzuki, Mamoru and Furuya, Masayoshi}, title = {Model experiment of benign paroxysmal positional vertigo mechanism using the whole membranous labyrinth.}, journal = {Acta oto-laryngologica}, year = {2003}, volume = {123}, issue = {4}, pages = {515--518}, keywords = {Animals; Ear, Inner, physiology; Humans; Otolithic Membrane, physiology; Posture, physiology; Rana catesbeiana; Semicircular Canals, physiology; Vertigo, physiopathology; Vestibular Diseases, etiology, physiopathology; Vestibule, Labyrinth, physiology; Vibration}, pmid = {12797587} }
Inagaki, T., Suzuki, M., Otsuka, K., Kitajima, N., Furuya, M., Ogawa, Y. and Takenouchi, T.	Model experiments of BPPV using isolated utricle and posterior semicircular canal. [Abstract] [BibTeX]	2006	Auris, nasus, larynx Vol. 33(2), pp. 129-134	article	DOI
Abstract: This study was aimed to experimentally investigate the effect of returned otoconia on the utricular using isolated utricles. The effect of interposed otoconia in models of canalolithiasis and cupulolithiasis were also investigated using isolated posterior semicircular canal (PSC). Bullfrogs were used. The utricles (Experiment I) and PSC (Experiment II) were removed in Ringer solution. Experiment I-a: The otoconia were carefully removed from the utricular macula with gentle flush of Ringer solution. Before and after the otoconial removal, sinusoidal rotatory stimulation (0.1 Hz, 135 degrees ) was given to record utricular compound action potentials (CAPs). Experiment I-b: (1) Instantaneous changes in the utricular potentials when the otoconial mass was positioned on the macula were recorded. (2) Utricular CAP changes in response to sinusoidal rotation immediately and 10 min after the otoconial positioning were recorded. Experiment II: PSC CAPs due to sinusoidal rotatory stimulation in normal specimen, canalolithiasis and cupulolithiasis models were recorded. Experiment I-a: The utricular CAPs in response to sinusoidal rotation showed sinusoidal oscillation. However, this oscillation disappeared after the otoconial removal. Experiment I-b: (1) The utricular potentials transiently increased for 3-4 s after positioning the otoconial mass. (2) The utricular CAPs increased in seven specimens and decreased in four. Ten minutes after the CAPs were almost the same as immediately after otoconial positioning. Experiment II: In cupulolithiasis model, the PSC CAPs decreased in all specimens. The otoconia played an essential role as a transducer of acceleration to the utricular macula. Otoconia returned to the utricular macula change utricular reactivity and hence are the possible cause of dizziness after physical therapy. PSC responses to sinusoidal rotation were suppressed in cupulolithiasis model.
BibTeX: @article{Inagaki2006, author = {Inagaki, Taro and Suzuki, Mamoru and Otsuka, Koji and Kitajima, Naoharu and Furuya, Masayoshi and Ogawa, Yasuo and Takenouchi, Tsuyoshi}, title = {Model experiments of BPPV using isolated utricle and posterior semicircular canal.}, journal = {Auris, nasus, larynx}, year = {2006}, volume = {33}, issue = {2}, pages = {129--134}, doi = {https://doi.org/10.1016/j.anl.2005.09.001}, keywords = {Animals; Disease Models, Animal; Nystagmus, Pathologic, physiopathology; Otolithic Membrane, anatomy & histology; Rana catesbeiana; Saccule and Utricle, anatomy & histology; Semicircular Canals, anatomy & histology; Vertigo, physiopathology}, pmid = {16309868} }
Otsuka, K., Suzuki, M., Shimizu, S., Konomi, U., Inagaki, T., Iimura, Y., Hayashi, M. and Ogawa, Y.	Model experiments of otoconia stability after canalith repositioning procedure of BPPV. [Abstract] [BibTeX]	2010	Acta oto-laryngologica Vol. 130(7), pp. 804-809	article	DOI
Abstract: Postural restrictions are probably not necessary after the canalith repositioning procedure (CRP). Epley reported the effect of CRP for benign paroxysmal positional vertigo (BPPV). After CRP, patients are often requested to restrict postural change. However, some studies suggested that CRP may work without postural restrictions. The present study aimed to determine the necessity of post-maneuver postural restriction using the frog labyrinth model. The otoconial mass from the sacculus was placed on the utricular macular otoconia, mimicking a condition after CRP. The stability of the otoconial mass was observed by tilting the preparation, immediately, 3 min, and 5 min after it was placed on the macular otoconia. The utricular macula was maintained in the vertical plane for 10 s, during which period the behavior of the otoconial mass was observed. In experiment 1 the utricular macula was intact, in experiment 2 otoconia were partially removed, and in experiment 3 they were totally removed from the macula. In experiments 1 and 2, in all preparations the otoconial mass became stabilized after 3 min. Even in experiment 3, in most preparations the otoconial mass became stabilized after 5 min.
BibTeX: @article{Otsuka2010, author = {Otsuka, Koji and Suzuki, Mamoru and Shimizu, Shigetaka and Konomi, Ujimoto and Inagaki, Taro and Iimura, Yoichi and Hayashi, Mami and Ogawa, Yasuo}, title = {Model experiments of otoconia stability after canalith repositioning procedure of BPPV.}, journal = {Acta oto-laryngologica}, year = {2010}, volume = {130}, issue = {7}, pages = {804--809}, doi = {https://doi.org/10.3109/00016480903456318}, keywords = {Acoustic Maculae, physiopathology; Animals; Benign Paroxysmal Positional Vertigo; Models, Animal; Otolithic Membrane, physiopathology; Posture, physiology; Rana catesbeiana; Vertigo, physiopathology}, pmid = {20095871} }
Hunt, W.T., Zimmermann, E.F. and Hilton, M.P.	Modifications of the Epley (canalith repositioning) manoeuvre for posterior canal benign paroxysmal positional vertigo (BPPV). [Abstract] [BibTeX]	2012	The Cochrane database of systematic reviews(4), pp. CD008675	article	DOI
Abstract: Benign paroxsymal positional vertigo (BPPV) is a syndrome characterised by short-lived episodes of vertigo associated with rapid changes in head position. It is a common cause of vertigo presenting to primary care and specialist otolaryngology (ENT) clinics. BPPV of the posterior canal is a specific type of BPPV for which the Epley (canalith repositioning) manoeuvre is a verified treatment. A range of modifications of the Epley manoeuvre are used in clinical practice, including post-Epley vestibular exercises and post-Epley postural restrictions. To assess whether the various modifications of the Epley manoeuvre for posterior canal BPPV enhance its efficacy in clinical practice. We searched the Cochrane ENT Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the search was 15 December 2011. Randomised controlled trials of modifications of the Epley manoeuvre versus a standard Epley manoeuvre as a control in adults with posterior canal BPPV diagnosed with a positive Dix-Hallpike test. Specific modifications sought were: application of vibration/oscillation to the mastoid region, vestibular rehabilitation exercises, additional steps in the Epley manoeuvre and post-treatment instructions relating to movement restriction. Two authors independently selected studies from the search results and the third author reviewed and resolved any disagreement. Two authors independently extracted data from the studies using standardised data forms. All authors independently assessed the trials for risk of bias. The review includes 11 trials involving 855 participants. A total of nine studies used post-Epley postural restrictions as their modification of the Epley manoeuvre. There was no evidence of a difference in the results for post-treatment vertigo intensity or subjective assessment of improvement in individual or pooled data. All nine trials included the conversion of a positive to a negative Dix-Hallpike test as an outcome measure. Pooled data identified a significant difference from the addition of postural restrictions in the frequency of Dix-Hallpike conversion when compared to the Epley manoeuvre alone. In the experimental group 88.7% (220 out of 248) patients versus 78.2% (219 out of 280) in the control group converted from a positive to negative Dix-Hallpike test (risk ratio (RR) 1.13, 95% confidence interval (CI) 1.05 to 1.22, P = 0.002). No serious adverse effects were reported, however three studies reported minor complications such as neck stiffness, horizontal BPPV, dizziness and disequilibrium in some patients.There was no evidence of benefit of mastoid oscillation applied during the Epley manoeuvre, or of additional steps in the Epley manoeuvre. No adverse effects were reported. There is evidence supporting a statistically significant effect of post-Epley postural restrictions in comparison to the Epley manoeuvre alone. However, it important to note that this statistically significant effect only highlights a small improvement in treatment efficacy. An Epley manoeuvre alone is effective in just under 80% of patients with typical BPPV. The additional intervention of postural restrictions has a number needed to treat (NNT) of 10. The addition of postural restrictions does not expose the majority of patients to risk of harm, does not pose a major inconvenience, and can be routinely discussed and advised. Specific patients who experience discomfort due to wearing a cervical collar and inconvenience in sleeping upright may be treated with the Epley manoeuvre alone and still expect to be cured in most instances.There is insufficient evidence to support the routine application of mastoid oscillation during the Epley manoeuvre, or additional steps in an 'augmented' Epley manoeuvre. Neither treatment is associated with adverse outcomes. Further studies should employ a rigorous randomisation technique, blinded outcome assessment, a post-treatment Dix-Hallpike test as an outcome measure and longer-term follow-up of patients.
BibTeX: @article{Hunt2012, author = {Hunt, William T and Zimmermann, Eleanor F and Hilton, Malcolm P}, title = {Modifications of the Epley (canalith repositioning) manoeuvre for posterior canal benign paroxysmal positional vertigo (BPPV).}, journal = {The Cochrane database of systematic reviews}, year = {2012}, issue = {4}, pages = {CD008675}, doi = {https://doi.org/10.1002/14651858.CD008675.pub2}, keywords = {Benign Paroxysmal Positional Vertigo; Exercise Therapy, methods; Humans; Immobilization, instrumentation, methods; Patient Positioning, methods; Posture, physiology; Randomized Controlled Trials as Topic; Vertigo, therapy; Vibration, therapeutic use}, pmid = {22513962} }
Harvey, S.A., Hain, T.C. and Adamiec, L.C.	Modified liberatory maneuver: effective treatment for benign paroxysmal positional vertigo. [Abstract] [BibTeX]	1994	The Laryngoscope Vol. 104(10), pp. 1206-1212	article
Abstract: A modification of the liberatory maneuver was used to treat 25 patients with benign paroxysmal positional vertigo (BPPV). The modified liberatory maneuver relieved symptoms without recurrence in 11 (44%) patients. A partial response was noted in 6 (24%) patients, and there was no improvement in 8 (32%) patients. Follow-up ranged from 1 to 20 months (median 4.0 months). Patient age was not predictive of response to treatment. Duration of symptoms before treatment, however, was greater in nonresponders (median 15.5 months) than in complete (median 5.0 months) or partial (median 3.5 months) responders. The modified liberatory maneuver takes approximately 5 minutes to perform and provides effective treatment in two thirds of patients who suffer from BPPV.
BibTeX: @article{Harvey1994, author = {Harvey, S A and Hain, T C and Adamiec, L C}, title = {Modified liberatory maneuver: effective treatment for benign paroxysmal positional vertigo.}, journal = {The Laryngoscope}, year = {1994}, volume = {104}, issue = {10}, pages = {1206--1212}, keywords = {Adult; Aged; Aged, 80 and over; Audiometry; Audiometry, Evoked Response; Electronystagmography; Female; Follow-Up Studies; Humans; Male; Middle Aged; Physical Therapy Modalities, methods; Posture; Recurrence; Vertigo, diagnosis, physiopathology, therapy}, pmid = {7934589} }
Tirelli, G., D'Orlando, E., Zarcone, O., Giacomarra, V. and Russolo, M.	Modified particle repositioning procedure. [Abstract] [BibTeX]	2000	The Laryngoscope Vol. 110(3 Pt 1), pp. 462-468	article	DOI
Abstract: To evaluate the efficacy of modifications to traditional particle repositioning maneuvers in the treatment of benign paroxysmal positional vertigo. Prospective trial of 118 patients with cupolocanalithiasis of the posterior canal treated with three different canal-repositioning techniques. Results were compared with the maneuvers employed and the statistical importance of rotating patients by 360 degrees along their longitudinal axis and head shaking on reaching each single position were evaluated. Treatment of patients with our maneuver, which, in comparison with traditional repositioning maneuvers, was modified by breaking the procedure up into seven positions and rotating patients by 360 degrees along their longitudinal axis, gives a higher, but not statistically significant, number of treatment successes (84.5%) than the traditional Parnes maneuver (60%) (P = .154); treatment of a third group of patients with our modified particle repositioning maneuver with the addition of head-shaking on reaching each single position gives a higher (95.6%), statistically significant number of treatment successes than traditional Parnes maneuver (P = .00011). The success rates achieved from modified particle repositioning maneuvers are statistically significant. Onset or persistence of dizziness, which patients frequently complain of after liberatory maneuvers, affects only 5.6% of the patients treated. This low incidence is statistically correlated to head-shaking.
BibTeX: @article{Tirelli2000, author = {Tirelli, G and D'Orlando, E and Zarcone, O and Giacomarra, V and Russolo, M}, title = {Modified particle repositioning procedure.}, journal = {The Laryngoscope}, year = {2000}, volume = {110}, issue = {3 Pt 1}, pages = {462--468}, doi = {https://doi.org/10.1097/00005537-200003000-00026}, keywords = {Calculi, pathology; Chi-Square Distribution; Dizziness, therapy; Head, anatomy & histology; Head Movements, physiology; Humans; Labyrinth Diseases, pathology; Nystagmus, Physiologic, physiology; Posture, physiology; Prone Position, physiology; Semicircular Canals, pathology; Supine Position, physiology; Vertigo, pathology, therapy}, pmid = {10718439} }
Molina, M.I., López-Escámez, J.A., Zapata, C. and Vergara, L.	Monitoring of caloric response and outcome in patients with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2007	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 28(6), pp. 798-800	article	DOI
Abstract: To analyze the time course of caloric response in patients with Benign Paroxysmal Positional Vertigo (BPPV). Seventy-four individuals with diagnosis of BPPV during Dix-Hallpike (DH) test. A prospective, longitudinal study. A tertiary referral center. Patients were treated by particle repositioning maneuvers according to the affected canal, and the effectiveness was evaluated at 180 and 360 days. Bithermal caloric response was obtained by using 44 and 30 degrees C water irrigations at diagnosis, 6 months, and 1 year after. Canal paresis (CP) and response to DH after treatment. The effectiveness of the treatment for BPPV (absence of vertigo and positional nystagmus during DH) was 65.2% (45 of 69) after 1 year of follow-up. Twenty-five percent of (16 of 64) individuals with BPPV presented CP at diagnosis, 27% (12 of 44) at 6 months, and 16% (9 of 56) 1 year after. One year after, seven individuals with CP showed a normal caloric response, another seven demonstrated persistent CP, and one case developed a bilateral CP. The effectiveness of particle repositioning maneuvers was not significantly different between subjects with or without CP after 1 year of follow-up (odds ratio, 1.31 [95% confidence intervals, 0.35-4.89], p = 0.88). Canal paresis is not associated with a lower outcome to repositioning.
BibTeX: @article{Molina2007, author = {Molina, Maria I and López-Escámez, Jose A and Zapata, Cristobal and Vergara, Laura}, title = {Monitoring of caloric response and outcome in patients with benign paroxysmal positional vertigo.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2007}, volume = {28}, issue = {6}, pages = {798--800}, doi = {https://doi.org/10.1097/MAO.0b013e318067e322}, keywords = {Aged; Audiometry, Pure-Tone; Caloric Tests; Ear Canal, pathology, surgery; Eye Movements, physiology; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nystagmus, Physiologic, physiology; Otologic Surgical Procedures; Paresis, pathology; Treatment Outcome; Vertigo, diagnosis, surgery, therapy}, pmid = {17721367} }
Yardley, L.	Motion sickness susceptibility and the utilisation of visual and otolithic information for orientation. [Abstract] [BibTeX]	1990	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 247(5), pp. 300-304	article
Abstract: Movement of large portions of the visual field can induce a static observer to experience illusory self-motion, changes in perceived orientation and motion sickness. Two experiments were performed to determine whether susceptibility to motion sickness might be related to an inability to ignore misleading visual information for orientation, measured here in terms of the magnitude of the apparent tilt of the vertical induced by rotation of the visual field about the line of sight. Significant and additive effects of sex and motion sickness susceptibility were demonstrated. Females susceptible to motion sickness proved highly inaccurate when attempting to set a line to the vertical with rotation of the background, while males resistant to motion sickness were the most accurate at this task. Two possible explanations are discussed, the first suggesting subclinical intersubject differences in otolithic sensitivity, and the second postulating deficiencies in intersensory integration. Parallels are drawn with the patterns of multisensory coordination for postural orientation seen in children and in patients with benign paroxysmal positional vertigo.
BibTeX: @article{Yardley1990, author = {Yardley, L}, title = {Motion sickness susceptibility and the utilisation of visual and otolithic information for orientation.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {1990}, volume = {247}, issue = {5}, pages = {300--304}, keywords = {Adult; Cues; Disease Susceptibility; Female; Humans; Kinesthesis, physiology; Male; Motion Sickness, etiology, physiopathology; Orientation, physiology; Otolithic Membrane, physiology; Saccule and Utricle, physiology; Visual Fields, physiology; Visual Perception, physiology}, pmid = {2393563} }
Grill, E., Akdal, G., Becker-Bense, S., Hübinger, S., Huppert, D., Kentala, E., Strobl, R., Zwergal, A. and Celebisoy, N.	Multicenter data banking in management of dizzy patients: first results from the DizzyNet registry project. [Abstract] [BibTeX]	2018	Journal of neurology Vol. 265(Suppl 1), pp. 3-8	article	DOI
Abstract: Comprehensive phenotypical data across countries is needed to understand the determinants, prognosis and consequences of vestibular disease. The registry is a data repository for the members of the European DizzyNet. We report results from a pilot study using data from Turkey and Germany. The pilot study included a convenience sample of patients aged 18 or above referred to Ege University Medical School Hospital, Dokuz Eylül University Hospital, Izmir, Turkey, and the German Center for German Center for Vertigo and Balance Disorders, University on Munich, Germany, with symptoms of vertigo or dizziness. Health-related quality of life was assessed with the EQ5-D and the Dizziness Handicap Inventory (DHI). To obtain comparable groups we matched data from the two countries for age, sex and diagnosis by propensity score. We included 80 adult patients, 40 from each country (60% female, mean age 54.1, SD 12.4). Matching was successful. Vestibular migraine (34%) was the most frequent diagnosis, followed by benign paroxysmal positional vertigo (29%) and Menière's disease (12%). Clinical signs and symptoms were comparable in both countries. Patients from Turkey were more likely to report headaches (65 vs. 32%) and to show gait unsteadiness (51 vs. 5%). Patients from Germany reported significantly higher quality of life and lower values of the DHI score. Sharing data facilitates research, enhances translation from basic science into clinical applications, and increases transparency. The DizzyNet registry is a first step to data sharing in vestibular research across Europe.
BibTeX: @article{Grill2018, author = {Grill, Eva and Akdal, Gülden and Becker-Bense, Sandra and Hübinger, Steffen and Huppert, Doreen and Kentala, Erna and Strobl, Ralf and Zwergal, Andreas and Celebisoy, Nese}, title = {Multicenter data banking in management of dizzy patients: first results from the DizzyNet registry project.}, journal = {Journal of neurology}, year = {2018}, volume = {265}, issue = {Suppl 1}, pages = {3--8}, doi = {https://doi.org/10.1007/s00415-018-8864-1}, keywords = {Adult; Aged; Aged, 80 and over; Disease Management; Dizziness, diagnosis, epidemiology, physiopathology, psychology; Europe; Female; Humans; Information Dissemination; Male; Middle Aged; Pilot Projects; Quality of Life; Registries; Turkey; Vertigo, diagnosis, epidemiology, physiopathology, psychology; Activities of daily living; Dizziness; Quality of life; Registries; Vertigo}, pmid = {29663119} }
Huntoon, K., Shaddy, S., Lehman, N. and Elder, J.B.	Multiple lesions of skull and cervical spine: a rare presentation of unicameral bone cysts. [Abstract] [BibTeX]	2018	BMJ case reports Vol. 2018	article	DOI
Abstract: A 55-year-old man with a history of Benign Paroxysmal Positional Vertigo unalleviated by Epley manoeuvre presented to an otolaryngologist for dizziness, right ear fullness and headache. MRI of the brain showed numerous marrow-replacing lesions throughout the calvarium, skull base and upper cervical spine which were hypointense on T1-weighted images, hyperintense on T2-weighted images and avidly enhanced following contrast, concerning for a malignant process such as metastatic disease or multiple myeloma (figure 1). Systemic X-ray survey (spine, skull, chest, pelvis, all long bones) and nuclear medicine whole body bone scan were negative except for the lesions seen on MRI. β-2microglobin, immunoglobin and monoclonal protein electrophoresis were negative for myeloma or immunological process. Given the concern for metastatic disease, biopsy of a skull lesion was recommended. Pathological analysis of a calvarial lesion was consistent with unicameral bone cyst (figure 1). No ongoing therapy was offered; however, brain and spine surveillance imaging will continue.
BibTeX: @article{Huntoon2018, author = {Huntoon, Kristin and Shaddy, Sophia and Lehman, Norman and Elder, James Bradley}, title = {Multiple lesions of skull and cervical spine: a rare presentation of unicameral bone cysts.}, journal = {BMJ case reports}, year = {2018}, volume = {2018}, doi = {https://doi.org/10.1136/bcr-2017-223927}, keywords = {Benign Paroxysmal Positional Vertigo, etiology; Bone Cysts, complications, diagnostic imaging; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Skull Base, diagnostic imaging; Spine, diagnostic imaging; Tomography, X-Ray Computed; neurooncology; neurosurgery}, pmid = {30012676} }
Lopez-Escamez, J.A., Molina, M.I., Gamiz, M., Fernandez-Perez, A.J., Gomez, M., Palma, M.J. and Zapata, C.	Multiple positional nystagmus suggests multiple canal involvement in benign paroxysmal vertigo. [Abstract] [BibTeX]	2005	Acta oto-laryngologica Vol. 125(9), pp. 954-961	article
Abstract: Video-oculography demonstrates a higher occurrence of atypical positional nystagmus in patients with benign paroxysmal positional vertigo (BPPV). This includes anterior and horizontal canal variants and multiple positional nystagmus, suggesting combined lesions affecting several canals. To analyse the video-oculographic findings of positional tests in patients with BPPV. Seventy individuals with symptoms of BPPV and positional nystagmus were included in this study. The diagnosis was based on a history of brief episodes of vertigo and the presence of positional nystagmus as confirmed by video-oculographic examination during the Dix-Hallpike test, the McClure test or the head-hanging manoeuvre. Patients were treated by means of different particle repositioning manoeuvres according to the affected canal (Epley's manoeuvre for the posterior or anterior canals and Lempert's manoeuvre for the lateral canal) and the effectiveness was evaluated at 7 and 30 days. Twenty-nine individuals (41.43%) presented an affected unilateral posterior canal. Fifteen patients (21.43%) presented a pure horizontal direction-changing positional nystagmus consistent with a diagnosis of horizontal canal BPPV. Twelve individuals (17.14%) presented a unilateral down-beating nystagmus, suggesting possible anterior canal BPPV. In addition, 14 patients (20%) showed multiple positional nystagmus during the examination corresponding to simultaneous multi-canal BPPV, 5 had bilateral posterior canal BPPV and 2 presented a positional down-beating nystagmus in both left and right Dix-Hallpike manoeuvres and the head-hanging manoeuvre, which is highly suggestive of anterior canal BPPV. However, seven individuals showed positional horizontal and vertical side-changing nystagmus that could not be explained by single-canal BPPV. These patients with multiple positional nystagmus showed changing patterns of positional nystagmus at follow-up.
BibTeX: @article{Lopez-Escamez2005, author = {Lopez-Escamez, Jose A and Molina, Maria I and Gamiz, Maria and Fernandez-Perez, Antonio J and Gomez, Manuel and Palma, Maria J and Zapata, Cristobal}, title = {Multiple positional nystagmus suggests multiple canal involvement in benign paroxysmal vertigo.}, journal = {Acta oto-laryngologica}, year = {2005}, volume = {125}, issue = {9}, pages = {954--961}, keywords = {Adult; Aged; Aged, 80 and over; Caloric Tests; Female; Head Movements; Humans; Male; Middle Aged; Nystagmus, Physiologic, physiology; Semicircular Canals, physiopathology; Vertigo, physiopathology; Vestibular Function Tests; Video Recording}, pmid = {16193587} }
Cambi, J., Astore, S., Mandalà, M., Trabalzini, F. and Nuti, D.	Natural course of positional down-beating nystagmus of peripheral origin. [Abstract] [BibTeX]	2013	Journal of neurology Vol. 260(6), pp. 1489-1496	article	DOI
Abstract: The aim of this study was to assess the natural course of positional down-beating nystagmus (pDBN) and vertigo in patients with no evidence of central nervous system involvement and of presumed peripheral origin. Fifty-three patients with pDBN had a complete otoneurological examination. All subjects, apart from three (excluded from the study), showed no additional neurological signs and normal brain imaging. Patients were randomly assigned to two groups: with or without treatment with exercise. Patients were seen again after 24 h, and then weekly for up to 6 months. Forty-seven patients (94%) showed pDBN in the straight head-hanging position and in a Dix-Hallpike position. A torsional component was detected in 17 patients (34%). The mean latency and duration of pDBN was 4.7 ± 5 s and 40.1 ± 22 s, respectively. After 2 weeks, only 12 patients (24%) still had pDBN and all but one patient had recovered by 1 month. Twenty patients (40%) were diagnosed with a typical posterior canal benign paroxysmal positional vertigo (PC BPPV) before or after pDBN. This study assessed for the first time the natural course of presumed peripheral pDBN, which was characterized by a spontaneous remission in 24 patients in the first week and in 49 patients within 4 weeks. pDBN is much more common than previously suggested, with about the same frequency as lateral canal BPPV. Furthermore, the clinical characteristics of pDBN have been highlighted, as well as its possible relationship to PC BPPV.
BibTeX: @article{Cambi2013, author = {Cambi, Jacopo and Astore, Serena and Mandalà, Marco and Trabalzini, Franco and Nuti, Daniele}, title = {Natural course of positional down-beating nystagmus of peripheral origin.}, journal = {Journal of neurology}, year = {2013}, volume = {260}, issue = {6}, pages = {1489--1496}, doi = {https://doi.org/10.1007/s00415-012-6815-9}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Exercise Therapy; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, complications, rehabilitation; Vertigo, complications}, pmid = {23292207} }
Imai, T., Takeda, N., Ito, M. and Inohara, H.	Natural course of positional vertigo in patients with apogeotropic variant of horizontal canal benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2011	Auris, nasus, larynx Vol. 38(1), pp. 2-5	article	DOI
Abstract: The purpose of this study was to assess the natural course of positional vertigo in patients with the apogeotropic variant of horizontal canal type of benign paroxysmal positional vertigo (AH-BPPV), which is reported to be more refractory to physiotherapy than the geotropic variant of horizontal canal type of BPPV (GH-BPPV). 14 patients with AH-BPPV treated without physiotherapy were asked to visit the hospital every 2 weeks. At every follow-up visit, they were interviewed and positional nystagmus was assessed. After the disappearance of positional nystagmus, patients were asked about the time of cessation of the positional vertigo. Thus, the primary outcomes were evaluated by the self-reported onset and remission of positional vertigo. The time course of remission of positional vertigo was then calculated. The average and median period from the onset to natural remission of positional vertigo in patients with AH-BPPV was 13 and 7 days, respectively. We have already reported that the average and median period from the onset to natural remission of positional vertigo in patients with GH-BPPV was 16 and 7 days, respectively (Imai et al., 2005 [8]). Thus, the natural course of AH-BPPV is not as refractory as that of GH-BPPV.
BibTeX: @article{Imai2011, author = {Imai, Takao and Takeda, Noriaki and Ito, Mahito and Inohara, Hidenori}, title = {Natural course of positional vertigo in patients with apogeotropic variant of horizontal canal benign paroxysmal positional vertigo.}, journal = {Auris, nasus, larynx}, year = {2011}, volume = {38}, issue = {1}, pages = {2--5}, doi = {https://doi.org/10.1016/j.anl.2010.05.011}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Female; Humans; Male; Middle Aged; Remission, Spontaneous; Semicircular Canals; Time Factors; Vertigo, physiopathology}, pmid = {20591594} }
Imai, T., Ito, M., Takeda, N., Uno, A., Matsunaga, T., Sekine, K. and Kubo, T.	Natural course of the remission of vertigo in patients with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2005	Neurology Vol. 64(5), pp. 920-921	article	DOI
Abstract: The authors assessed the natural course of benign paroxysmal positional vertigo (BPPV) in 108 patients who were not treated with canalith repositioning procedure. The average number of days from onset to remission of positional vertigo in patients with posterior canal BPPV (P-BPPV) (39 days) was longer than in those with horizontal canal BPPV (H-BPPV) (16 days). The ratio of patients with H-BPPV to those with BPPV was 33%.
BibTeX: @article{Imai2005, author = {Imai, T and Ito, M and Takeda, N and Uno, A and Matsunaga, T and Sekine, K and Kubo, T}, title = {Natural course of the remission of vertigo in patients with benign paroxysmal positional vertigo.}, journal = {Neurology}, year = {2005}, volume = {64}, issue = {5}, pages = {920--921}, doi = {https://doi.org/10.1212/01.WNL.0000152890.00170.DA}, keywords = {Adult; Age Distribution; Age Factors; Aged; Aged, 80 and over; Disease Progression; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, etiology, physiopathology; Otolithic Membrane, physiopathology; Postural Balance, physiology; Posture, physiology; Remission, Spontaneous; Semicircular Canals, physiopathology; Sex Factors; Time Factors; Vertigo, diagnosis, physiopathology}, pmid = {15753441} }
Sekine, K., Imai, T., Sato, G., Ito, M. and Takeda, N.	Natural history of benign paroxysmal positional vertigo and efficacy of Epley and Lempert maneuvers. [Abstract] [BibTeX]	2006	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 135(4), pp. 529-533	article	DOI
Abstract: We assessed the efficacy of Epley maneuver in patients with posterior canal benign paroxysmal positional vertigo (P-BPPV) and Lempert maneuver in patients with horizontal canal BPPV (H-BPPV). In patients with P-BPPV, positional vertigo in patients treated by Epley maneuver was significantly resolved more quickly than that in untreated patients. But in patients with H-BPPV, there were no significant differences of time course in remission of positional vertigo between untreated patients and patients treated by Lempert maneuver. Among the untreated patients, the positional vertigo in patients with H-BPPV was significantly resolved more quickly than that in patients with P-BPPV. Epley maneuver was effective for the treatment of patients with P-BPPV, whereas the efficacy of Lempert maneuver for the treatment of patients with H-BPPV was limited. The natural courses in remission of positional vertigo in untreated patients with H-BPPV showed significantly faster resolution than that in patients with P-BPPV.
BibTeX: @article{Sekine2006, author = {Sekine, Kazunori and Imai, Takao and Sato, Go and Ito, Mahito and Takeda, Noriaki}, title = {Natural history of benign paroxysmal positional vertigo and efficacy of Epley and Lempert maneuvers.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2006}, volume = {135}, issue = {4}, pages = {529--533}, doi = {https://doi.org/10.1016/j.otohns.2005.09.021}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Child; Female; Humans; Male; Middle Aged; Physical Therapy Modalities; Posture; Remission Induction; Vertigo, therapy}, pmid = {17011412} }
Shim, D.B., Ko, K.M., Lee, J.H., Park, H.J. and Song, M.H.	Natural history of horizontal canal benign paroxysmal positional vertigo is truly short. [Abstract] [BibTeX]	2015	Journal of neurology Vol. 262(1), pp. 74-80	article	DOI
Abstract: The objective of the study is to characterize the natural course of positional vertigo and nystagmus in patients with horizontal canal benign paroxysmal positional vertigo (h-BPPV) and to analyze the difference in the natural course between the two variants of h-BPPV. We conducted a prospective study in 106 patients with geotropic type h-BPPV [h-BPPV (Geo)] (n = 43) and apogeotropic type h-BPPV [h-BPPV (Apo)] (n = 63) who agreed and signed the written informed consent of no treatment. All patients were asked to answer a detailed interview about the onset time of positional vertigo and to visit the hospital every 1-3 days. At every visit, they were interviewed about cessation time of positional vertigo and positional nystagmus was assessed. The mean period ± SD between the onset and remission of vertigo in the h-BPPV (Geo) was 6.7 ± 6.3 days, whereas that in the h-BPPV (Apo) was 3.7 ± 4.1 days. In addition, the mean period ± SD from the initial diagnosis to the disappearance of positional nystagmus in the h-BPPV (Geo) was 4.7 ± 3.9 days, whereas that in the h-BPPV (Apo) was 4.4 ± 5.0 days. Although the duration until natural remission of positional nystagmus did not differ between the two variants of h-BPPV, the remission of vertigo occurred faster in h-BPPV (Apo) than h-BPPV (Geo) (p < 0.05). The natural course of h-BPPV is much shorter than that indicated in previous reports. The positional vertigo disappeared faster in the h-BPPV (Apo) compared to the h-BPPV (Geo) unlike the positional nystagmus.
BibTeX: @article{Shim2015, author = {Shim, Dae Bo and Ko, Kyung Min and Lee, Joon Hee and Park, Hong Ju and Song, Mee Hyun}, title = {Natural history of horizontal canal benign paroxysmal positional vertigo is truly short.}, journal = {Journal of neurology}, year = {2015}, volume = {262}, issue = {1}, pages = {74--80}, doi = {https://doi.org/10.1007/s00415-014-7519-0}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, physiopathology; Disease Progression; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nystagmus, Physiologic, physiology; Vestibular Function Tests; Young Adult}, pmid = {25305003} }
Mikulec, A.A., Kowalczyk, K.A., Pfitzinger, M.E., Harris, D.A. and Jackson, L.E.	Negative association between treated osteoporosis and benign paroxysmal positional vertigo in women. [Abstract] [BibTeX]	2010	The Journal of laryngology and otology Vol. 124(4), pp. 374-376	article	DOI
Abstract: To determine the degree of association, if any, between benign paroxysmal positional vertigo and osteoporosis, both of which are disorders of impaired calcium carbonate homeostasis. A retrospective chart review was undertaken in two otology clinics to assess the prevalence of treated osteoporosis in 260 women with and without benign paroxysmal positional vertigo, between the ages of 51 and 80 years. There was a statistically significant, negative association between benign paroxysmal positional vertigo and treated osteoporosis in women aged 51 to 60 years. We also observed a trend towards a negative association for women in their 60s, and for the group as a whole. Osteoporosis, or the medication used to treat it, may provide protection against benign paroxysmal positional vertigo.
BibTeX: @article{Mikulec2010, author = {Mikulec, A A and Kowalczyk, K A and Pfitzinger, M E and Harris, D A and Jackson, L E}, title = {Negative association between treated osteoporosis and benign paroxysmal positional vertigo in women.}, journal = {The Journal of laryngology and otology}, year = {2010}, volume = {124}, issue = {4}, pages = {374--376}, doi = {https://doi.org/10.1017/S002221510999209X}, keywords = {Age Factors; Aged; Aged, 80 and over; Diphosphonates, therapeutic use; Female; Humans; Middle Aged; Osteoporosis, drug therapy, epidemiology; Prevalence; Retrospective Studies; Vertigo, epidemiology}, pmid = {19930786} }
Goto, F., Tsutsumi, T., Nakamura, I. and Ogawa, K.	Neurally mediated syncope presenting with paroxysmal positional vertigo and tinnitus. [Abstract] [BibTeX]	2012	Auris, nasus, larynx Vol. 39(5), pp. 531-533	article	DOI
Abstract: A 72-year-old man with positional vertigo and tinnitus was referred to us. He did not want to perform provoking test except once due to his fear. No positional nystagmus was provoked. He found that his attacks usually occurred when he lay on his right ear. From his clinical history, benign paroxysmal positional vertigo was suspected. Conventional pharmacotherapy as well as non-specific physical therapy did not have significant effect. His feeling of positional vertigo with pyrosis was actually presyncope. We suspected cardiovascular disorders, and referred him to a cardiologist. Portable cardiogram monitoring revealed paroxysmal bradycardia. He was diagnosed with neurally mediated syncope, and a pacemaker was implanted. His paroxysmal dizziness soon disappeared. It is important to study the clinical history of the patients in detail, as they are not always able to accurately explain their symptoms. We should carefully rule out cardiovascular disorders, especially when we see the patients with suspected BPPV without the characteristic positional nystagmus.
BibTeX: @article{Goto2012, author = {Goto, Fumiyuki and Tsutsumi, Tomoko and Nakamura, Iwao and Ogawa, Kaoru}, title = {Neurally mediated syncope presenting with paroxysmal positional vertigo and tinnitus.}, journal = {Auris, nasus, larynx}, year = {2012}, volume = {39}, issue = {5}, pages = {531--533}, doi = {https://doi.org/10.1016/j.anl.2011.10.003}, keywords = {Aged; Benign Paroxysmal Positional Vertigo; Bradycardia, complications, diagnosis, therapy; Diagnosis, Differential; Dizziness, etiology; Humans; Male; Pacemaker, Artificial; Syncope, Vasovagal, etiology; Tinnitus, etiology; Vertigo, diagnosis, etiology; Vestibular Function Tests}, pmid = {22062400} }
Baloh, R.W.	Neurology-important advances in clinical medicine: benign paroxysmal positional vertigo. [BibTeX]	1982	The Western journal of medicine Vol. 137(4), pp. 311-312	article
BibTeX: @article{Baloh1982, author = {Baloh, R W}, title = {Neurology-important advances in clinical medicine: benign paroxysmal positional vertigo.}, journal = {The Western journal of medicine}, year = {1982}, volume = {137}, issue = {4}, pages = {311--312}, pmid = {18749213} }
Marcelli, V., Piazza, F., Pisani, F. and Marciano, E.	Neuro-otological features of benign paroxysmal vertigo and benign paroxysmal positioning vertigo in children: a follow-up study. [Abstract] [BibTeX]	2006	Brain & development Vol. 28(2), pp. 80-84	article	DOI
Abstract: Causes of benign episodic vertigo in paediatric age include benign paroxysmal vertigo of childhood (BPV) and benign paroxysmal positional vertigo (BPPV). The aim is to review the clinical, audiological and vestibular findings in a cohort of children with BPV and in a group of children with BPPV and to highlight the differences useful to formulating a differential diagnosis. Eighteen children, aged 4-9 years, consecutively examined for paroxysmal attacks of dizziness and/or vertigo attacks between January 2002 and December 2002 entered our study. The clinical characteristics of vertigo, presence of triggering factors, family history of migraine, presence of motion sickness, migraine and other accompanying symptoms were considered. Neurological, ophthalmologic, vestibular and auditory functions were assessed. Eight children suffered from BPPV and ten children from BPV. In the BPPV group, the vestibular examination was normal except for the Dix-Hallpike maneuver. Liberatory maneuvers were immediately effective in all patients and all remained symptom-free during the follow-up. In the BPV group, the vestibular examination was positive in 3 patients but none had positive Dix-Hallpike maneuver. All patients with BPV have a positive family history of migraine and seven had a history of motion sickness. In all, migraine was present one year before the vertigo symptoms, with a frequency of at least two migraine episodes a month. BPV differs from BPPV in terms of family history, clinical symptoms, otoneurological signs, therapy and clinical evolution. BPPV is characterized by specific otoneurological signs, and must be treated with liberatory maneuvers: neither medical therapy nor strict follow-up is needed.
BibTeX: @article{Marcelli2006, author = {Marcelli, Vincenzo and Piazza, Fabio and Pisani, Francesco and Marciano, Elio}, title = {Neuro-otological features of benign paroxysmal vertigo and benign paroxysmal positioning vertigo in children: a follow-up study.}, journal = {Brain & development}, year = {2006}, volume = {28}, issue = {2}, pages = {80--84}, doi = {https://doi.org/10.1016/j.braindev.2005.05.003}, keywords = {Adolescent; Child; Child, Preschool; Female; Follow-Up Studies; Humans; Male; Nystagmus, Pathologic, complications; Posture; Retrospective Studies; Severity of Illness Index; Vertigo, physiopathology; Vestibular Function Tests; Vestibule, Labyrinth, physiopathology}, pmid = {16168599} }
Porta-Etessam, J., García-Cobos, R., Cuadrado, M.L., Casanova, I., Lapeña, T. and García-Ramos, R.	Neuro-otological symptoms in patients with migraine. [Abstract] [BibTeX]	2011	Neurologia (Barcelona, Spain) Vol. 26(2), pp. 100-104	article	DOI
Abstract: Neurootological symptoms are common in patients with migraine, and have been reported to be associated with diverse conditions. A total of 70 patients with a diagnosis of episodic migraine, with or without aura, attending our Migraine Unit were selected. The specific variables studied were the diagnosis of instability, psycho-physiological dizziness, presyncopal symptoms, benign paroxysmal positional vertigo (BPPV), migraine associated recurrent vertigo (MARV), and Meniere's disease. A total of 44.3% of cases had orthostatism or syncope, 15.7% with instability (possibly due to bilateral vestibular hypofunction), 14.2% with MARV and 8.6% with BPPV. The presence of BPPV was observed in older patients (40 years), whilst MARV was a condition seen in younger ones (35 years). These findings are of interest and remind us that benign paroxysmal vertigo is a childhood condition and age is a risk for BPPV. Migraine patients often present with neuro-otological symptoms that can be classified as inter-episodic and episodic symptoms, and specific and non-specific migraine symptoms. This approach is of obvious pathophysiological interest, given that MARV and the possible vestibular hypofunction of migraine patients are symptoms that share physiological aspects with migraine, while the orthostatism symptoms and BPPV are non-specific and are seen to be associated with other conditions.
BibTeX: @article{Porta-Etessam2011, author = {Porta-Etessam, J and García-Cobos, R and Cuadrado, M L and Casanova, I and Lapeña, T and García-Ramos, R}, title = {Neuro-otological symptoms in patients with migraine.}, journal = {Neurologia (Barcelona, Spain)}, year = {2011}, volume = {26}, issue = {2}, pages = {100--104}, doi = {https://doi.org/10.1016/j.nrl.2010.06.001}, keywords = {Adolescent; Adult; Ear Diseases, etiology; Female; Humans; Male; Middle Aged; Migraine Disorders, complications, diagnosis; Nervous System Diseases, etiology; Young Adult}, pmid = {21163190} }
Bruzzone, M.G., Grisoli, M., De Simone, T. and Regna-Gladin, C.	Neuroradiological features of vertigo. [Abstract] [BibTeX]	2004	Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology Vol. 25 Suppl 1, pp. S20-S23	article	DOI
Abstract: The diagnostic pathway in a patient with vertigo starts with the accurate evaluation of medical history followed by a general physical and neurological examination. This step can often lead to the identification of the correct cause of the disease or, at least, to a distinction between peripheral and central vertigo. Neuroradiological investigations have to be considered as elective diagnostic procedures and include: computed tomography (CT), magnetic resonance (MR), MR angiography (MRA), angiography. For the diagnosis of peripheral vertigo, benign paroxysmal positional vertigo, labyrinthitis, Meniere disease, perilymphatic fistula, local trauma, toxic labyrinthitis, acute otitis media and chronic middle ear effusion,the role of imaging techniques is controversial. CT and MR are performed to rule out other pathologies and to confirm the diagnosis. Increased resolution and application of special MR sequences enhancing the intralabyrinthine fluids have enabled more detailed analysis of labyrinthine structures and pathology. Both T2 and T1 contrast sequences are necessary. A high resolution CT study is required when otitis media is suspected and in the follow-up of post-traumatic vertigo. The causes of central vertigo are numerous and include: vertebro-basilar circulation vascular events, multiple sclerosis (MS), migraine-associated vertigo, cerebellar and brainstem tumors, CNS infections. Among them cerebrovascular ischemia and multiple sclerosis are the most frequent. In these situations imaging studies become mandatory. CT can diagnose most cerebellar hemorrhages and some cerebellar and brainstem acute ischemia, enhanced MR has proved to be the most sensitive tool to detect posterior fossa lesion. Diffusion-weighted MR can reveal acute ischemic changes before routine MR. There has been evidence that MR angiography, providing angiogram-like images of the intracranial vessels may sometimes avoid invasive angiography. MRA resolution is not as good as traditional angiography and may also be compromised by movements and other artifacts. Selective angiography of the posterior circulation is often indicated for therapeutic decisions.
BibTeX: @article{Bruzzone2004, author = {Bruzzone, M G and Grisoli, M and De Simone, T and Regna-Gladin, C}, title = {Neuroradiological features of vertigo.}, journal = {Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology}, year = {2004}, volume = {25 Suppl 1}, pages = {S20--S23}, doi = {https://doi.org/10.1007/s10072-004-0211-x}, keywords = {Brain, diagnostic imaging, pathology, physiopathology; Humans; Magnetic Resonance Angiography, standards; Magnetic Resonance Imaging, standards; Tomography, X-Ray Computed, standards; Vertebrobasilar Insufficiency, diagnostic imaging, pathology, physiopathology; Vertigo, diagnostic imaging, pathology, physiopathology; Vestibular Diseases, diagnostic imaging, pathology, physiopathology; Vestibule, Labyrinth, diagnostic imaging, pathology, physiopathology}, pmid = {15045615} }
Jáuregui-Renaud, K., Gutierrez-Marquez, A., Viveros-Rentería, L., Ramos-Toledo, V. and Gómez-Alvarez, F.	Neurotology symptoms at referral to vestibular evaluation. [Abstract] [BibTeX]	2013	Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale Vol. 42, pp. 55	article	DOI
Abstract: Dizziness-vertigo is common in adults, but clinical providers may rarely diagnose vestibular impairment and referral could be delayed. To assess neurotology symptoms (including triggers) reported by patients with peripheral vestibular disease, during the year just before their referral to vestibular evaluation. 282 patients with peripheral vestibular disease and 282 control subjects accepted to participate. They had no middle ear, retinal, neurological, psychiatric, autoimmune or autonomic disorders. They reported their symptoms by a standardized questionnaire along with their anxiety/depression symptoms. Patients were referred after months or years from the onset of their symptoms, 24% of them reported frequent falls with a long clinical evolution; 10% of them reported no vertigo but instability related to specific triggers; 86% patients and 12% control subjects reported instability when moving the head rapidly and 79% patients and 6% control subjects reported instability when changing posture. Seven out of the 9 symptoms explored by the questionnaire allowed the correct classification of circa 95% of the participants (Discriminant function analysis, p < 0.001). High blood pressure, dyslipidemia and anxiety/depression symptoms showed a mild correlation with the total score of symptoms (multiple R2 =0.18, p < 0.001). Late referral to vestibular evaluation may underlie a history of frequent falls; some patients may not report vertigo, but instability related to specific triggers, which could be useful to prompt vestibular evaluation. High blood pressure, dyslipidemia and anxiety/depression symptoms may have a mild influence on the report of symptoms of vestibular disease in both, patients and control subjects.
BibTeX: @article{Jauregui-Renaud2013, author = {Jáuregui-Renaud, Kathrine and Gutierrez-Marquez, Aralia and Viveros-Rentería, Leticia and Ramos-Toledo, Verónica and Gómez-Alvarez, Fátima}, title = {Neurotology symptoms at referral to vestibular evaluation.}, journal = {Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale}, year = {2013}, volume = {42}, pages = {55}, doi = {https://doi.org/10.1186/1916-0216-42-55}, keywords = {Accidental Falls, statistics & numerical data; Adolescent; Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Dizziness, etiology; Female; Humans; Male; Meniere Disease, diagnosis; Middle Aged; Multivariate Analysis; Referral and Consultation; Vertigo, diagnosis, etiology; Vestibular Diseases, complications, diagnosis; Young Adult}, pmid = {24279682} }
Ryu, H., Yamamoto, S., Sugiyama, K. and Nozue, M.	Neurovascular compression syndrome of the eighth cranial nerve. What are the most reliable diagnostic signs? [Abstract] [BibTeX]	1998	Acta neurochirurgica Vol. 140(12), pp. 1279-1286	article
Abstract: Forty-three surgical cases were retrospectively analyzed to establish diagnostic criteria and operative indications for vertigo and tinnitus due to neurovascular compression (NVC) of the eighth cranial nerve (8th N). Many NVC syndromes were mistakenly diagnosed as Ménière's disease or benign paroxysmal positional vertigo. NVC was confirmed in 31 of the 43 patients. Neurovascular decompression (NVD) resulted in complete recovery or marked improvement of subjective symptoms in all 19 cases with vertigo (100%), and in 19 of 29 patients with tinnitus (65.5%). Multiple factor analysis revealed that abnormal caloric responses have high diagnostic value for vertigo due to NVC. Vertigo due to NVC is of short duration (a few sec to a few min.) in the early phase of the disease, which becomes longer and hearing becomes impaired as the history of NVC lengthens. Low pitch pulsatile and high pitch continuous tinnitus are probably due to NVC and are cured by NVD if hearing is still preserved. Tinnitus associated with hemifacial spasm is strongly indicative of NVD. Decompression of the 8th N should be performed in the early phase of disease, since cochlear and vestibular functions are irreversibly impaired if NVC continues for a long period of time.
BibTeX: @article{Ryu1998, author = {Ryu, H and Yamamoto, S and Sugiyama, K and Nozue, M}, title = {Neurovascular compression syndrome of the eighth cranial nerve. What are the most reliable diagnostic signs?}, journal = {Acta neurochirurgica}, year = {1998}, volume = {140}, issue = {12}, pages = {1279--1286}, keywords = {Adult; Aged; Diagnosis, Differential; Factor Analysis, Statistical; Humans; Male; Middle Aged; Nerve Compression Syndromes, complications, diagnosis, surgery; Retrospective Studies; Tinnitus, diagnosis, etiology, surgery; Vertigo, diagnosis, etiology, surgery; Vestibulocochlear Nerve, blood supply, surgery}, pmid = {9932129} }
Mulavara, A.P., Cohen, H.S., Peters, B.T., Sangi-Haghpeykar, H. and Bloomberg, J.J.	New analyses of the sensory organization test compared to the clinical test of sensory integration and balance in patients with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2013	The Laryngoscope Vol. 123(9), pp. 2276-2280	article	DOI
Abstract: To determine whether the Sensory Organization Test (SOT) of the computerized dynamic posturography battery or the Clinical Test of Sensory Integration and Balance (CTSIB) is more likely to indicate balance disorders in people with benign paroxysmal positional vertigo (BPPV). Normal controls were compared to patients with unilateral BPPV of the posterior semicircular canal. Subjects performed tests with eyes open or closed on stable and unstable surfaces, with head still or with head moving at 0.33 Hz in pitch or yaw. Dependent variables were the percent time of the standard duration each subject could perform the task, the number of head motions made, and kinematic variables measured with head- and torso-mounted inertial motion units. Because equilibrium scores of control subjects improved significantly over repeated trials on SOT, patients were given only one trial per condition. For percent time between-group differences were found on CTSIB with eyes closed, on foam, head moving in yaw showing significantly reduced performance by BPPV subjects compared to controls. Compared to controls, patients made significantly fewer head movements on CTSIB, eyes closed, on foam, head still, in pitch and yaw. Kinematic data also differed between the groups on tests with eyes closed and unstable surfaces with different head movement combinations, indicating increased instability in BPPV patients. For screening, CTSIB with head movements is more likely than SOT to indicate balance deficits, especially when dependent measures include percent time as well as head movement counts and kinematic measures.
BibTeX: @article{Mulavara2013, author = {Mulavara, Ajitkumar P and Cohen, Helen S and Peters, Brian T and Sangi-Haghpeykar, Haleh and Bloomberg, Jacob J}, title = {New analyses of the sensory organization test compared to the clinical test of sensory integration and balance in patients with benign paroxysmal positional vertigo.}, journal = {The Laryngoscope}, year = {2013}, volume = {123}, issue = {9}, pages = {2276--2280}, doi = {https://doi.org/10.1002/lary.24075}, keywords = {Adult; Benign Paroxysmal Positional Vertigo; Case-Control Studies; Female; Head Impulse Test, methods; Humans; Male; Middle Aged; Postural Balance, physiology; Reference Values; Semicircular Canals, physiopathology; Sensitivity and Specificity; Vertigo, diagnosis; Vestibular Function Tests, methods; Young Adult; Balance testing; Romberg; screening; vestibular testing}, pmid = {23553110} }
Epley, J.M.	New dimensions of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	1980	Otolaryngology and head and neck surgery Vol. 88(5), pp. 599-605	article
Abstract: Twenty-nine patients who demonstrated the classic nystagmus of benign paroxysmal positional vertigo in the provocative, ear-down position had a high incidence of concurrent symptoms. These included vertigo provoked by arising, bending over, head rotation, linear acceleration, and vertical oscillation. Some have not been reported previously in relation to this syndrome. Elimination of both concurrent and classic symptoms via singular neurectomy in nine patients indicates a common pathophysiologic mechanism, probably involving cuplolithiasis in the posterior semicircular canal. These concurrent symptoms should be considered part of the syndrome.
BibTeX: @article{Epley1980, author = {Epley, J M}, title = {New dimensions of benign paroxysmal positional vertigo.}, journal = {Otolaryngology and head and neck surgery}, year = {1980}, volume = {88}, issue = {5}, pages = {599--605}, keywords = {Adult; Calculi, complications; Cranial Nerves, surgery; Female; Humans; Male; Nystagmus, Pathologic, physiopathology; Posture; Semicircular Canals, innervation; Vertigo, diagnosis, physiopathology, surgery}, pmid = {7443266} }
Cohen, H.S.	New epidemiological findings on benign paroxysmal positional vertigo. [BibTeX]	2007	Journal of neurology, neurosurgery, and psychiatry Vol. 78(7), pp. 663	article	DOI
BibTeX: @article{Cohen2007a, author = {Cohen, H S}, title = {New epidemiological findings on benign paroxysmal positional vertigo.}, journal = {Journal of neurology, neurosurgery, and psychiatry}, year = {2007}, volume = {78}, issue = {7}, pages = {663}, doi = {https://doi.org/10.1136/jnnp.2006.109447}, keywords = {Adult; Age of Onset; Aged; Data Collection; Humans; Incidence; Middle Aged; Posture; Prevalence; Vertigo, epidemiology}, pmid = {17135453} }
Li, J. and Li, H.	New repositioning techniques for benign paroxysmal positional vertigo: the Li repositioning manoeuvres. [Abstract] [BibTeX]	2010	The Journal of laryngology and otology Vol. 124(8), pp. 905-908	article	DOI
Abstract: Benign paroxysmal positional vertigo can be treated by repositioning manoeuvres. Current manoeuvres can be cumbersome to perform and require determination of the canal affected, usually by assessing nystagmus direction on provocation. We developed a new series of manoeuvres to manage benign paroxysmal positional vertigo of each semicircular canal. The canal affected, and thus the manoeuvre used in each case, was determined by the patient's subjective report of vertigo on provocative head positioning. The reported manoeuvres were utilised in 216 patients, with an excellent rate of symptom resolution (96.7 per cent). The Li particle repositioning manoeuvres are effective, reliable and simply performed alternatives for the management of benign paroxysmal positional vertigo.
BibTeX: @article{Li2010a, author = {Li, J and Li, H}, title = {New repositioning techniques for benign paroxysmal positional vertigo: the Li repositioning manoeuvres.}, journal = {The Journal of laryngology and otology}, year = {2010}, volume = {124}, issue = {8}, pages = {905--908}, doi = {https://doi.org/10.1017/S0022215109992520}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo; Female; Humans; Male; Middle Aged; Patient Positioning, methods; Posture; Rotation; Semicircular Canals, physiopathology; Treatment Outcome; Vertigo, diagnosis, therapy; Young Adult}, pmid = {20053308} }
Imai, T., Higashi-Shingai, K., Takimoto, Y., Masumura, C., Hattori, K. and Inohara, H.	New scoring system of an interview for the diagnosis of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2016	Acta oto-laryngologica Vol. 136(3), pp. 283-288	article	DOI
Abstract: Conclusion This study investigated a novel instrument to diagnose benign paroxysmal positional vertigo (BPPV). Objective To develop a new scoring system of an interview for the diagnosis of BPPV. Methods The answers to questions on dizziness and/or vertigo (D/V) (571 patients) were analyzed and the questions for which the answers differed significantly between the patients with and without BPPV were selected. Results This study established an intensive questionnaire with a scoring system. It consists of the following questions: (1) Is rotary vertigo a characteristic of your D/V? (2) Is your D/V triggered when you roll your head over in a supine position? (3) Does your D/V disappear within 5 min? (4) Have you previously experienced hearing loss in one ear, or have you experienced hearing loss, tinnitus, or ear fullness with this D/V? One point each was given to an answer of 'yes' to questions (1) and (2). Two points were given to an answer of 'yes' to question (3). One point was subtracted upon an answer of 'yes' to question (4). When the total score was greater than two points, the patient was diagnosed with BPPV. The sensitivity of the diagnosis of BPPV by this scoring system was 81% and the specificity was 69%.
BibTeX: @article{Imai2016, author = {Imai, Takao and Higashi-Shingai, Kayoko and Takimoto, Yasumitsu and Masumura, Chisako and Hattori, Kenji and Inohara, Hidenori}, title = {New scoring system of an interview for the diagnosis of benign paroxysmal positional vertigo.}, journal = {Acta oto-laryngologica}, year = {2016}, volume = {136}, issue = {3}, pages = {283--288}, doi = {https://doi.org/10.3109/00016489.2015.1121547}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Algorithms; Benign Paroxysmal Positional Vertigo, diagnosis; Child; Child, Preschool; Female; Humans; Interviews as Topic; Male; Middle Aged; Retrospective Studies; Young Adult; Benign paroxysmal positional vertigo; interview; nystagmus; sensitivity; specificity}, pmid = {26838579} }
Yacovino, D.A., Hain, T.C. and Gualtieri, F.	New therapeutic maneuver for anterior canal benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2009	Journal of neurology Vol. 256(11), pp. 1851-1855	article	DOI
Abstract: This article describes the clinical features of anterior semicircular canal benign paroxysmal positional vertigo (AC-BPPV) and a new therapeutic maneuver for its management. Our study was a retrospective review of cases from an ambulatory tertiary referral center. Thirteen patients afflicted with positional paroxysmal vertigo exhibiting brief positional down-beating nystagmus in positional tests (Dix-Hallpike and head-hanging position) were treated with a maneuver comprised of the following movements: Sequential head positioning beginning supine with head hanging 30 degrees dependent with respect to the body, then supine with head inclined 30 degrees forward, and ending sitting with head 30 degrees forward. All cases showed excellent therapeutic response to our repositioning procedure, i.e. relief of vertigo and elimination of nystagmus. The maneuver described is an option for AC-BPPV treatment.
BibTeX: @article{Yacovino2009, author = {Yacovino, Dario A and Hain, Timothy C and Gualtieri, Francisco}, title = {New therapeutic maneuver for anterior canal benign paroxysmal positional vertigo.}, journal = {Journal of neurology}, year = {2009}, volume = {256}, issue = {11}, pages = {1851--1855}, doi = {https://doi.org/10.1007/s00415-009-5208-1}, keywords = {Adult; Aged; Aged, 80 and over; Clinical Trials as Topic; Disability Evaluation; Female; Head Movements; Humans; Male; Middle Aged; Posture, physiology; Retrospective Studies; Semicircular Canals, physiopathology; Treatment Outcome; Vertigo, physiopathology, therapy; Vestibular Function Tests, methods}, pmid = {19536580} }
Zuma e Maia, F.	New Treatment Strategy for Apogeotropic Horizontal Canal Benign Paroxysmal Positional Vertigo. [Abstract] [BibTeX]	2016	Audiology research Vol. 6(2), pp. 163	article	DOI
Abstract: The apogeotropic variant of horizontal semicircular canal benign paroxysmal positional vertigo (HC-BPPV) is attributed to canalithiasis of the anterior arm or cupulolithiasis. Despite some therapeutic maneuvers, I propose a new treatment strategy for apogeotropic HC-BPPV that is designed to detach both the otoconial debris from the anterior arm of the semicircular canal and the debris that is attached to the utricular side of the cupula using inertia and gravity and based on simulations with a 3D biomechanical model.
BibTeX: @article{ZumaeMaia2016, author = {Zuma e Maia, Francisco}, title = {New Treatment Strategy for Apogeotropic Horizontal Canal Benign Paroxysmal Positional Vertigo.}, journal = {Audiology research}, year = {2016}, volume = {6}, issue = {2}, pages = {163}, doi = {https://doi.org/10.4081/audiores.2016.163}, keywords = {Apogeotropic horizontal canal benign paroxysmal positional vertigo; repositioning maneuver; vertigo}, pmid = {27942374} }
Yamanaka, T., Sawai, Y., Murai, T., Okamoto, H., Fujita, N. and Hosoi, H.	New treatment strategy for cupulolithiasis associated with benign paroxysmal positional vertigo of the lateral canal: the head-tilt hopping exercise. [Abstract] [BibTeX]	2014	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 271(12), pp. 3155-3160	article	DOI
Abstract: This study was performed to determine whether a novel treatment was effective against cupulolithiasis associated with benign paroxysmal positional vertigo (BPPV) of the lateral semicircular canal, which is characterized by apogeotropic direction-changing nystagmus. We herein describe our head-tilt hopping (HtH) exercise, which is designed to release otoconial debris strongly adhered to the cupula. The subjects were trained to hop while tilting their heads laterally. They completed 3 to 5 exercise sessions per day over a 4-week period. Each session ended with a 20-hop trial. The HtH exercises were performed by 27 patients with intractable lateral canal BPPV who exhibited positional vertigo and persistent nystagmus beating toward the uppermost ear for more than 4 weeks, despite performing therapeutic head shaking in the horizontal plane maneuver. All the patients were subjected to the supine roll test before and immediately after the first trial as well as after 1 and 4 weeks of the program to evaluate the effect of the treatment on their apogeotropic nystagmus. Nystagmus of 9 (33.3 %) patients disappeared immediately after the first training session. After 1 and 4 weeks of the training, the number of patients that had experienced either of these improvements had increased to 15 (55.6 %) and 19 (70.4 %) subjects, respectively. These results suggest that HtH exercises aimed at releasing otoconial debris from the cupula are feasible as a new therapy for cupulolithiasis associated with intractable lateral canal BPPV. However, further studies for comparison with control are required to confirm these preliminary results.
BibTeX: @article{Yamanaka2014, author = {Yamanaka, Toshiaki and Sawai, Yachiyo and Murai, Takayuki and Okamoto, Hideyuki and Fujita, Nobuya and Hosoi, Hiroshi}, title = {New treatment strategy for cupulolithiasis associated with benign paroxysmal positional vertigo of the lateral canal: the head-tilt hopping exercise.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2014}, volume = {271}, issue = {12}, pages = {3155--3160}, doi = {https://doi.org/10.1007/s00405-013-2808-2}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo, diagnosis, etiology, therapy; Exercise Therapy, methods; Female; Humans; Lithiasis, complications, diagnosis, physiopathology, therapy; Male; Middle Aged; Nystagmus, Pathologic, diagnosis, etiology, therapy; Otolithic Membrane; Semicircular Canals, pathology, physiopathology; Treatment Outcome}, pmid = {24232831} }
Sczepanek, J., Wiese, B., Hummers-Pradier, E. and Kruschinski, C.	Newly diagnosed incident dizziness of older patients: a follow-up study in primary care. [Abstract] [BibTeX]	2011	BMC family practice Vol. 12, pp. 58	article	DOI
Abstract: Dizziness is a common complaint of older patients in primary care, yet not much is known about the course of incident dizziness. The aim of the study was to follow-up symptoms, subjective impairments and needs of older patients (≥65) with incident dizziness and to determine predictors of chronic dizziness. Furthermore, we analysed general practitioners' (GPs') initial diagnoses, referrals and revised diagnoses after six months. An observational study was performed in 21 primary care practices in Germany, including a four-week and six-month follow-up. A questionnaire comprising characteristic matters of dizziness and a series of validated instruments was completed by 66 participants during enrollment and follow-up (after 1 month and 6 months). After six months, chart reviews and face-to-face interviews were also performed with the GPs. Mean scores of dizziness handicap, depression and quality of life were not or only slightly affected, and did not deteriorate during follow-up; however, 24 patients (34.8%) showed a moderate or severe dizziness handicap, and 43 (62.3%) showed a certain disability in terms of quality of life at the time of enrollment. In multivariate analysis, n = 44 patients suffering from chronic dizziness (dependent variable, i.e. relapsing or persistent at six months) initially had a greater dizziness handicap (OR 1.42, 95%CI 1.05-1.47) than patients with transient dizziness. GPs referred 47.8% of the patients to specialists who detected two additional cases of benign paroxysmal positional vertigo (BPPV). New-onset dizziness relapsed or persisted in a considerable number of patients within six months. This was difficult to predict due to the patients' heterogeneous complaints and characteristics. Symptom persistence does not seem to be associated with deterioration of the psychological status in older primary care patients. Management strategies should routinely consider BPPV as differential diagnosis.
BibTeX: @article{Sczepanek2011, author = {Sczepanek, Julia and Wiese, Birgitt and Hummers-Pradier, Eva and Kruschinski, Carsten}, title = {Newly diagnosed incident dizziness of older patients: a follow-up study in primary care.}, journal = {BMC family practice}, year = {2011}, volume = {12}, pages = {58}, doi = {https://doi.org/10.1186/1471-2296-12-58}, keywords = {Aged; Aged, 80 and over; Dizziness, diagnosis; Female; Follow-Up Studies; Humans; Male; Primary Health Care; Prospective Studies}, pmid = {21702962} }
Casqueiro, J.C., Ayala, A. and Monedero, G.	No more postural restrictions in posterior canal benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2008	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 29(5), pp. 706-709	article	DOI
Abstract: To establish if postural restrictions are useful after repositioning maneuvers in posterior canal benign paroxysmal positional vertigo (BPPV). Prospective double-blind consecutive case study. This study was conducted at a tertiary referral hospital. Three hundred ninety-one consecutive patients diagnosed of posterior canal BPPV with a positive Dix-Hallpike test. Two hundred seven patients diagnosed during the first year of our study were instructed to follow postural restrictions after repositioning maneuvers, and 184 patients who were diagnosed in the second year of our study did not receive any postural restriction after treatment. All of them were reevaluated 10 days later, and they were followed up until their symptoms resolved. We compared the success rates of each treatment analyzing the number of maneuvers needed until symptoms resolved, recurrence rate, and subjective recovery at the end of treatment between both groups. There were no statistical differences in number of maneuvers needed to resolve symptoms between patients who restricted their movements (80.2% of success with 1 maneuver) and those who did not (72.3%). Recurrence rate was not statistically different among groups (2.3 and 3.1%), and almost all patients declared to feel better after treatment in both groups (97.1 and 98.9%). Efficacy of Epley maneuver is not improved by postural restrictions. Therefore, we do not recommend any postural restrictions to patients with posterior canal BPPV.
BibTeX: @article{Casqueiro2008, author = {Casqueiro, Jose Carlos and Ayala, Alejandra and Monedero, Gerardo}, title = {No more postural restrictions in posterior canal benign paroxysmal positional vertigo.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2008}, volume = {29}, issue = {5}, pages = {706--709}, doi = {https://doi.org/10.1097/MAO.0b013e31817d01e8}, keywords = {Adult; Aged; Aged, 80 and over; Double-Blind Method; Female; Humans; Male; Middle Aged; Posture; Prospective Studies; Vertigo, physiopathology, therapy}, pmid = {18520622} }
Pace-Balzan, A. and Rutka, J.A.	Non-ampullary plugging of the posterior semicircular canal for benign paroxysmal positional vertigo. [Abstract] [BibTeX]	1991	The Journal of laryngology and otology Vol. 105(11), pp. 901-906	article
Abstract: Benign paroxysmal positional vertigo (BPPV) is a common condition which is usually self-limiting. Surgical treatment is rarely required and for many years the mainstay of such treatment has been singular neurectomy (posterior ampullary nerve section). A new operation has recently been described for the treatment of BPPV involving occlusion of the posterior semicircular canal. We have performed this operation on five patients with intractable BPPV and report our results with follow up of between 12 and 36 months from operation. The excellent results of posterior semicircular canal occlusion which have been previously reported in the literature are confirmed by our experience. In our opinion the operation is a safe and effective alternative to singular neurectomy.
BibTeX: @article{Pace-Balzan1991, author = {Pace-Balzan, A and Rutka, J A}, title = {Non-ampullary plugging of the posterior semicircular canal for benign paroxysmal positional vertigo.}, journal = {The Journal of laryngology and otology}, year = {1991}, volume = {105}, issue = {11}, pages = {901--906}, keywords = {Adult; Audiometry, Evoked Response; Electronystagmography; Female; Follow-Up Studies; Hearing Loss, Conductive, etiology; Humans; Male; Middle Aged; Postoperative Complications; Radiography; Semicircular Canals, diagnostic imaging, surgery; Vertigo, diagnostic imaging, surgery}, pmid = {1761943} }
Sasaki, O., Gagey, P.M., Ouaknine, A.M., Martinerie, J., Le Van Quyen, M., Toupet, M. and L'Heritier, A.	Nonlinear analysis of orthostatic posture in patients with vertigo or balance disorders. [Abstract] [BibTeX]	2001	Neuroscience research Vol. 41(2), pp. 185-192	article
Abstract: The stabilometry signals involve irregular and unpredictable components. In order to identify the hidden dynamics that underlie the multi-link networks consisted of the multiple sensory systems, motor components and central integration, we applied a nonlinear analysis to these signals. We evaluated the postural control differences between eyes open and closed by means of the dynamical closeness between two states, known as similarity index, for the patients with vestibular disorders. We were able to demonstrate that some patients (eight of 21) showed a difference between the conventional and nonlinear measures. Especially, the similarity index tended to reflect the clinical course of the vestibular compensation and the findings in the patients with benign paroxysmal positional vertigo (BPPV) demonstrated that its vestibular function may include various pathologies besides canalithiasis. These results suggest that nonlinear analysis can elucidate the complex postural control networks and this procedure may also be able to provide the new findings of the stabilometry examinations.
BibTeX: @article{Sasaki2001, author = {Sasaki, O and Gagey, P M and Ouaknine, A M and Martinerie, J and Le Van Quyen, M and Toupet, M and L'Heritier, A}, title = {Nonlinear analysis of orthostatic posture in patients with vertigo or balance disorders.}, journal = {Neuroscience research}, year = {2001}, volume = {41}, issue = {2}, pages = {185--192}, keywords = {Adult; Aged; Algorithms; Central Nervous System, physiopathology; Cues; Feedback, physiology; Female; Humans; Male; Middle Aged; Nonlinear Dynamics; Orientation, physiology; Postural Balance, physiology; Posture, physiology; Reference Values; Space Perception, physiology; Stochastic Processes; Vertigo, diagnosis, physiopathology; Vestibule, Labyrinth, injuries, pathology, physiopathology}, pmid = {11591445} }
Lea, J., Lechner, C., Halmagyi, G.M. and Welgampola, M.S.	Not so benign positional vertigo: paroxysmal downbeat nystagmus from a superior cerebellar peduncle neoplasm. [BibTeX]	2014	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 35(6), pp. e204-e205	article	DOI
BibTeX: @article{Lea2014, author = {Lea, Jane and Lechner, Corinna and Halmagyi, G Michael and Welgampola, Miriam S}, title = {Not so benign positional vertigo: paroxysmal downbeat nystagmus from a superior cerebellar peduncle neoplasm.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2014}, volume = {35}, issue = {6}, pages = {e204--e205}, doi = {https://doi.org/10.1097/MAO.0000000000000245}, keywords = {Aged; Benign Paroxysmal Positional Vertigo, complications, pathology; Cerebellum, pathology; Female; Humans; Magnetic Resonance Imaging; Nystagmus, Pathologic, etiology, pathology}, pmid = {24643027} }
Rose-Martel, M., Smiley, S. and Hincke, M.T.	Novel identification of matrix proteins involved in calcitic biomineralization. [Abstract] [BibTeX]	2015	Journal of proteomics Vol. 116, pp. 81-96	article	DOI
Abstract: Calcitic biomineralization is essential for otoconia formation in vertebrates. This process is characterized by protein-crystal interactions that modulate crystal growth on an extracellular matrix. An excellent model for the study of calcitic biomineralization is the avian eggshell, the fastest known biomineralization process. The objective of this study is to identify and characterize matrix proteins associated with the eggshell mammillary cones, which are hypothesized to regulate the earliest stage of eggshell calcification. Mammillary cones were isolated from 2 models, fertilized and unfertilized, and the released proteins were identified by RP-nanoLC and ES-MS/MS proteomics. Proteomics analysis identified 49 proteins associated with the eggshell membrane fibers and, importantly, 18 mammillary cone-specific proteins with an additional 18 proteins identified as enriched in the mammillary cones. Among the most promising candidates for modulating protein-crystal interactions were extracellular matrix proteins, including ABI family member 3 (NESH) binding protein (ABI3BP), tiarin-like, hyaluronan and proteoglycan link protein 3 (HAPLN3), collagen alpha-1(X), collagen alpha-1(II) and fibronectin, in addition to the calcium binding proteins calumenin, EGF-like repeats and discoidin 1-like domains 3 (EDIL3), nucleobindin-2 and SPARC. In conclusion, we identified several cone-resident proteins that are candidates to regulate initiation of eggshell calcification. Further study of these proteins will determine their roles in modulating calcitic biomineralization and lead to insight into the process of otoconia formation/regeneration. Biomineralization is essential for the development of hard tissues in vertebrates, which includes both calcium phosphate and calcium carbonate structures. Calcitic mineralization by calcium carbonate is an important process in the formation of otoconia, which are gravity receptor organs located in the inner ear and are responsible for balance and for sensing linear acceleration. Deficiencies in the regulation of their biomineralization can lead to otoconia degeneration and eventually benign paroxysmal position vertigo (BPPV), which is the main cause of vertigo in humans. Eggshell formation in chicken is one of the fastest known biomineralization processes and is an excellent model for the study of calcitic biomineralization. Cross-analysis of proteomic data from two mineralized models, fertilized and unfertilized chicken eggshells, identified proteins associated with the mammillary cones that are the sites of initiation of eggshell formation. We hypothesize that these proteins regulate the earliest stages of eggshell calcification. The human homologs of these proteins are therefore potential candidates to play a role in otoconia biomineralization.
BibTeX: @article{Rose-Martel2015, author = {Rose-Martel, Megan and Smiley, Sandy and Hincke, Maxwell T}, title = {Novel identification of matrix proteins involved in calcitic biomineralization.}, journal = {Journal of proteomics}, year = {2015}, volume = {116}, pages = {81--96}, doi = {https://doi.org/10.1016/j.jprot.2015.01.002}, keywords = {Animals; Calcification, Physiologic, physiology; Chickens; Egg Proteins, metabolism; Humans; Proteome, metabolism; Proteomics; Zygote, metabolism; Biomineralization; Calcium carbonate; Eggshell membrane; Mammillary cone; Otoconia}, pmid = {25585129} }
Moreno, N.S. and André, A.P.d.R.	Number of maneuvers need to get a negative Dix-Hallpike test. [Abstract] [BibTeX]	2009	Brazilian journal of otorhinolaryngology Vol. 75(5), pp. 650-653	article
Abstract: Benign Paroxysmal Positional Vertigo is one of the most common causes of dizziness. Its characteristic clinical profile is dizziness at head movements. The main diagnostic maneuver of posterior canal Benign Paroxysmal Positional Vertigo is the Dix-Hallpike test. If the maneuver is positive (vertigo and/or nystagmus), the physician can perform the Epley maneuver on the injured side. This paper aims at checking the number of maneuvers necessary for patients with posterior canal Benign Paroxysmal Positional Vertigo to have a negative Dix-Hallpike test. we carried out a retrospective analysis of 71 charts of patients with posterior canal Benign Paroxysmal Positional Vertigo, who were treated with the modified Epley maneuver. Cross-Sectional Retrospective. We found that 76.00% of the patients analyzed had the symptoms completely resolved and negative Dix-Hallpike test with a single maneuver. Based on our results it is possible to conclude that the number of modified Epley maneuvers is variable depending on the etiology, being that the Benign Paroxysmal Positional Vertigo secondary to the traumatic brain injury needed a greater number of maneuvers for Dix-Hallpike test to become negative.
BibTeX: @article{Moreno2009, author = {Moreno, Nathali Singaretti and André, Ana Paula do Rego}, title = {Number of maneuvers need to get a negative Dix-Hallpike test.}, journal = {Brazilian journal of otorhinolaryngology}, year = {2009}, volume = {75}, issue = {5}, pages = {650--653}, keywords = {Adult; Aged; Aged, 80 and over; Cross-Sectional Studies; Female; Humans; Male; Middle Aged; Physical Therapy Modalities; Retrospective Studies; Treatment Outcome; Vertigo, diagnosis, etiology, therapy}, pmid = {19893930} }
Djukic, T. and Filipovic, N.	Numerical modeling of the cupular displacement and motion of otoconia particles in a semicircular canal. [Abstract] [BibTeX]	2017	Biomechanics and modeling in mechanobiology Vol. 16(5), pp. 1669-1680	article	DOI
Abstract: Balance is achieved and maintained by a balance system called a labyrinth that is composed of three semicircular canals and the otolith organs that sense linear gravity and acceleration. Within each semicircular canal, there is a gelatinous structure called the cupula, which is deformed under the influence of the surrounding endolymph. One of the balance disorders is benign paroxysmal positional vertigo, and one of the pathological conditions that have been identified as possible causes of this syndrome is canalithiasis-disturbance of the endolymph flow and cupular displacement caused by the free-moving otoconia particles within the lumen of the canal. Analysis of phenomena occurring within the semicircular canal can help to explain some balance-related disorders and the response of the vestibular system to external perturbations under various pathological conditions. Numerical simulations allow a study of the influence of a wide range of factors, without the need to perform experiments and clinical examinations. In case of canalithiasis, an accurate explanation and tracking of the motion of otoconia particles in vivo is obviously nearly impossible. In this study, a numerical model was developed to predict the motion of otoconia particles within the semicircular canal and the effect of the endolymph flow and particles on the deformation of the cupula.
BibTeX: @article{Djukic2017, author = {Djukic, Tijana and Filipovic, Nenad}, title = {Numerical modeling of the cupular displacement and motion of otoconia particles in a semicircular canal.}, journal = {Biomechanics and modeling in mechanobiology}, year = {2017}, volume = {16}, issue = {5}, pages = {1669--1680}, doi = {https://doi.org/10.1007/s10237-017-0912-8}, keywords = {Biomechanical Phenomena; Computer Simulation; Endolymph, physiology; Humans; Motion; Numerical Analysis, Computer-Assisted; Otolithic Membrane, metabolism; Semicircular Canals, metabolism; Viscosity; Balance; Deformable membrane; Endolymph flow; Immersed particles; Solid–fluid interaction; Vestibular system}, pmid = {28470420} }
Kerber, K.A., Morgenstern, L.B., Meurer, W.J., McLaughlin, T., Hall, P.A., Forman, J., Fendrick, A.M. and Newman-Toker, D.E.	Nystagmus assessments documented by emergency physicians in acute dizziness presentations: a target for decision support? [Abstract] [BibTeX]	2011	Academic emergency medicine : official journal of the Society for Academic Emergency Medicine Vol. 18(6), pp. 619-626	article	DOI
Abstract: Dizziness is a common presenting complaint to the emergency department (ED), and emergency physicians (EPs) consider these presentations a priority for decision support. Assessing for nystagmus and defining its features are important steps for any acute dizziness decision algorithm. The authors sought to describe nystagmus documentation in routine ED care to determine if nystagmus assessments might be an important target in decision support efforts. Medical records from ED visits for dizziness were captured as part of a surveillance study embedded within an ongoing population-based cohort study. Visits with documentation of a nystagmus assessment were reviewed and coded for presence or absence of nystagmus, ability to draw a meaningful inference from the description, and coherence with the final EP diagnosis when a peripheral vestibular diagnosis was made. Of 1,091 visits for dizziness, 887 (81.3%) documented a nystagmus assessment. Nystagmus was present in 185 of 887 (20.9%) visits. When nystagmus was present, no further characteristics were recorded in 48 of the 185 visits (26%). The documentation of nystagmus (including all descriptors recorded) enabled a meaningful inference about the localization or cause in only 10 of the 185 (5.4%) visits. The nystagmus description conflicted with the EP diagnosis in 113 (80.7%) of the 140 visits that received a peripheral vestibular diagnosis. Nystagmus assessments are frequently documented in acute dizziness presentations, but details do not generally enable a meaningful inference. Recorded descriptions usually conflict with the diagnosis when a peripheral vestibular diagnosis is rendered. Nystagmus assessments might be an important target in developing decision support for dizziness presentations.
BibTeX: @article{Kerber2011, author = {Kerber, Kevin A and Morgenstern, Lewis B and Meurer, William J and McLaughlin, Thomas and Hall, Pamela A and Forman, Jane and Fendrick, A Mark and Newman-Toker, David E}, title = {Nystagmus assessments documented by emergency physicians in acute dizziness presentations: a target for decision support?}, journal = {Academic emergency medicine : official journal of the Society for Academic Emergency Medicine}, year = {2011}, volume = {18}, issue = {6}, pages = {619--626}, doi = {https://doi.org/10.1111/j.1553-2712.2011.01093.x}, keywords = {Acute Disease; Adult; Aged; Benign Paroxysmal Positional Vertigo; Decision Support Techniques; Dizziness, etiology; Emergency Service, Hospital; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic; Nystagmus, Physiologic; Vertigo, complications, diagnosis; Vestibular Neuronitis, complications, diagnosis}, pmid = {21676060} }
VanDerHeyden, C.M., Carender, W.J. and Heidenreich, K.D.	Nystagmus discordance with 2-dimensional videonystagmography in posterior semicircular canal benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2015	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 152(4), pp. 724-728	article	DOI
Abstract: The Dix-Hallpike test is a standard component of the videonystagmography test battery and can diagnose posterior semicircular canal benign paroxysmal positional vertigo. The purpose of this study is to determine the prevalence of discordant, equivocal, and concordant nystagmus tracings in active posterior semicircular canal benign paroxysmal positional vertigo when compared directly with the eye video. Case series with chart review of patients diagnosed with posterior semicircular canal benign paroxysmal positional vertigo by 2-dimensional videonystagmography from August 1, 2007, to August 1, 2012. A tertiary vestibular test laboratory. Ninety-six adults (4 had bilateral involvement) with posterior semicircular canal benign paroxysmal positional vertigo were included. A total of 100 videos with accompanying videonystagmography tracings were reviewed to determine nystagmus trajectory as well as globe position. Descriptive statistics were used to describe prevalence. Fisher exact test was used to compare proportions. Sixty-two percent of cases involved benign paroxysmal positional vertigo of the right posterior semicircular canal, while 38% involved the left posterior semicircular canal. The prevalence of discordant, equivocal, and concordant tracings was 65% (65/100), 29% (29/100), and 6% (6/100). All tracing errors involved the horizontal channel. There was no association between tracing accuracy and the ear of involvement or globe position (P > .05). Two-dimensional videonystagmography tracings are not reliable for identifying nystagmus trajectory in posterior semicircular canal benign paroxysmal positional vertigo.
BibTeX: @article{VanDerHeyden2015, author = {VanDerHeyden, Crystal M and Carender, Wendy J and Heidenreich, Katherine D}, title = {Nystagmus discordance with 2-dimensional videonystagmography in posterior semicircular canal benign paroxysmal positional vertigo.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2015}, volume = {152}, issue = {4}, pages = {724--728}, doi = {https://doi.org/10.1177/0194599814564373}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, complications, diagnosis; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, complications, diagnosis; Semicircular Canals; Vestibular Function Tests; Video Recording; Young Adult; benign paroxysmal positional vertigo; posterior semicircular canal; tracing; videonystagmography}, pmid = {25560403} }
Lee, S.-H., Choi, K.-D., Jeong, S.-H., Oh, Y.-M., Koo, J.-W. and Kim, J.S.	Nystagmus during neck flexion in the pitch plane in benign paroxysmal positional vertigo involving the horizontal canal. [Abstract] [BibTeX]	2007	Journal of the neurological sciences Vol. 256(1-2), pp. 75-80	article	DOI
Abstract: In benign paroxysmal positional vertigo involving the horizontal canal (HC-BPPV), nystagmus may be induced by neck flexion in the pitch plane while sitting (head-bending nystagmus). To determine the characteristics and lateralizing value of head-bending nystagmus in HC-BPPV. Using video-oculography, head-bending nystagmus was recorded in 54 patients with HC-BPPV (32 canalolithiasis and 22 cupulolithiasis). Lesion side was determined by comparing intensity of the nystagmus induced by lateral head turning (head-turning nystagmus) in supine. Head-bending nystagmus was observed in 39 patients (72.2%) and lying-down nystagmus in 41 (75.9%). Thirty three patients (61.1%) showed both types of nystagmus while six (11.1%) had only head-bending and another eight (14.8%) showed only lying-down nystagmus. In 45 patients with asymmetrical head-turning nystagmus, the direction of head-bending nystagmus was mostly toward the affected ear in canalolithasis (88.9%) and toward the intact ear in cupulolithasis (80.0%). In 9 (16.7%) patients whose affected ear could not be determined due to symmetrical head-turning nystagmus, the particle repositioning maneuver based on the direction of head-bending or lying-down nystagmus resulted in the resolution of symptom. Two patients showed a transition from canalo- to cupulolithiasis during head-bending posture. In HC-BPPV, neck flexion in the pitch plane while sitting may generate nystagmus by inducing ampullopetal migration of the otolithic debris in the horizontal canal or by ampullofugal deflection of the cupula by the attached otolithic debris. Head-bending nystagmus may be a valuable sign for lateralizing the involved canal in HC-BPPV, especially when patients show symmetrical head-turning nystagmus. Conversion of canalo- into cupulolithiasis by the neck flexion supports the current explanation of the mechanisms of HC-BPPV.
BibTeX: @article{Lee2007, author = {Lee, Seung-Han and Choi, Kwang-Dong and Jeong, Seong-Hae and Oh, Young-Mi and Koo, Ja-Won and Kim, Ji Soo}, title = {Nystagmus during neck flexion in the pitch plane in benign paroxysmal positional vertigo involving the horizontal canal.}, journal = {Journal of the neurological sciences}, year = {2007}, volume = {256}, issue = {1-2}, pages = {75--80}, doi = {https://doi.org/10.1016/j.jns.2007.02.026}, keywords = {Adult; Aged; Aged, 80 and over; Female; Head Movements, physiology; Humans; Male; Middle Aged; Neck, physiopathology; Nystagmus, Pathologic, pathology, physiopathology; Posture; Reflex, physiology; Semicircular Canals, physiopathology; Vertigo, physiopathology}, pmid = {17382962} }
Yagi, T. and Ushio, K.	Nystagmus in benign paroxysmal positional vertigo: a three-component analysis. [Abstract] [BibTeX]	1995	Acta oto-laryngologica. Supplementum Vol. 520 Pt 2, pp. 238-240	article
Abstract: Three-component analysis of nystagmus was carried out in 10 patients with benign paroxysmal positional vertigo (BPPV), focusing on the horizontal, vertical and torsional components, with the aid of a computerized eye movement analysis system. Using a pendular rotation stimulus we also measured three eye components of eye movement evoked from the vertical semicircular canals in 3 normal subject; two components (vertical and torsional) of nystagmus in patients with BPPV were compared with that of eye movements derived from the vertical semicircular canals. The time course of slow phase velocity of three components in BPPV patients was similar. In BPPV, the torsional component of eye movements was larger than that of the vertical component without obvious horizontal eye deviation. On the other hand, the vertical component from vertical semicircular canals was larger than that of the torsional component. From the view point of the vestibulo-ocular reflex, it is difficult to support the idea that the pathology of BPPV is localized only to the posterior semicircular canal.
BibTeX: @article{Yagi1995, author = {Yagi, T and Ushio, K}, title = {Nystagmus in benign paroxysmal positional vertigo: a three-component analysis.}, journal = {Acta oto-laryngologica. Supplementum}, year = {1995}, volume = {520 Pt 2}, pages = {238--240}, keywords = {Electronystagmography; Humans; Nystagmus, Pathologic, diagnosis, physiopathology; Nystagmus, Physiologic, physiology; Orientation, physiology; Postural Balance, physiology; Posture, physiology; Semicircular Canals, physiopathology; Signal Processing, Computer-Assisted; Torsion Abnormality; Vertigo, diagnosis, physiopathology; Videotape Recording}, pmid = {8749128} }
White, J. and Krakovitz, P.	Nystagmus in Enlarged Vestibular Aqueduct: A Case Series. [Abstract] [BibTeX]	2015	Audiology research Vol. 5(1), pp. 120	article	DOI
Abstract: Enlarged vestibular aqueduct (EVA) is one of the commonly identified congenital temporal bone abnormalities associated with sensorineural hearing loss. Hearing loss may be unilateral or bilateral, and typically presents at birth or in early childhood. Vestibular symptoms have been reported in up to 50% of affected individuals, and may be delayed in onset until adulthood. The details of nystagmus in patients with EVA have not been previously reported. The objectives were to describe the clinical history, vestibular test findings and nystagmus seen in a case series of patients with enlarged vestibular aqueduct anomaly. Chart review, included computed tomography temporal bones, infrared nystagmography with positional and positioning testing, caloric testing, rotary chair and vibration testing. Clinical history and nystagmus varied among the five patients in this series. All patients were initially presumed to have benign paroxysmal positional vertigo, but repositioning treatments were not effective, prompting referral, further testing and evaluation. In three patients with longstanding vestibular complaints, positional nystagmus was consistently present. One patient had distinct recurrent severe episodes of positional nystagmus. Nystagmus was unidirectional and horizontal. In one case horizontal nystagmus was consistently reproducible with seated head turn to the affected side, and reached 48 d/s. Nystagmus associated with enlarged vestibular aqueduct is often positional, and can be confused with benign paroxysmal positional vertigo. Unexplained vestibular symptoms in patients with unilateral or bilateral sensorineural hearing loss should prompt diagnostic consideration of EVA.
BibTeX: @article{White2015, author = {White, Judith and Krakovitz, Paul}, title = {Nystagmus in Enlarged Vestibular Aqueduct: A Case Series.}, journal = {Audiology research}, year = {2015}, volume = {5}, issue = {1}, pages = {120}, doi = {https://doi.org/10.4081/audiores.2015.120}, keywords = {enlarged vestibular aqueduct; nystagmus; vertigo}, pmid = {26557362} }
Marcelli, V.	Nystagmus intensity and direction in bow and lean test: an aid to diagnosis of lateral semicircular canal benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2016	Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale Vol. 36(6), pp. 520-526	article	DOI
Abstract: The objective was to evaluate nystagmus intensity and direction (NID) during bow and lean test (BLT) in subjects suffering from idiopathic lateral semicircular canal benign paroxysmal positional vertigo (LSC-BPPV), in order to differentiate between the geotropic and the apogeotropic form and to determine the affected ear before using classic diagnostic procedures. The BLT was performed in 32 subjects affected by LSC-BPPV. "Nystagmus intensity" evaluation allows distinguishing the geotropic variant from the apogeotropic one, while the "nystagmus direction" allows identification of the side. In particular, a more intense nystagmus in the bow position compared to the lean position indicates an ampullipetal flow caused by the presence of free-floating particles in the non-ampullary arm, and is suggestive of geotropic form. In this case, if the nystagmus in the bow position is left beating, the free-floating particles necessarily occupy the left LSC non-ampullary arm, while a right-beating nystagmus indicates the right LSC involvement. In contrast, a more intense nystagmus in the lean position compared to the bow position indicates an ampullifugal flow due to the presence of particles adherent to the cupula (cupulolithiasis) or free-floating in the ampullary arm (canalolithiasis), suggesting an apogeotropic form. In this situation, if the nystagmus in the lean position is left beating, the particles are in the left LSC ampullar arm or are coated on the left LSC cupula; vice versa, a right-beating nystagmus in the lean position is suggestive of the involvement of the right LSC. As a general rule, in both forms the direction of the more intense nystagmus points to the affected side. "NID-BLT" was effective in identifying the form and the side in 22/28 subjects (79% of the study population). The proper execution and interpretation of the "NID-BLT" helps to establish the form (geotropic versus apogeotropic) and side (right versus left) in most cases of LSC-BPPV. Unlike Choung's test, which requires knowing a priori if the form is geotropic or apogeotropic, our test enables fast and accurate diagnosis, or at least provides indispensable elements if the diagnosis of the affected side is doubtful, with the patient remaining in the sitting position.
BibTeX: @article{Marcelli2016, author = {Marcelli, V}, title = {Nystagmus intensity and direction in bow and lean test: an aid to diagnosis of lateral semicircular canal benign paroxysmal positional vertigo.}, journal = {Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale}, year = {2016}, volume = {36}, issue = {6}, pages = {520--526}, doi = {https://doi.org/10.14639/0392-100X-795}, keywords = {Benign Paroxysmal Positional Vertigo, complications, diagnosis, physiopathology; Diagnostic Techniques, Otological; Female; Humans; Male; Middle Aged; Nystagmus, Physiologic; Benign paroxysmal positional vertigo; Lateral semicircular canal; Nystagmus; Vestibular system}, pmid = {28177336} }
Cohen, H.S. and Sangi-Haghpeykar, H.	Nystagmus parameters and subtypes of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2010	Acta oto-laryngologica Vol. 130(9), pp. 1019-1023	article	DOI
Abstract: Although computational models suggest the existence of canalithiasis and cupulolithiasis subtypes of benign paroxysmal positional vertigo (BPPV), these subtypes cannot be distinguished from each other based on characteristics of nystagmus. Therefore, although the subtypes probably exist more information is needed from each patient than is available without invasive procedures. Also, some patients may have clinical syndromes that include both canalithiasis and cupulolithiasis subtypes. To determine if the parameters of nystagmus provide sufficient information to determine the subtype of nystagmus in a patient with BPPV. Patients (n = 118) had unilateral BPPV of the posterior canal; 15 patients also had BPPV of the lateral canal. The main outcome measures were parameters of nystagmus in response to the Dix-Hallpike maneuver: latency to onset of nystagmus, maximum slow phase velocity, and maximum duration. Correlations between pairs of variables showed minimal or no relationships. Also, cluster analyses showed no significant subtypes. The contralateral eye moved significantly faster than the ipsilateral eye.
BibTeX: @article{Cohen2010b, author = {Cohen, Helen S and Sangi-Haghpeykar, Haleh}, title = {Nystagmus parameters and subtypes of benign paroxysmal positional vertigo.}, journal = {Acta oto-laryngologica}, year = {2010}, volume = {130}, issue = {9}, pages = {1019--1023}, doi = {https://doi.org/10.3109/00016481003664777}, keywords = {Adult; Aged; Aged, 80 and over; Cluster Analysis; Female; Humans; Lithiasis, classification, physiopathology; Male; Middle Aged; Nystagmus, Pathologic, etiology, physiopathology; Vertigo, classification, complications, physiopathology}, pmid = {20331407} }
Asprella Libonati, G.	Nystagmus while recumbent in horizontal canal benign paroxysmal positional vertigo. [BibTeX]	2006	Neurology Vol. 67(9), pp. 1723-4; author reply 1723-4	article	DOI
BibTeX: @article{AsprellaLibonati2006, author = {Asprella Libonati, Giacinto}, title = {Nystagmus while recumbent in horizontal canal benign paroxysmal positional vertigo.}, journal = {Neurology}, year = {2006}, volume = {67}, issue = {9}, pages = {1723--4; author reply 1723-4}, doi = {https://doi.org/10.1212/01.wnl.0000247891.63880.1c}, keywords = {Functional Laterality, physiology; Humans; Monitoring, Physiologic, methods, standards; Neurologic Examination, methods, standards; Nystagmus, Physiologic, physiology; Postural Balance, physiology; Posture, physiology; Semicircular Canals, physiopathology; Vertigo, diagnosis, physiopathology; Video Recording, methods, standards}, pmid = {17101924} }
Han, B.I., Oh, H.J. and Kim, J.S.	Nystagmus while recumbent in horizontal canal benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2006	Neurology Vol. 66(5), pp. 706-710	article	DOI
Abstract: The identification of the affected ear is crucial for the successful treatment of benign paroxysmal positional vertigo involving the horizontal canal (HC-BPPV) by using particle-repositioning maneuvers. To determine the lateralizing value of lying-down nystagmus in HC-BPPV. The authors prospectively investigated lying-down nystagmus in 152 consecutive patients with confirmed HC-BPPV (99 geotropic and 53 apogeotropic types). Lying-down nystagmus was induced by placing patients in a supine position. For the geotropic type of HC-BPPV, the affected ear was identified by assuming that nystagmus is more intense when the head is rotated to the affected side while supine. The reverse assumption was adopted for the apogeotropic type. Lying-down nystagmus was observed in 58 patients (38.2%), 36 (36.4%) of the geotropic and 22 (41.5%) of the apogeotropic type. The direction of lying-down nystagmus was mostly away from the affected ear in the geotropic type, but toward the affected ear in the apogeotropic type. Of the 16 geotropic patients in whom the affected ear was not identified initially, 7 with lying-down nystagmus showed resolution of vertigo after particle-repositioning maneuvers when the involved ear was identified by observing lying-down nystagmus. Lying-down nystagmus is a valuable sign for determining which ear is affected in benign paroxysmal positional vertigo involving the horizontal canal, especially when patients show symmetric nystagmus on turning the head to either side.
BibTeX: @article{Han2006, author = {Han, Byung In and Oh, Hui Jong and Kim, Ji Soo}, title = {Nystagmus while recumbent in horizontal canal benign paroxysmal positional vertigo.}, journal = {Neurology}, year = {2006}, volume = {66}, issue = {5}, pages = {706--710}, doi = {https://doi.org/10.1212/01.wnl.0000201184.69134.23}, keywords = {Functional Laterality; Gravitropism; Humans; Nystagmus, Pathologic, physiopathology; Posture; Supine Position, physiology; Vertigo, physiopathology}, pmid = {16534107} }
Straube, A.	Nystagmus: an update on treatment in adults. [Abstract] [BibTeX]	2005	Expert opinion on pharmacotherapy Vol. 6(4), pp. 583-590	article	DOI
Abstract: Recent developments in the treatment of nystagmus in adults have changed the traditional approach to such illnesses as benign paroxysmal positional vertigo, vestibular neuritis, Meniere's disease, superior canal dehiscence syndrome, vestibular paroxysmia, superior oblique myokymia, downbeat/upbeat nystagmus and acquired pendular nystagmus, as well as periodic alternating nystagmus. Treatments reported to suppress nystagmus, with tolerable side effects, are now available for some of these syndromes. Due to the absence of large controlled studies, however, treatment recommendations rest only on class C evidence.
BibTeX: @article{Straube2005, author = {Straube, Andreas}, title = {Nystagmus: an update on treatment in adults.}, journal = {Expert opinion on pharmacotherapy}, year = {2005}, volume = {6}, issue = {4}, pages = {583--590}, doi = {https://doi.org/10.1517/14656566.6.4.583}, keywords = {Adult; Cortisone, therapeutic use; Humans; Meniere Disease, complications, drug therapy, physiopathology; Nystagmus, Pathologic, complications, drug therapy, physiopathology; Pharmaceutical Preparations, administration & dosage; Potassium Channel Blockers, therapeutic use; Vestibular Diseases, complications, drug therapy, physiopathology}, pmid = {15934884} }
Ichijo, H., Ichinohe, M., Usami, S. and Shinkawa, H.	Observation of positional nystagmus with infrared CCD camera. [Abstract] [BibTeX]	1995	Acta oto-laryngologica. Supplementum Vol. 520 Pt 2, pp. 366-368	article
Abstract: Using infrared CCD camera and electronystagmography we analyzed positional nystagmus in 33 patients with peripheral positional vertigo. Patients were classified into three types; (a) lateral type: nystagmus occurs in lateral position, (b) sagittal type: nystagmus occurs in head-hanging position (so-called benign paroxysmal positional vertigo, BPPV), and (c) mixed type. Nystagmus in the lateral type was horizontal and that in the sagittal type was rotatory. In all types, the vertigo and nystagmus began with a few seconds' latency after head tilt and briefly increased to a maximum, and then gradually decreased. The duration of horizontal nystagmus in the lateral and mixed type was significantly longer than that of rotatory nystagmus in the sagittal type mixed type. The mean value of the former was 90.6 s and that of the latter 18.1 s. We suggest that the velocity storage mechanism of the horizontal vestibulo-ocular reflex (VOR) is considerably different from that in the vertical VOR.
BibTeX: @article{Ichijo1995, author = {Ichijo, H and Ichinohe, M and Usami, S and Shinkawa, H}, title = {Observation of positional nystagmus with infrared CCD camera.}, journal = {Acta oto-laryngologica. Supplementum}, year = {1995}, volume = {520 Pt 2}, pages = {366--368}, keywords = {Adolescent; Adult; Aged; Caloric Tests, instrumentation; Electronystagmography, instrumentation; Female; Humans; Image Processing, Computer-Assisted, instrumentation; Infrared Rays; Male; Meniere Disease, diagnosis, physiopathology; Middle Aged; Nystagmus, Physiologic, physiology; Orientation, physiology; Postural Balance, physiology; Posture, physiology; Reference Values; Reflex, Vestibulo-Ocular, physiology; Vertigo, diagnosis, physiopathology; Vestibular Function Tests, instrumentation; Video Recording, instrumentation}, pmid = {8749163} }
Korres, S., Balatsouras, D.G., Kaberos, A., Economou, C., Kandiloros, D. and Ferekidis, E.	Occurrence of semicircular canal involvement in benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2002	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 23(6), pp. 926-932	article
Abstract: To study the occurrence of each variant of benign paroxysmal positional vertigo (BPVV) and to present some specific clinical features and the results of their treatment by appropriate repositioning maneuvers. A retrospective review of the records of patients with BPPV. Neurotology clinic of the ear, nose, and throat department of a general hospital. One hundred twenty-two patients were included in the study, 54 male and 68 female, mean ages 61.8 and 59.6 years, respectively, ranging in age from 25 years to 86 years and with symptoms lasting for an average of 124 days. The diagnosis of each type of BPPV was based on the history of the patients and on the positive results of the appropriate provoking maneuver. From all the patients, a comprehensive history was obtained, followed by clinical examination of the ears, nose, and throat and a complete audiologic and neurotologic examination, including electronystagmography. All patients were treated with an appropriate repositioning maneuver, depending on the type of BPPV. Of 122 patients, 110 had posterior canal involvement, 10 had horizontal canal involvement, and only 2 had the anterior canal variant. The canalith repositioning procedure was immediately successful in 106 patients and in 8 more patients proved successful after its repetition in a second session, resulting in a total success rate of 93.4%. All the BPPV variants shared the same clinical and demographic characteristics and responded equally well to treatment. However, differential diagnosis was necessary to apply the appropriate canalith repositioning procedure. Although data from clinical and histologic studies do not fully account for the observed relative occurrence of each variant of BPPV, a satisfactory explanation may be provided by the anatomic location of each semicircular canal and additionally by self-treatment of most cases of the horizontal and the anterior canal variety.
BibTeX: @article{Korres2002, author = {Korres, Stavros and Balatsouras, Dimitrios G and Kaberos, Antonis and Economou, Constantinos and Kandiloros, Dimitrios and Ferekidis, Eleftherios}, title = {Occurrence of semicircular canal involvement in benign paroxysmal positional vertigo.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2002}, volume = {23}, issue = {6}, pages = {926--932}, keywords = {Adult; Aged; Aged, 80 and over; Electronystagmography; Female; Humans; Male; Middle Aged; Otolithic Membrane, physiopathology; Retrospective Studies; Semicircular Canals, physiopathology; Treatment Outcome; Vertigo, physiopathology, therapy}, pmid = {12438857} }
Bremova, T., Bayer, O., Agrawal, Y., Kremmyda, O., Brandt, T., Teufel, J. and Strupp, M.	Ocular VEMPs indicate repositioning of otoconia to the utricle after successful liberatory maneuvers in benign paroxysmal positioning vertigo. [Abstract] [BibTeX]	2013	Acta oto-laryngologica Vol. 133(12), pp. 1297-1303	article	DOI
Abstract: This study showed a transient increase of ocular vestibular evoked myogenic potential (oVEMP) amplitudes in the affected ear after successful liberatory maneuvers and no changes in cervical VEMP (cVEMP) amplitudes. These findings support the hypothesis that successful liberatory maneuvers can lead to a repositioning of otoconia to the utricle. To evaluate whether oVEMP amplitudes increase after successful liberatory maneuvers in patients with posterior semicircular canal benign paroxysmal positioning vertigo (pc-BPPV), while cVEMP amplitudes do not change. These findings may indicate a successful repositioning of dislodged otoconia to the utricular macula, but not to the saccular macula. Thirty patients with unilateral pc-BPPV were prospectively examined with bone-conducted oVEMP and air-conducted cVEMP at four time points: before, after, 1 week after, and 1 month after the liberatory maneuvers (Sémont maneuvers). At the 1-week follow-up, 20 of 30 patients were asymptomatic (responders); BPPV could still be induced in the other 10 (non-responders). In responders the mean n10 amplitude on the affected side increased from 12 ± 6.5 µV at baseline (before the treatment) to 15.9 ± 7.1 µV at 1 week after treatment; this increase was significantly (p = 0.001) higher in responders than in non-responders. cVEMP did not differ significantly.
BibTeX: @article{Bremova2013, author = {Bremova, Tatiana and Bayer, Otmar and Agrawal, Yuri and Kremmyda, Olympia and Brandt, Thomas and Teufel, Julian and Strupp, Michael}, title = {Ocular VEMPs indicate repositioning of otoconia to the utricle after successful liberatory maneuvers in benign paroxysmal positioning vertigo.}, journal = {Acta oto-laryngologica}, year = {2013}, volume = {133}, issue = {12}, pages = {1297--1303}, doi = {https://doi.org/10.3109/00016489.2013.829922}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Female; Follow-Up Studies; Humans; Male; Middle Aged; Otolithic Membrane, physiopathology; Patient Positioning; Posture, physiology; Prospective Studies; Saccule and Utricle, physiopathology; Vertigo, physiopathology, rehabilitation; Vestibular Evoked Myogenic Potentials, physiology; Vestibular Function Tests, methods}, pmid = {24245699} }
Amor-Dorado, J.C., Barreira-Fernandez, M.P., Llorca, J. and Gonzalez-Gay, M.A.	Oculographic, Clinical Test of Sensory Integration and Balance and Computerized Dynamic Posturography Findings in Patients With Psoriatic Arthritis. [Abstract] [BibTeX]	2017	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 38(3), pp. 448-453	article	DOI
Abstract: To assess the frequency and characteristics of the oculographic findings and the usefulness of the clinical test of sensory integration and balance (CTSIB) for the evaluation of balance in patients with psoriatic arthritis (PsA) by comparing this test with the computerized dynamic posturography (CDP). A series of consecutive patients that fulfilled the Moll and Wright criteria for PsA and matched controls were studied. The study was performed at the Otolaryngology Division of a tertiary reference center. Vestibular evaluation including CTSIB followed by CDP was performed to all patients and age, sex, and ethnically frequency-matched controls. Patterns of CTSIB and CDP (gold standard) were assessed and compared. Sixty PsA patients (63.3% women) and 60 matched controls. PsA patients had higher frequency of abnormal oculocephalic response (13.3%) and abnormal caloric test (26.7%) than controls (0% in both cases) (p = 0.006 and p < 0.001, respectively). Benign paroxysmal positional vertigo (BPPV) was diagnosed in two (3.4%) patients and none of the controls (p = 1). Significantly increased frequency of abnormal CTSIB test with vestibular loss pattern (33.3%) in patients compared with controls (6%) was observed (p = 0.002). Significantly increased frequency of abnormal CDP was also observed in PsA patients (14 [23.3%] versus 0 [0%] of controls) (p < 0.001). CTSIB yielded 100% sensitivity, 73% specificity, 48% positive predictive value, and 100% negative predictive value. This study indicates that oculographic findings are common in PsA. CTSIB is useful for assessing balance disorder screening in the routine clinical practice in these patients.
BibTeX: @article{Amor-Dorado2017, author = {Amor-Dorado, Juan Carlos and Barreira-Fernandez, Maria P and Llorca, Javier and Gonzalez-Gay, Miguel A}, title = {Oculographic, Clinical Test of Sensory Integration and Balance and Computerized Dynamic Posturography Findings in Patients With Psoriatic Arthritis.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2017}, volume = {38}, issue = {3}, pages = {448--453}, doi = {https://doi.org/10.1097/MAO.0000000000001296}, keywords = {Adult; Aged; Arthritis, Psoriatic, complications; Female; Humans; Male; Middle Aged; Postural Balance, physiology; Sensation Disorders, diagnosis, etiology; Vestibular Function Tests, methods}, pmid = {27918366} }
Hogue, J.D.	Office evaluation of dizziness. [Abstract] [BibTeX]	2015	Primary care Vol. 42(2), pp. 249-258	article	DOI
Abstract: Patients presenting to primary care with complaints of dizziness are common. Differentiating the cause of dizziness can be made easier by considering 4 main categories of dizziness: vertigo, presyncope/syncope, disequilibrium, and nonspecific symptoms. Differentials should immediately include the most common causes of dizziness, such as benign paroxysmal positional vertigo and orthostatic hypotension. Diagnostic tests should be ordered for patients who have abnormal findings on physical examination that may indicate a more serious cause of dizziness.
BibTeX: @article{Hogue2015, author = {Hogue, James D}, title = {Office evaluation of dizziness.}, journal = {Primary care}, year = {2015}, volume = {42}, issue = {2}, pages = {249--258}, doi = {https://doi.org/10.1016/j.pop.2015.01.004}, keywords = {Diagnosis, Differential; Dizziness, etiology; Humans; Physical Examination; Primary Health Care, methods; Syncope, complications; Vertigo, complications; Disequilibrium; Dix-Hallpike maneuver; Dizziness; Nonspecific dizziness; Nystagmus; Presyncope; Syncope; Vertigo}, pmid = {25979586} }
Waleem, S.S.U., Malik, S.M., Ullah, S. and ul Hassan, Z.	Office management of benign paroxysmal positional vertigo with Epley's maneuver. [Abstract] [BibTeX]	2008	Journal of Ayub Medical College, Abbottabad : JAMC Vol. 20(1), pp. 77-79	article
Abstract: The underlying cause of benign paroxysmal positional vertigo is free floating endolymph particles (otoconia displaced from the otolithic membrane of the utricle) in the posterior semicircular canal. Particle repositioning techniques are one of the effective method of treatment. The purpose of the study was to determine the effectiveness of Epley's maneuver against expectant treatment and to find out if this treatment should be used more frequently than watchful waiting for the treatment of BPPV. This study was carried out at outpatient clinic, departments of ENT, Combined Military hospital Rawalpindi and PNS Shifa hospital Karachi over a three years period from Jan, 2002 to Jan, 2005. Based upon history and Dix-hallpike testing 44 patients diagnosed as benign paroxysmal positional vertigo were collected by convenient sampling from these hospital's outpatient departments and divided by non probability convenience into two groups of 22 each. The control group (group A) was given placebo and the test group (group B) received single treatment by Epley's maneuver in the OPD. The results were analyzed at the end of one and two weeks by history taking and Dix-hallpike testing. Computer software SPSS version 10 was used. At the end of week one 14 (63.63%) patients of group B were symptom free and 2 (9.1%) patients was much better as compared to the control group where only 1 (4.5%) patient reported as symptom free and another 5 (22.7%) reported as much better. At the end of second week out of those treated by Epley's maneuver 16 (72.7%) reported as symptom free and another 2 (9.1%) as much better whereas 4 (18.2%) patients reported no improvement at all. In the control group only 4 (18.2%) patients reported as symptom free, 3 (13.6%) as much better, 6 (27.3%) as better and 9 (40.9%) reported no change in the symptoms. Chi square test was applied and the value of p came out to be 0.001 and 0.002 at week one and week two respectively. It was concluded that Epley's maneuver is a much better form of management for benign paroxysmal positional vertigo.
BibTeX: @article{Waleem2008, author = {Waleem, Sheikh Saadat Ullah and Malik, Sher Muhammad and Ullah, Saeed and ul Hassan, Zaheer}, title = {Office management of benign paroxysmal positional vertigo with Epley's maneuver.}, journal = {Journal of Ayub Medical College, Abbottabad : JAMC}, year = {2008}, volume = {20}, issue = {1}, pages = {77--79}, keywords = {Case-Control Studies; Female; Humans; Male; Office Visits; Outpatients; Physical Therapy Modalities; Pilot Projects; Vertigo, etiology, physiopathology, therapy}, pmid = {19024193} }
Okazaki, S., Imai, T., Higashi-Shingai, K., Matsuda, K., Takeda, N., Kitahara, T., Uno, A., Horii, A., Ohta, Y., Morihana, T., Masumura, C., Nishiike, S. and Inohara, H.	Office-based differential diagnosis of transient and persistent geotropic positional nystagmus in patients with horizontal canal type of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2017	Acta oto-laryngologica Vol. 137(3), pp. 265-269	article	DOI
Abstract: A 30 s observation of geotropic positional nystagmus is sufficient to distinguish persistent geotropic positional nystagmus (PGPN) from transient geotropic positional nystagmus (TGPN) in patients with horizontal canal type of benign paroxysmal positional vertigo (H-BPPV) in ENT office. As a canalith repositioning procedure effectively treats H-BPPV with TGPN, but not PGPN, the differentiation between patients with PGPN and with TGPN is essential. The purpose of this study is to determine the observation period enough to distinguish TGPN from PGPN. This study first analyzed positional nystagmus images recorded with an infrared CCD camera three-dimensionally in 47 patients with H-BPPV. PGPN is distinguished from TGPN in patients with H-BPPV precisely by means of time constant calculated form analysis of positional nystagmus. Ten-second and 30-s movies were made of positional nystagmus of the all 47 patients. Ten independent otolaryngologists were then asked to distinguish TGPN from PGPN after a 10 s or 30 s observation of the geotropic positional nystagmus images in 47 patients with H-BPPV. The sensitivity and specificity to distinguish TGPN from PGPN was 100% and 97% after 30 s observation, but 100% and 40% after 10 s observation, respectively.
BibTeX: @article{Okazaki2017, author = {Okazaki, Suzuyo and Imai, Takao and Higashi-Shingai, Kayoko and Matsuda, Kazunori and Takeda, Noriaki and Kitahara, Tadashi and Uno, Atsuhiko and Horii, Arata and Ohta, Yumi and Morihana, Tetsuo and Masumura, Chisako and Nishiike, Suetaka and Inohara, Hidenori}, title = {Office-based differential diagnosis of transient and persistent geotropic positional nystagmus in patients with horizontal canal type of benign paroxysmal positional vertigo.}, journal = {Acta oto-laryngologica}, year = {2017}, volume = {137}, issue = {3}, pages = {265--269}, doi = {https://doi.org/10.1080/00016489.2016.1227478}, keywords = {Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, classification, diagnosis; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Nystagmus, Physiologic; Geotropic positional nystagmus; benign paroxysmal positional vertigo; three-dimensional; time constant}, pmid = {27644766} }
Ogawa, T. and Rutka, J.	Olfactory dysfunction in head injured workers. [Abstract] [BibTeX]	1999	Acta oto-laryngologica. Supplementum Vol. 540, pp. 50-57	article
Abstract: Olfactory dysfunction following trauma has been widely reported and is currently compensable according to existing American Medical Association guidelines when it occurs in the occupational setting. Its presence and the risk factors for its development, however, have not been clearly delineated in occupationally head injured workers. In order to assess this phenomenon, a series of 365 consecutive head injured workers from 1993-1997 was assessed in order to determine the incidence of post-traumatic olfactory dysfunction and its association with the severity of the head injury, the mechanism of injury and other neurotological abnormalities in the same cohort group. Olfactory dysfunction was identified in 13.7% (9.3% with anosmia, 4.4% with hyposmia/dysosmia). It was more likely where the loss of consciousness > 1 h (p < 0.002), in more severe head injuries (grades II-V) (p < 0.001) and when skull fracture (p < 0.001) occurred. The direction of the blow applied to the skull did not influence its presence, although radiologically confirmed skull fractures in the frontal, occipital, skull base and midface were twice as likely as temporal and parietal fractures to result in an olfactory change. From a neurotologic perspective, approximately 21.9% of head injured workers were determined to have recognizable evidence of cochleovestibular dysfunction. Olfactory dysfunction as a physical finding post-head injury compares favourably with the presence of post-traumatic benign positional paroxysmal vertigo (BPPV) and its atypical variants in 11.2% of head injured workers.
BibTeX: @article{Ogawa1999, author = {Ogawa, T and Rutka, J}, title = {Olfactory dysfunction in head injured workers.}, journal = {Acta oto-laryngologica. Supplementum}, year = {1999}, volume = {540}, pages = {50--57}, keywords = {Craniocerebral Trauma, complications, epidemiology, etiology; Female; Humans; Incidence; Male; Middle Aged; Occupational Diseases, epidemiology, etiology; Olfaction Disorders, epidemiology, etiology; Risk Factors; Skull Fractures, complications, epidemiology, etiology; Smell, physiology; Trauma Severity Indices; Unconsciousness, epidemiology, etiology; Vestibular Diseases, epidemiology, etiology}, pmid = {10445080} }
Tegeler, L. and Blumer, J.	OMT May Be Helpful in the Management of Benign Paroxysmal Positional Vertigo. [BibTeX]	2018	The Journal of the American Osteopathic Association Vol. 118(1), pp. 51-52	article	DOI
BibTeX: @article{Tegeler2018, author = {Tegeler, Luke and Blumer, Janice}, title = {OMT May Be Helpful in the Management of Benign Paroxysmal Positional Vertigo.}, journal = {The Journal of the American Osteopathic Association}, year = {2018}, volume = {118}, issue = {1}, pages = {51--52}, doi = {https://doi.org/10.7556/jaoa.2018.010}, keywords = {Benign Paroxysmal Positional Vertigo; Dizziness; Health Personnel; Humans; Osteopathic Medicine; Quality of Life}, pmid = {29309095} }
Taura, A., Funabiki, K., Ohgita, H., Ogino, E., Torii, H., Matsunaga, M. and Ito, J.	One-third of vertiginous episodes during the follow-up period are caused by benign paroxysmal positional vertigo in patients with Meniere's disease. [Abstract] [BibTeX]	2014	Acta oto-laryngologica Vol. 134(11), pp. 1140-1145	article	DOI
Abstract: In the present study, about one-third of patients with Meniere's disease developed benign paroxysmal positional vertigo (BPPV)-like attacks. Additionally, more than one-third of all vertigo attacks were BPPV-like attacks. Thus, vertigo attacks in patients with Meniere's disease must be carefully treated because the therapy for such vertigo attacks is totally different from the therapy for BPPV. Physicians sometimes encounter patients with previously diagnosed Meniere's disease who develop BPPV attacks during the course of clinical follow-up. In this study, we explored the frequency with which BPPV was involved in all vertiginous episodes among patients with Meniere's disease. This retrospective study involved 296 patients with Meniere's disease who visited Kyoto University Hospital. The diagnosis of Meniere's disease was based on the guidelines for the diagnosis of Meniere's disease proposed by the Committee on Hearing and Equilibrium. We judged the cause of vertigo as one of the following five types: (1) definite Meniere's disease attack, (2) suspicious Meniere's disease attack, (3) definite BPPV attack, (4) suspicious BPPV attack, or (5) unknown. In all, 96 patients (32.8%) developed BPPV-like attacks, and 187 vertiginous episodes (37.9%) were caused by BPPV. The lateral semicircular canal was the most frequently involved canal.
BibTeX: @article{Taura2014, author = {Taura, Akiko and Funabiki, Kazuo and Ohgita, Hideaki and Ogino, Eriko and Torii, Hiroko and Matsunaga, Mami and Ito, Juichi}, title = {One-third of vertiginous episodes during the follow-up period are caused by benign paroxysmal positional vertigo in patients with Meniere's disease.}, journal = {Acta oto-laryngologica}, year = {2014}, volume = {134}, issue = {11}, pages = {1140--1145}, doi = {https://doi.org/10.3109/00016489.2014.936624}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo, complications, epidemiology; Female; Humans; Japan; Male; Meniere Disease, complications, epidemiology; Middle Aged; Retrospective Studies; Kyoto University Hospital; Meniere’s disease; Vertigo attack}, pmid = {25166020} }
Khan, J., Gill, M. and Clarke, H.	Onset of benign paroxysmal positional vertigo after total laparoscopic hysterectomy in the Trendelenburg position. [Abstract] [BibTeX]	2012	Journal of minimally invasive gynecology Vol. 19(6), pp. 798-800	article	DOI
Abstract: Herein is reported the case of a 51-year-old woman who underwent total laparoscopic hysterectomy in the steep Trendelenburg position who developed postoperative benign paroxysmal positional vertigo. The etiology of benign paroxysmal positional vertigo is examined and the Trendelenburg position during surgery as the triggering factor is explored.
BibTeX: @article{Khan2012, author = {Khan, James and Gill, Mandeep and Clarke, Hance}, title = {Onset of benign paroxysmal positional vertigo after total laparoscopic hysterectomy in the Trendelenburg position.}, journal = {Journal of minimally invasive gynecology}, year = {2012}, volume = {19}, issue = {6}, pages = {798--800}, doi = {https://doi.org/10.1016/j.jmig.2012.08.772}, keywords = {Benign Paroxysmal Positional Vertigo; Female; Humans; Hysterectomy; Laparoscopy; Middle Aged; Patient Positioning, adverse effects; Remission, Spontaneous; Vertigo, diagnosis, etiology}, pmid = {23084691} }
Liston, D.B., Adelstein, B.D. and Stone, L.S.	Onset of positional vertigo during exposure to combined G loading and chest-to-spine vibration. [Abstract] [BibTeX]	2014	Aviation, space, and environmental medicine Vol. 85(2), pp. 183-186	article
Abstract: Aerospace environments commonly expose pilots to vibration and sustained acceleration, alone and in combination. Of 16 experimental research participants, 3 reported symptoms of vertigo and signs of torsional nystagmus during or shortly following exposure to sustained chest-to-spine (+3.8 Gx) acceleration (G loading) and chest-to-spine (0.5 g(x)) vibration in the 8-16 Hz band. Two of the participants reported intermittent vertigo for up to 2 wk, were diagnosed with benign paroxysmal positional vertigo (BPPV), and were treated successfully with the Epley Maneuver. On a follow-up survey, a third participant reported transient BPPV-like vertigo, which resolved spontaneously. The follow-up survey also prompted participants to self-report other effects following research protocol exposure to vibration and G loading, revealing details about other minor and transient, but more common, effects that resolved within 3 h. Our studies indicated a significantly elevated incidence of BPPV following exposure to vibration plus G loading compared to vibration alone that was positively correlated with participant age. One mechanism for the rolling sensation in BPPV involves broken or dislodged otoconia floating within one of the posterior semicircular canals, making the canal gravity-sensitive. Our observations highlight a heretofore unforeseen risk of otolith damage sustained during launch, undetectable in space, potentially contributing to vertigo and perceived tumbling upon re-entry from microgravity.
BibTeX: @article{Liston2014, author = {Liston, Dorion B and Adelstein, Bernard D and Stone, Leland S}, title = {Onset of positional vertigo during exposure to combined G loading and chest-to-spine vibration.}, journal = {Aviation, space, and environmental medicine}, year = {2014}, volume = {85}, issue = {2}, pages = {183--186}, keywords = {Acceleration, adverse effects; Adult; Female; Humans; Hypergravity, adverse effects; Male; Middle Aged; Nystagmus, Pathologic, etiology; Vertigo, etiology, therapy; Vibration, adverse effects; Young Adult}, pmid = {24597164} }
Ichijo, H.	Onset time of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2017	Acta oto-laryngologica Vol. 137(2), pp. 144-148	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is strongly related to sleep. This study proposes a micro-otoconia accumulation theory in which the pathological debris is an aggregate of micro-otoconia over a long time period, and which begins to slide by its own weight during sleep. To examine the onset time of idiopathic BPPV and to investigate its etiology. Patients (n = 351) were classified as posterior canalolithiasis (PC), horizontal canalolithiasis (HC), and horizontal heavy cupula (HHC) according to nystagmus findings. This study examined the medical records, and categorized the onset times into the following four groups; (1) during sleep, (2) at the time of rising, (3) morning, and (4) afternoon. PC (n = 135): In 33 patients, vertigo occurred during sleep, in 69 patients at rising, in 10 patients in the morning, and in 23 patients in the afternoon. HC (n = 87): In 38 patients, vertigo occurred during sleep, in 30 patients at rising, in eight patients in the morning, and in 11 patients in the afternoon. HHC (n = 129): In 27 patients, vertigo occurred during sleep, in 59 patients at rising, in 15 patients in the morning, and in 28 patients in the afternoon.
BibTeX: @article{Ichijo2017a, author = {Ichijo, Hiroaki}, title = {Onset time of benign paroxysmal positional vertigo.}, journal = {Acta oto-laryngologica}, year = {2017}, volume = {137}, issue = {2}, pages = {144--148}, doi = {https://doi.org/10.1080/00016489.2016.1221130}, keywords = {Benign Paroxysmal Positional Vertigo, etiology; Female; Humans; Male; Middle Aged; Retrospective Studies; Sleep; Time Factors; Canalolithiasis; heavy cupula; otoconia accumulation theory; positional nystagmus; semicircular canal; sleep}, pmid = {27577049} }
Yamanaka, T., Shirota, S., Sawai, Y., Murai, T., Fujita, N. and Hosoi, H.	Osteoporosis as a risk factor for the recurrence of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2013	The Laryngoscope Vol. 123(11), pp. 2813-2816	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) frequently occurs in females over 50 years old, suggesting that a postmenopausal decrease in estrogen secretion might be involved in its onset. An estrogen deficiency is generally known to cause osteoporosis through a reduction in bone mass. This study was designed to investigate a clinical association between idiopathic BPPV and osteoporosis. Case-control study. We measured the bone mineral density (BMD) at the lumbar vertebrae in 61 patients with idiopathic BPPV who were postmenopausal women over 50 years old using dual-energy x-ray absorptiometry. After being treated with the canalith repositioning maneuver, the patients were followed up for at least 1 year. Our results showed that the incidence of osteoporosis in patients with BPPV was 26.2%, which was similar to those observed in epidemiological surveys conducted in Japan. However, we found that in BPPV patients with osteoporosis, the incidence of recurrence was 56.3%, which was significantly higher than that observed in patients with normal bone mineral density (16.1%). Furthermore, the frequency of BPPV recurrence increased as BMD decreased. These results suggest that osteoporosis is a risk factor for BPPV recurrence. The prognosis of BPPV might be clinically predicted by BMD reduction.
BibTeX: @article{Yamanaka2013, author = {Yamanaka, Toshiaki and Shirota, Shiho and Sawai, Yachiyo and Murai, Takayuki and Fujita, Nobuya and Hosoi, Hiroshi}, title = {Osteoporosis as a risk factor for the recurrence of benign paroxysmal positional vertigo.}, journal = {The Laryngoscope}, year = {2013}, volume = {123}, issue = {11}, pages = {2813--2816}, doi = {https://doi.org/10.1002/lary.24099}, keywords = {Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Bone Density; Case-Control Studies; Female; Humans; Incidence; Middle Aged; Osteoporosis, complications; Prognosis; Recurrence; Risk Factors; Vertigo, epidemiology, etiology; Benign paroxysmal positional vertigo; bone mineral density; osteoporosis; otolith; recurrence}, pmid = {23568754} }
Choi, H.G., Lee, J.K., Kong, I.G., Lim, H. and Kim, S.Y.	Osteoporosis increases the risk of benign paroxysmal positional vertigo: a nested case-control study using a national sample cohort. [Abstract] [BibTeX]	2018	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery	article	DOI
Abstract: The previous studies suggested an association between osteoporosis and sudden sensory neural hearing loss (SSNHL). The aim of the present study was to evaluate the association between osteoporosis and benign paroxysmal positional vertigo (BPPV). Data from the Korean National Health Insurance Service-National Sample Cohort of participants who were ≥ 50 years old were collected from 2002 to 2013. A total of 13,484 BPPV participants were matched with respect to age group, sex, income group, region of residence, hypertension, diabetes, and dyslipidemia to 53,936 controls. In both the BPPV and control groups, the previous histories of osteoporosis were evaluated. Crude (simple) and adjusted odds ratios (ORs) of osteoporosis for BPPV were analyzed using unconditional logistic regression analyses. Subgroup analyses were conducted according to age, sex, and BPPV frequency. A total of 18.64% (2514/13,464) of the BPPV group and 12.21% (6589/53,936) of the control group had a history of osteoporosis (P < 0.001). The adjusted OR of osteoporosis for BPPV was 1.29 (95% CI = 1.23-1.35, P < 0.001). In the subgroup analysis according to age and sex, the ≥ 70-year-old men did not demonstrate a high adjusted OR of osteoporosis for BPPV. All other age and sex subgroups demonstrated high adjusted ORs of osteoporosis for BPPV. Osteoporosis increased the risk of BPPV in the population aged ≥ 50 years. The OR of osteoporosis was higher in the frequent BPPV group than in the less frequent BPPV group.
BibTeX: @article{Choi2018, author = {Choi, Hyo Geun and Lee, Joon Kyu and Kong, Il Gyu and Lim, Hyun and Kim, So Young}, title = {Osteoporosis increases the risk of benign paroxysmal positional vertigo: a nested case-control study using a national sample cohort.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2018}, doi = {https://doi.org/10.1007/s00405-018-5230-y}, keywords = {Benign paroxysmal positional vertigo; Case–control studies; Cohort studies; Epidemiology; Osteoporosis; Risk factors}, pmid = {30511104} }
Chan, K.-C., Tsai, Y.-T., Yang, Y.-H., Chen, P.-C. and Chang, P.-H.	Osteoporosis is associated with increased risk for benign paroxysmal positional vertigo: a nationwide population-based study. [Abstract] [BibTeX]	2017	Archives of osteoporosis Vol. 12(1), pp. 106	article	DOI
Abstract: Recent evidence has indicated that osteoporosis is a risk factor for benign paroxysmal positional vertigo (BPPV). This large population-based study demonstrated that patients with osteoporosis had a 1.82-fold higher risk of developing BPPV than those without osteoporosis through the use of the Taiwan National Health Insurance Research Database. Benign paroxysmal positional vertigo (BPPV) is one of the most frequent causes of vertigo. Osteoporosis reflects a homeostatic imbalance in the rate of bone turnover, with the rate of bone resorption exceeding that of bone formation. Recent evidence has indicated that osteoporosis is a risk factor for BPPV. We aimed to validate the risk of BPPV in osteoporotic patients through a nationwide, population-based, cohort study. Patients treated for osteoporosis were identified from entries made in the Taiwan National Health Insurance Research Database (NHIRD) between 2000 and 2013. Each osteoporosis patient was age- and sex-matched with four randomly selected subjects without osteoporosis. We compared the incidence rates of BPPV in the two cohorts (with and without osteoporosis) and identified risk factors. We identified 6649 osteoporosis patients and 26,596 match controls. According to the incidence of BPPV among the two groups, patients with osteoporosis were found to have a 1.82-fold higher risk of developing BPPV than those without osteoporosis. The incidence rate ratio (IRR) between osteoporotic patients and the control cohort was 2.0 (p < 0.001). This large population-based study demonstrated that patients with osteoporosis were associated with an increased risk for BPPV. The results of this study provide some insight into the management of BPPV.
BibTeX: @article{Chan2017, author = {Chan, Kai-Chieh and Tsai, Yao-Te and Yang, Yao-Hsu and Chen, Pau-Chung and Chang, Po-Hung}, title = {Osteoporosis is associated with increased risk for benign paroxysmal positional vertigo: a nationwide population-based study.}, journal = {Archives of osteoporosis}, year = {2017}, volume = {12}, issue = {1}, pages = {106}, doi = {https://doi.org/10.1007/s11657-017-0403-7}, keywords = {Aged; Benign Paroxysmal Positional Vertigo, epidemiology, etiology; Bone Remodeling; Case-Control Studies; Cohort Studies; Databases, Factual; Female; Humans; Incidence; Male; Middle Aged; Osteoporosis, complications; Risk Factors; Taiwan, epidemiology; BPPV; Osteoporosis; Vertigo}, pmid = {29177633} }
Kao, W.T.K., Parnes, L.S. and Chole, R.A.	Otoconia and otolithic membrane fragments within the posterior semicircular canal in benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2017	The Laryngoscope Vol. 127(3), pp. 709-714	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most common vestibular disorder with an incidence between 10.7 and 17.3 per 100,000 persons per year. The mechanism for BPPV has been postulated to involve displaced otoconia resulting in canalithiasis. Although particulate matter has been observed in the endolymph of affected patients undergoing posterior canal occlusion surgery, an otoconial origin for the disease is still questioned. In this study, particulate matter was extracted from the posterior semicircular canal of two patients and examined with scanning electron microscopy. The samples were obtained from two patients intraoperatively during posterior semicircular canal occlusion. The particles were fixed, stored in ethanol, and chemically dehydrated. The samples were sputter coated and viewed under a scanning electron microscope. Digital images were obtained. Intact and degenerating otoconia with and without linking filaments were found attached to amorphous particulate matter. Many otoconia appeared to be partially embedded in a gel matrix, presumably that which encases and anchors the otoconia within the otolith membrane, whereas others stood alone with no attached filaments and matrix. The otoconia measured roughly 2 to 8 μm in length and displayed a uniform outer shape with a cylindrical bulbous body and a 3 + 3 rhombohedral plane at each end. These findings suggest that the source of the particulate matter in the semicircular canals of patients with BPPV is broken off fragments of the utricular otolithic membrane with attached and detached otoconia. NA Laryngoscope, 127:709-714, 2017.
BibTeX: @article{Kao2017, author = {Kao, Wee Tin K and Parnes, Lorne S and Chole, Richard A}, title = {Otoconia and otolithic membrane fragments within the posterior semicircular canal in benign paroxysmal positional vertigo.}, journal = {The Laryngoscope}, year = {2017}, volume = {127}, issue = {3}, pages = {709--714}, doi = {https://doi.org/10.1002/lary.26115}, keywords = {Aged; Benign Paroxysmal Positional Vertigo, diagnosis, pathology, surgery; Biopsy, Needle; Female; Follow-Up Studies; Humans; Immunohistochemistry; Microscopy, Electron, Scanning; Middle Aged; Otolithic Membrane, pathology, ultrastructure; Otologic Surgical Procedures, methods; Particulate Matter; Sampling Studies; Semicircular Canals, pathology, surgery, ultrastructure; Severity of Illness Index; Treatment Outcome; Otoconia; benign positional vertigo; otolithic membrane; scanning electron microscopy}, pmid = {27726156} }
Wong, A. and Fung, K.	Otolaryngology in undergraduate medical education. [Abstract] [BibTeX]	2009	Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale Vol. 38(1), pp. 38-48	article
Abstract: Otolaryngologic problems are common in primary care but are underrepresented in undergraduate medical education (UME). A significant portion of the total structured teaching received by physicians in primary care specialties is spent in UME, but teaching of otolaryngology in UME is limited and not standardized across Canadian medical schools. This study assessed the content and structure of otolaryngology UME at Canadian undergraduate medical programs and postgraduate primary care programs and surveyed community otolaryngologists to identify important clinical topics for inclusion in an otolaryngology curriculum. A survey was created based on previously validated and published curriculum needs assessment instruments for medical education. Surveys were distributed to (1) undergraduate directors of otolaryngology, (2) postgraduate program directors of family and emergency medicine at English-language medical schools, and (3) community otolaryngologists in Canada. There is large variation in the quantity of otolaryngology teaching in UME. Knowledge of otolaryngology is formally evaluated at half of the responding programs, although skills in otolaryngology are rarely tested. Clerkship rotations are not uniformly offered, and the length of these placements is limited. Opportunities in postgraduate training for formal education in otolaryngology are rare. Several important topics that are not uniformly taught include sudden sensorineural hearing loss, sleep apnea, and nasal trauma. Important skills that are not uniformly taught include treatment of benign paroxysmal positional vertigo and epistaxis. There is limited time for teaching otolaryngology in UME; therefore, it is essential to emphasize teaching key topics and skills, which are highlighted in the results of this study.
BibTeX: @article{Wong2009, author = {Wong, Adrienne and Fung, Kevin}, title = {Otolaryngology in undergraduate medical education.}, journal = {Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale}, year = {2009}, volume = {38}, issue = {1}, pages = {38--48}, keywords = {Canada; Curriculum; Education; Education, Medical, Undergraduate; Humans; Language; Otolaryngology, education}, pmid = {19344612} }
DʼSilva, L.J., Staecker, H., Lin, J., Maddux, C., Ferraro, J., Dai, H. and Kluding, P.M.	Otolith Dysfunction in Persons With Both Diabetes and Benign Paroxysmal Positional Vertigo. [Abstract] [BibTeX]	2017	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 38(3), pp. 379-385	article	DOI
Abstract: Vestibular dysfunction is a well-recognized complication of type 2 diabetes (DM) that may contribute to increased fall risk. The prevalence of benign paroxysmal positional vertigo (BPPV) is higher in people with DM. The impact of DM on the otolith organs of the vestibular system in people with BPPV is unknown. The purpose of this study was to analyze otolith function using vestibular-evoked myogenic potential (VEMP) tests in people with DM and concurrent BPPV (BPPV + DM), and to examine the relationships between VEMP variables and diabetes-related variables. Prospective, cross-sectional study. Tertiary academic medical center. Participants 40 to 65 years were recruited in four groups: controls (n = 20), people with DM (n = 19), BPPV (n = 18), and BPPV + DM (n = 14). Saccule and utricle function were examined using cervical VEMP (cVEMP) and ocular VEMP (oVEMP), respectively. Diabetes-related variables such as HbA1c, duration of diabetes, and presence of sensory impairment due to diabetes were collected. The frequency of abnormal cVEMP responses was higher in the DM (p = 0.005), BPPV (p = 0.003), and BPPV + DM (p <0.001) groups compared with controls. In the participants with diabetes, higher HbA1c levels were correlated with prolonged P1 (p = 0.03) and N1 latencies (p = 0.03). The frequency of abnormal oVEMP responses was not different between groups (p = 0.2). Although BPPV and DM may independently affect utricle and saccule function, they do not seem to have a distinct cumulative effect.
BibTeX: @article{DʼSilva2017, author = {DʼSilva, Linda J and Staecker, Hinrich and Lin, James and Maddux, Christy and Ferraro, John and Dai, Hongying and Kluding, Patricia M}, title = {Otolith Dysfunction in Persons With Both Diabetes and Benign Paroxysmal Positional Vertigo.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2017}, volume = {38}, issue = {3}, pages = {379--385}, doi = {https://doi.org/10.1097/MAO.0000000000001309}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo, complications; Cross-Sectional Studies; Diabetes Mellitus, Type 2, complications; Female; Humans; Male; Middle Aged; Otolithic Membrane, physiopathology; Prospective Studies; Vestibular Evoked Myogenic Potentials, physiology}, pmid = {27930443} }
Lee, S.K., Kim, S.J., Park, M.S. and Byun, J.Y.	Otolith organ function according to subtype of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2014	The Laryngoscope Vol. 124(4), pp. 984-988	article	DOI
Abstract: The clinical features and treatment outcomes of benign paroxysmal positional vertigo (BPPV) are known to be different depending on the type of and involved canal. This difference could be due to differences in the functional change of the otolith organ. Case series. Forty-nine patients were diagnosed to primary BPPV; 18 were categorized as posterior canal canalolithiasis (PC canalolithiasis), and 31 were categorized as horizontal canal (HC) BPPV with canalolithiasis or cupulolithiasis (HC canalolithiasis or HC cupulolithiasis). Diagnostic interventions to measure vestibular functions were performed such as electronystagmography (ENG), videonystagmography (VNG), and static and dynamic subjective visual vertical (SVV). BPPV was confirmed with nystagmus during positioning/positional test under ENG and VNG. Static SVV was recorded with a light-emitting diode (LED) bar located in front of the patients before eccentric rotation and dynamic SVV was recorded during eccentric rotation with the LED bar. SVV angles were read by the examiner and analyzed. The measured values were compared to those of normal controls and each other. Dynamic SVV toward the lesion side in all subtypes of BPPV were significantly different from those of the controls; HC cupulolithiasis showed significantly lower values than those of PC canalolithiasis and HC canalolithiasis. HC cupulolithiasis shows a lesser degree of utricular dysfunction compared with other subtypes. It could postulate the difference of pathophysiology between canalolithiasis and cupulolithiasis. 4.
BibTeX: @article{Lee2014b, author = {Lee, Sun K and Kim, Su J and Park, Moon S and Byun, Jae Y}, title = {Otolith organ function according to subtype of benign paroxysmal positional vertigo.}, journal = {The Laryngoscope}, year = {2014}, volume = {124}, issue = {4}, pages = {984--988}, doi = {https://doi.org/10.1002/lary.24381}, keywords = {Adolescent; Adult; Aged; Benign Paroxysmal Positional Vertigo; Electronystagmography; Eye Movements, physiology; Female; Follow-Up Studies; Head Movements, physiology; Humans; Male; Middle Aged; Otolithic Membrane, physiopathology; Posture, physiology; Retrospective Studies; Semicircular Canals, physiopathology; Vertigo, diagnosis, physiopathology; Young Adult; Benign paroxysmal positional vertigo; otolith organ; subjective visual vertical}, pmid = {24105837} }
Martínez Pascual, P. and Amaro Merino, P.	Otolithic damage study in patients with benign paroxysmal positional vertigo with vestibular evoked myogenic potentials. [Abstract] [BibTeX]	2018	Acta otorrinolaringologica espanola	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) pathophysiology is based on otoconia migration from the utricle and saccule to the semicircular canals, however, the role of the saccule is still under study. Our aim is to study the otolith damage in these patients with vestibular evoked myogenic potentials (VEMPS) and correlate the results with those of computerised dynamic posturography (CDP). We present 79 patients diagnosed with BPPV between March and June 2017. VEMPS and CDP studies were performed. We selected 67 patients with posterior semi-circular canal BPPV and we compared them with 60 healthy subjects. BPPV group had abnormal cervical VEMPS in 49.25% of patients compared to 16.67% in the control group. Ocular VEMPS were altered in 61.19% of the patients and 6.67% of the healthy subjects. Abnormal ocular VEMPS in patients with recurrent BPPV was statistically significant. There was no significant correlation with CDP results. Utricular and saccular dysfunction in BPPV patients proved by VEMPS is higher than in healthy individuals. This result may be related to symptoms of instability experienced by these patients occasionally.
BibTeX: @article{MartinezPascual2018, author = {Martínez Pascual, Paula and Amaro Merino, Pedro}, title = {Otolithic damage study in patients with benign paroxysmal positional vertigo with vestibular evoked myogenic potentials.}, journal = {Acta otorrinolaringologica espanola}, year = {2018}, doi = {https://doi.org/10.1016/j.otorri.2018.04.003}, keywords = {Benign paroxysmal positional vertigo; Daño otolítico; Inestabilidad; Instability; Otolith damage; Potenciales evocados miogénicos vestibulares; VEMPS; Vértigo posicional paroxístico benigno}, pmid = {29895391} }
Lin, H.W. and Bhattacharyya, N.	Otologic diagnoses in the elderly: current utilization and predicted workload increase. [Abstract] [BibTeX]	2011	The Laryngoscope Vol. 121(7), pp. 1504-1507	article	DOI
Abstract: To establish the current outpatient workload for otologic conditions in the elderly and to estimate its potential increase based on an anticipated aging population. Cross-sectional analysis of a national database. All outpatient clinic visits for patients aged ≥ 65 years receiving one of six common otologic diagnoses from 2005 to 2007 in the United States were determined from the National Ambulatory Medical Care Survey. The distribution of the visits for these diagnoses across 15 specialties was assessed. The number of visits was projected to the 2020 population based on changes in population demographics predicted by the US Census Bureau. An estimated 4.48 ± 0.49 million clinic visits with an otologic issue as a coded diagnosis were conducted in 2005 to 2007 in patients aged ≥ 65 years. These consisted of 230,000 visits for benign positional paroxysmal vertigo, 263,000 visits for vestibular neuritis, 292,000 visits for Meniere's disease, 1.09 million visits for tinnitus, and 2.85 million visits for sensorineural hearing loss. Otolaryngology, internal medicine, family practice, and neurology managed the most visits, seeing 57.0%, 21.0%, 14.3%, and 2.2% of the cases, respectively. With expected changes in population demographics by 2020, annual clinic visits for an otologic diagnosis will increase from 1.49 ± 0.78 million to 2.14 million visits in the elderly, annualized, including 1.218 million visits to otolaryngology. These data quantify the current outpatient otology workload and predict a substantial increase for many specialties, including otolaryngology. Efforts to prepare for this increase including manpower planning and education appear imperative.
BibTeX: @article{Lin2011, author = {Lin, Harrison W and Bhattacharyya, Neil}, title = {Otologic diagnoses in the elderly: current utilization and predicted workload increase.}, journal = {The Laryngoscope}, year = {2011}, volume = {121}, issue = {7}, pages = {1504--1507}, doi = {https://doi.org/10.1002/lary.21827}, keywords = {Aged; Aging, physiology; Ambulatory Care, statistics & numerical data; Child; Cross-Sectional Studies; Databases, Factual; Ear Diseases, diagnosis, epidemiology, therapy; Female; Geriatric Assessment; Health Services for the Aged, organization & administration; Humans; Male; Needs Assessment; Otolaryngology, organization & administration; Outpatients, statistics & numerical data; Practice Patterns, Physicians', statistics & numerical data; Predictive Value of Tests; United States; Workload, statistics & numerical data}, pmid = {21557249} }
Kiran, K.B., Kumar, A.R. and Senthil, K.	Otological manifestations in head injury and their management - a case report. [Abstract] [BibTeX]	2003	Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India Vol. 55(1), pp. 46-49	article	DOI
Abstract: 32 year old male presented with right facial palsy following head injury. Clinical evaluation showed hemotympanum on right with moderately severe conductive hearing loss, grade III LMN facial palsy and BPPV. HRCT of temporal bone demonstrated fracture base of skull involving the roof of mastoid with no evidence of bony injury to fallopian canal. Conservative management of head trauma resulted in satisfactory outcome except for conductive hearing loss and faciel palsy. Facial palsy was managed conservatively [physiotherapy and oral steroids] with full recovery of function after 4 weeks. Conductive hearing loss was managed by combined approach tympanaplasty. Preoperutively incudostapedial joint dislocation and fracture anterior crus of stapes were noted. Type II tympanoplasty with horizontal incus repositioning was carried out.PTA after 6 weeks showed 15-20 dB air-bone gap compared to 50-55dB air-bone gap preoperatively. BPPV recovered spontaneously. This case is reported to highlight:Importance of imaging of temporal bone.Spontaneous recovery of facial nerve function in neuropraxtc injury.Timely and appropriate surgical intervention of ossicular damage following head injury resulting in satisfatctory outcome.
BibTeX: @article{Kiran2003, author = {Kiran, K Bala and Kumar, A Ravi and Senthil, K}, title = {Otological manifestations in head injury and their management - a case report.}, journal = {Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India}, year = {2003}, volume = {55}, issue = {1}, pages = {46--49}, doi = {https://doi.org/10.1007/BF02968755}, keywords = {Head injury; ossiculoplasty; otologic trauma; stapes fracture}, pmid = {23119937} }
Lopez-Gonzalez, M.A., Cherta, G., Nieto, J.A. and Esteban, F.	Otology versus Otosociology. [Abstract] [BibTeX]	2012	ISRN otolaryngology Vol. 2012, pp. 145317	article	DOI
Abstract: Otology concerns the biological study of ear alterations and diseases, solely. So, the diagnosis of audiovestibular diseases tends to be idiopathic or is based on theoretical concepts such as idiopathic sudden deafness, Ménière disease, benign paroxysmal positional vertigo, tinnitus, hyperacusis, or idiopathic facial paralysis. The treatment for these pathologies is symptomatic. Otosociology takes the aetiology and pathogenesis of the ear and situates them within the social and cultural environment of the patient. Then, audiovestibular disease is based on evidence, and the treatment options seek to solve the causes and consequences produced. Otosociology should be considered as a new discipline. Otosociology came into being since otology does not provide definitive solutions for the audiovestibular alterations produced from the point of view of the ear, whereas otosociology finds these solutions within the social/cultural environment of the patient. Where otology emphasises the diseases of the ear, otosociology deals with social manifestations. Where otology deals with idiopathic diseases, otosociology deals with causes and pathogeny produced by interactions in the social and cultural surroundings of the patient. Where otology offers symptomatic treatment, otosociology offers treatment of causes and consequences. Otosociology can fill significant voids in audiovestibular processes from the perspective of the patient's social environment.
BibTeX: @article{Lopez-Gonzalez2012, author = {Lopez-Gonzalez, Miguel A and Cherta, Georgina and Nieto, Jose A and Esteban, Francisco}, title = {Otology versus Otosociology.}, journal = {ISRN otolaryngology}, year = {2012}, volume = {2012}, pages = {145317}, doi = {https://doi.org/10.5402/2012/145317}, pmid = {23762611} }
Imoto, T. and Nakai, Y.	Otoneurological test results analyzed by means of a quantitative statistical method. [Abstract] [BibTeX]	1983	ORL; journal for oto-rhino-laryngology and its related specialties Vol. 45(4), pp. 203-215	article	DOI
Abstract: This report is a presentation of an approach to the prediction of cerebellar-pontine (C-P) angle tumors and four peripheral vestibular diseases from a mathematical statistical point of view. The present study was performed in an attempt to quantify multidimensional, quantitative data. The data analyzed were from a total of 143 patients with C-P angle tumors, Menière's disease, sudden deafness, vestibular neuronitis, and benign paroxysmal positional vertigo (BPPV). Tests were carried out mainly on otoneurological parameters. By means of discriminant analysis as employed in the quantification method, the patients were classified in the 4-dimensional space.
BibTeX: @article{Imoto1983, author = {Imoto, T and Nakai, Y}, title = {Otoneurological test results analyzed by means of a quantitative statistical method.}, journal = {ORL; journal for oto-rhino-laryngology and its related specialties}, year = {1983}, volume = {45}, issue = {4}, pages = {203--215}, doi = {https://doi.org/10.1159/000275644}, keywords = {Adult; Aged; Analysis of Variance; Cerebellar Neoplasms, diagnosis; Cerebellopontine Angle; Diagnosis, Differential; Female; Hearing Loss, Sudden, diagnosis; Hearing Tests; Humans; Labyrinth Diseases, diagnosis; Male; Meniere Disease, diagnosis; Middle Aged; Neuritis, diagnosis; Vertigo, diagnosis; Vestibular Function Tests; Vestibular Nerve; Vestibulocochlear Nerve Diseases, diagnosis}, pmid = {6603601} }
Hughes, I., Blasiole, B., Huss, D., Warchol, M.E., Rath, N.P., Hurle, B., Ignatova, E., Dickman, J.D., Thalmann, R., Levenson, R. and Ornitz, D.M.	Otopetrin 1 is required for otolith formation in the zebrafish Danio rerio. [Abstract] [BibTeX]	2004	Developmental biology Vol. 276(2), pp. 391-402	article	DOI
Abstract: Orientation with respect to gravity is essential for the survival of complex organisms. The gravity receptor is one of the phylogenetically oldest sensory systems, and special adaptations that enhance sensitivity to gravity are highly conserved. The fish inner ear contains three large extracellular biomineral particles, otoliths, which have evolved to transduce the force of gravity into neuronal signals. Mammalian ears contain thousands of small particles called otoconia that serve a similar function. Loss or displacement of these structures can be lethal for fish and is responsible for benign paroxysmal positional vertigo (BPPV) in humans. The distinct morphologies of otoconial particles and otoliths suggest divergent developmental mechanisms. Mutations in a novel gene Otopetrin 1 (Otop1), encoding multi-transmembrane domain protein, result in nonsyndromic otoconial agenesis and a severe balance disorder in mice. Here we show that the zebrafish, Danio rerio, contains a highly conserved gene, otop1, that is essential for otolith formation. Morpholino-mediated knockdown of zebrafish Otop1 leads to otolith agenesis without affecting the sensory epithelium or other structures within the inner ear. Despite lack of otoliths in early development, otolith formation partially recovers in some fish after 2 days. However, the otoliths are malformed, misplaced, lack an organic matrix, and often consist of inorganic calcite crystals. These studies demonstrate that Otop1 has an essential and conserved role in the timing of formation and the size and shape of the developing otolith.
BibTeX: @article{Hughes2004, author = {Hughes, Inna and Blasiole, Brian and Huss, David and Warchol, Mark E and Rath, Nigam P and Hurle, Belen and Ignatova, Elena and Dickman, J David and Thalmann, Ruediger and Levenson, Robert and Ornitz, David M}, title = {Otopetrin 1 is required for otolith formation in the zebrafish Danio rerio.}, journal = {Developmental biology}, year = {2004}, volume = {276}, issue = {2}, pages = {391--402}, doi = {https://doi.org/10.1016/j.ydbio.2004.09.001}, keywords = {Animals; Calcium Carbonate, metabolism; Gene Expression Regulation, Developmental; Gravitation; Humans; In Situ Hybridization; Membrane Proteins, genetics, metabolism; Mice; Microscopy, Electron, Scanning; Morphogenesis; Oligonucleotides, genetics, metabolism; Otolithic Membrane, anatomy & histology, chemistry, embryology, metabolism; Saccule and Utricle, anatomy & histology, embryology, ultrastructure; X-Ray Diffraction; Zebrafish, anatomy & histology, embryology, genetics; Zebrafish Proteins, genetics, metabolism; Non-programmatic}, pmid = {15581873} }
Tan, F., Bartels, C. and Walsh, R.M.	Our experience with 500 patients with benign paroxysmal positional vertigo: Reexploring aetiology and reevaluating MRI investigation. [Abstract] [BibTeX]	2018	Auris, nasus, larynx Vol. 45(2), pp. 248-253	article	DOI
Abstract: To explore the aetiology of and to evaluate the importance of MRI investigation on the posterior semicircular canal benign paroxysmal positional vertigo in an Irish population. A retrospective observational study of 500 patients with posterior semicircular canal benign paroxysmal positional vertigo, diagnosed and treated by the senior author over a 10-year period. Most patients underwent an MRI brain and inner ear, following the same scan protocol. This included T1 weighted sagittal IR-FSPGR volume, axial T2 weighted, gradient echo T2 weighted and FLAIR sequences plus time of flight cerebral angiography. The average age of presentation was 56 years; with the overall female to male ratio was 1.6:1, which was largely the net results of 2 age groups. Over 30% of our patients recalled distinct aetiological triggers, of which the top 3 were trauma, infection, and surgery. These accounted for 16%, 6%, and 5%, respectively. More than 25% of the patients were discovered to have abnormal intracranial findings on MRI. The 2 most common non-infarct incidental findings were neoplasia and vascular abnormalities. Although fewer than 20 patients had acute intracranial haemorrhage or malignant tumours, most of them were urgently referred to neurosurgeon due to the life-threatening nature of the condition. One round of particle repositioning manoeuver was successful in treating 84% of the patients, and the 2-year recurrence rate was only 2.2%. The diagnosis of posterior semicircular canal benign paroxysmal positional vertigo is thought to be relatively easy to make, and the treatment is highly effective. Clinicians should be fully aware of and prepared for the diverse aetiology, and thus have no hesitation in requesting MRI scan as an important investigation.
BibTeX: @article{Tan2018, author = {Tan, Fei and Bartels, Constantin and Walsh, Rory McConn}, title = {Our experience with 500 patients with benign paroxysmal positional vertigo: Reexploring aetiology and reevaluating MRI investigation.}, journal = {Auris, nasus, larynx}, year = {2018}, volume = {45}, issue = {2}, pages = {248--253}, doi = {https://doi.org/10.1016/j.anl.2017.05.017}, keywords = {Acute Disease; Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, diagnostic imaging, etiology, therapy; Brain Neoplasms, complications, diagnostic imaging; Craniocerebral Trauma, complications; Female; Humans; Incidental Findings; Intracranial Hemorrhages, complications, diagnostic imaging; Labyrinthitis, complications; Magnetic Resonance Imaging; Male; Middle Aged; Nasal Surgical Procedures; Neck Injuries, complications; Otologic Surgical Procedures; Patient Positioning, methods; Postoperative Complications, diagnostic imaging, etiology; Retrospective Studies; Young Adult; Aetiology; Algorithm; BPPV; Demographics; Dix-Hallpike; Epley manoeuvre; European; Incidental finding; Infection; MRI; Scan; Semicircular canal; Surgery; Trauma; Tumour; Vertigo}, pmid = {28943053} }
Novotný, M., Skutil, J., Trnka, A. and Kostrica, R.	Our experience with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2006	The international tinnitus journal Vol. 12(1), pp. 71-73	article
Abstract: Benign paroxysmal positional vertigo has been considered a separate nosological entity. This status is explained by the theories of cupulolithiasis and canalolithiasis. The disorder is treated with training; success was achieved in 88% of our cases, which correlates with the literary data. Trauma and inflammation in the head and neck region may be regarded as possible etiological factors.
BibTeX: @article{Novotny2006, author = {Novotný, Miroslav and Skutil, Jan and Trnka, Ales and Kostrica, Rom}, title = {Our experience with benign paroxysmal positional vertigo.}, journal = {The international tinnitus journal}, year = {2006}, volume = {12}, issue = {1}, pages = {71--73}, keywords = {Female; Humans; Male; Middle Aged; Posture; Treatment Outcome; Vertigo, diagnosis, etiology, physiopathology, rehabilitation; Vestibular Function Tests}, pmid = {17147044} }
Asal, S., Sobhy, O. and Balbaa, A.	oVEMP as an objective indicator of successful repositioning maneuver. [Abstract] [BibTeX]	2018	Acta otorrinolaringologica espanola Vol. 69(3), pp. 141-148	article	DOI
Abstract: Benign paroxysmal positioning vertigo (BPPV) is the most common peripheral vestibular disorder. Canalolithiasis in the posterior semi-circular canal is the most common underlying pathology that can be treated effectively by repositioning maneuvers. Our hypothesis suggested that successful maneuvers can lead to repositioning of dislodged otoconia to the utricle. Air conducted oVEMP, which is thought to originate from the contra-lateral utricular organ was measured in twenty patients with unilateral BPPV and we compared n1-p1 peak to peak amplitude of the affected ears in 3 separate intervals: on pre-treatment when typical nystagmus was confirmed, immediately after, and 1 week after repositioning maneuvers to assess change, if any, in amplitude. This study showed significant increase of oVEMP amplitude in the affected ears after successful repositioning maneuver that was more significant after 1 week. oVEMP can be used as a reliable objective test for ensuring a successful maneuver rather than subjective dependence on the patient's symptoms, which may be misleading due to a remission.
BibTeX: @article{Asal2018, author = {Asal, Samir and Sobhy, Osama and Balbaa, Amany}, title = {oVEMP as an objective indicator of successful repositioning maneuver.}, journal = {Acta otorrinolaringologica espanola}, year = {2018}, volume = {69}, issue = {3}, pages = {141--148}, doi = {https://doi.org/10.1016/j.otorri.2017.06.004}, keywords = {Adult; Benign Paroxysmal Positional Vertigo, physiopathology, therapy; Female; Humans; Male; Middle Aged; Patient Positioning, methods; Prospective Studies; Vestibular Evoked Myogenic Potentials; Benign paroxysmal positioning vertigo; Maniobras de reposicionamiento; Ocular vestibular evoked myogenic potential; Potencial miogénico evocado vestibular ocular; Repositioning maneuvers; Vértigo posicional paroxístico benigno}, pmid = {28865839} }
Bisdorff, A.R., Staab, J.P. and Newman-Toker, D.E.	Overview of the International Classification of Vestibular Disorders. [Abstract] [BibTeX]	2015	Neurologic clinics Vol. 33(3), pp. 541-50, vii	article	DOI
Abstract: Classifications and definitions are essential to facilitate communication; promote accurate diagnostic criteria; develop, test, and use effective therapies; and specify knowledge gaps. This article describes the development of the International Classification of Vestibular Disorders (ICVD) initiative. It describes its history, scope, and goals. The Bárány Society has played a central role in organizing the ICVD by establishing internal development processes and outreach to other scientific societies. The ICVD is organized in four layers. The current focus is on disorders with a high epidemiologic importance, such as Menière disease, benign paroxysmal positional vertigo, vestibular migraine, and behavioral aspects of vestibular disorders.
BibTeX: @article{Bisdorff2015, author = {Bisdorff, Alexandre R and Staab, Jeffrey P and Newman-Toker, David E}, title = {Overview of the International Classification of Vestibular Disorders.}, journal = {Neurologic clinics}, year = {2015}, volume = {33}, issue = {3}, pages = {541--50, vii}, doi = {https://doi.org/10.1016/j.ncl.2015.04.010}, keywords = {Dizziness, diagnosis; Humans; Migraine Disorders, complications, diagnosis; Vertigo, diagnosis; Vestibular Diseases, classification, complications, diagnosis; Bárány Society; Classification; Symptoms; Vertigo; Vestibular}, pmid = {26231270} }
Şahin, E., Deveci, İ., Dinç, M.E., Özker, B.Y., Biçer, C. and Erel, Ö.	Oxidative Status in Patients with Benign Paroxysmal Positional Vertigo. [Abstract] [BibTeX]	2018	The journal of international advanced otology Vol. 14(2), pp. 299-303	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most frequent peripheral vestibular disorder and is particularly seen among older patients suffering from vertigo. The brief vertigo attacks in and imbalance symptoms of BPPV are caused by freely floating otoconia within the semicircular canals. The aim of this prospective study was to evaluate the role of oxidative stress, using native thiol/disulfide (SH/SS) homeostasis as a novel indicator, in the etiology of BPPV. The 62 participants in the study included 31 patients with BPPV and, as the control group, 31 healthy individuals without any cochleovestibular disorders. Patients with BPPV initially had significantly lower native SH levels and significantly lower SH/total thiol (TT) ratios, as well as significantly higher SS/SH and SS/TT ratios, than the healthy controls. After successful treatment of their vertigo, which was confirmed based on the results obtained from the second blood sample, patients with BPPV still had lower SH levels and SH/TT ratios and significantly higher SS/SH and SS/TT ratios than the healthy controls. Our results suggest a role of oxidative stress in the development of BPPV, through both calcium metabolism and the direct toxic effects of free oxygen radicals, including the triggering of apoptosis.
BibTeX: @article{Sahin2018, author = {Şahin, Ethem and Deveci, İldem and Dinç, Mehmet Emre and Özker, Berna Yayla and Biçer, Cemile and Erel, Özcan}, title = {Oxidative Status in Patients with Benign Paroxysmal Positional Vertigo.}, journal = {The journal of international advanced otology}, year = {2018}, volume = {14}, issue = {2}, pages = {299--303}, doi = {https://doi.org/10.5152/iao.2018.4756}, pmid = {30256204} }
Iglebekk, W., Tjell, C. and Borenstein, P.	Pain and other symptoms in patients with chronic benign paroxysmal positional vertigo (BPPV). [Abstract] [BibTeX]	2013	Scandinavian journal of pain Vol. 4(4), pp. 233-240	article	DOI
Abstract: Background and aim A diagnosis of chronic benign paroxysmal positional vertigo (BPPV) is based on brief attacks of rotatory vertigo and concomitant nystagmus elicited by rapid changes in head position relative to gravity. However, the clinical course of BPPV may vary considerably from a self-limiting to a persisting and/or recurrent disabling problem. The authors' experience is that the most common complaints of patients with chronic BPPV are nautical vertigo or dizziness with other symptoms including neck pain, headache, widespread musculoskeletal pain, fatigue, and visual disturbances. Trauma is believed to be the major cause of BPPV in individuals younger than fifty years. Chronic BPPV is associated with high morbidity. Since these patients often suffer from pain and do not have rotatory vertigo, their symptoms are often attributed to other conditions. The aim of this study was to investigate possible associations between these symptoms and chronic BPPV. Methods During 2010 a consecutive prospective cohort observational study was performed. Diagnostic criteria: (A) BPPV diagnosis confirmed by the following: (1) a specific history of vertigo/dizziness evoked by acceleration/deceleration, (2) nystagmus in the first position of otolith repositioning maneuvers, and (3) appearing and disappearing nystagmus during the repositioning maneuvers; (B) the disorder has persisted for at least six months. (C) Normal MRI of the cerebrum. (A) Any disorder of the central nervous system (CNS), (B) migraine, (C) active Ménière's disease, and (D) severe eye disorders. Symptom questionnaire ('yes or no' answers during a personal interview) and Dizziness Handicap Inventory (DHI) were used. Results We included 69 patients (20 males and 49 females) with a median age of 45 years (range 21-68 years). The median duration of the disease was five years and three months. The video-oculography confirmed BPPV in more than one semicircular canal in all patients. In 15% there was a latency of more than 1 min before nystagmus occurred. The Dizziness Handicap Inventory (DHI) median score was 55.5 (score >60 indicates a risk of fall). Seventy-five percent were on 50-100% sick leave. Eighty-one percent had a history of head or neck trauma. Nineteen percent could not recall any history of trauma. In our cohort, nautical vertigo and dizziness (81%) was far more common than rotatory vertigo (20%). The majority of patients (87%) reported pain as a major symptom: neck pain (87%), headache (75%) and widespread pain (40%). Fatigue (85%), visual disturbances (84%), and decreased concentration ability (81%) were the most frequently reported symptoms. In addition, unexpected findings such as involuntary movements of the extremities, face, neck or torso were found during otolith repositioning maneuvers (12%). We describe one case, as an example, how treatment of his BPPV also resolved his chronic, severe pain condition. Conclusion This observational study demonstrates a likely connection between chronic BPPV and the following symptoms: nautical vertigo/dizziness, neck pain, headache, widespread pain, fatigue, visual disturbances, cognitive dysfunctions, nausea, and tinnitus. Implications Patients with complex pain conditions associated with nautical vertigo and dizziness should be evaluated with the Dizziness Handicap Inventory (DHI)-questionnaire which can identify treatable balance disorders in patients with chronic musculoskeletal pain.
BibTeX: @article{Iglebekk2013, author = {Iglebekk, Wenche and Tjell, Carsten and Borenstein, Peter}, title = {Pain and other symptoms in patients with chronic benign paroxysmal positional vertigo (BPPV).}, journal = {Scandinavian journal of pain}, year = {2013}, volume = {4}, issue = {4}, pages = {233--240}, doi = {https://doi.org/10.1016/j.sjpain.2013.06.004}, keywords = {Dizziness; Fatigue; Pain; Paroxysmal positional; Vertigo}, pmid = {29913653} }
Di Girolamo, M., Napolitano, B., Arullani, C.A., Bruno, E. and Di Girolamo, S.	Paroxysmal positional vertigo as a complication of osteotome sinus floor elevation. [Abstract] [BibTeX]	2005	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 262(8), pp. 631-633	article	DOI
Abstract: Paroxysmal positional vertigo (PPV) is a high prevalence, vestibular end organ disorder due to the detachment of the utricular otoconia floating in the posterior or lateral semicircular canal. Even though in the majority of cases the etiology of PPV is unknown, it may follow viral infection, vascular disorders and head trauma after different surgical procedures. The aim of this study was to investigate the correlation between PPV and the surgical trauma induced by the vibratory and percussive forces on the upper maxilla during the osteotome sinus floor elevation procedure. We performed a complete otoneurological examination on 146 patients affected by atrophic ridges before and after upper maxilla surgery. Four patients showed a PPV of the posterior semicircular canal controlateral to the implanted side 1 or 2 days after the surgical procedure, which promptly was solved with the Epley re-positioning maneuver. We hypothesize that the surgical trauma, and specifically the pressure exerted by the osteotomes, determines the detachment of the otoliths from the utricular macula while the patient head position, hyper-extended and tilted opposite to the side where the surgeon is working, favors the entry of these free-floating particles in the posterior semicircular canal of the implanted side. Although this disease is rather frequent in the normal population and it is a benign, self-limiting peripheral disorder, it should be considered by the oral surgeon as a possible complication of pre-prosthetic upper maxilla surgery, and the patient should be informed before undergoing surgery.
BibTeX: @article{DiGirolamo2005, author = {Di Girolamo, Michele and Napolitano, Bianca and Arullani, Carlo Andrea and Bruno, Ernesto and Di Girolamo, Stefano}, title = {Paroxysmal positional vertigo as a complication of osteotome sinus floor elevation.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2005}, volume = {262}, issue = {8}, pages = {631--633}, doi = {https://doi.org/10.1007/s00405-004-0879-9}, keywords = {Aged; Alveolar Process, pathology, surgery; Atrophy, surgery; Female; Follow-Up Studies; Humans; Male; Maxillary Sinus, surgery; Middle Aged; Osteotomy, adverse effects, instrumentation; Prospective Studies; Treatment Outcome; Vertigo, diagnosis, etiology, therapy}, pmid = {15735973} }
Casani, A.P., Cerchiai, N. and Navari, E.	Paroxysmal positional vertigo despite complete vestibular impairment: the role of instrumental assessment. [Abstract] [BibTeX]	2018	Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale Vol. 38(6), pp. 563-568	article	DOI
Abstract: Lindsay-Hemenway syndrome is characterised by a posterior canal benign paroxysmal positional vertigo following a partial unilateral vestibular loss affecting the same side. The syndrome is caused by damage of structures innervated by the superior division of the vestibular nerve and perfused by the anterior vestibular artery; the detached otoconia can cause vertigo in the still intact posterior semicircular canal. The most recent vestibular instrumental techniques allow reaching an accurate topodiagnosis in case of peripheral vestibular failure. We report on two cases of Lindsay-Hemenway syndrome despite complete vestibular failure demonstrated by vestibular instrumental assessment. After making some critical considerations on these findings, we underline the importance of not disregarding the diagnosis of paroxysmal positional vertigo in an established complete labyrinthine loss of function.
BibTeX: @article{Casani2018, author = {Casani, A P and Cerchiai, N and Navari, E}, title = {Paroxysmal positional vertigo despite complete vestibular impairment: the role of instrumental assessment.}, journal = {Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale}, year = {2018}, volume = {38}, issue = {6}, pages = {563--568}, doi = {https://doi.org/10.14639/0392-100X-1549}, keywords = {Benign paroxysmal positional vertigo; Lindsay-Hemenway syndrome; Unilateral vestibular loss; Vestibular evoked myogenic potentials (VEMPs); video Head Impulse Test (vHIT)}, pmid = {29498717} }
Honrubia, V., Baloh, R.W., Harris, M.R. and Jacobson, K.M.	Paroxysmal positional vertigo syndrome. [Abstract] [BibTeX]	1999	The American journal of otology Vol. 20(4), pp. 465-470	article
Abstract: This study was initiated to investigate the differential diagnosis of patients with benign paroxysmal positional vertigo (BPPV) of different canals' origin. The eye movements of 292 patients were evaluated with the use of Frenzel glasses and infrared video cameras after positional tests. Epley's canal repositioning procedure (CRP) was conducted, with appropriate modifications for individual cases, on every patient. Two different types of positional nystagmus were observed corresponding to the presence of otoliths in the lumen of each of the semicircular canals and on the cupola of the horizontal semicircular canal. The posterior canal was involved in 250 patients unilaterally and 23 patients bilaterally. The anterior canal variety was observed in four patients. In the horizontal canal, nine were of the cupulolithiasis and six of the canalithiasis variety. In seven patients. the affected canal converted to a different location. The canal repositioning procedure eliminated vertigo and abnormal eye movements in 88% of the unilateral posterior canal variety. The success rate of the procedure in the other varieties was 50%. Positional vertigo can have characteristics corresponding to the presence of otolith particles in each of the semicircular canals. The treatment requires different strategies to move the otoliths, depending on their location in the vestibule.
BibTeX: @article{Honrubia1999, author = {Honrubia, V and Baloh, R W and Harris, M R and Jacobson, K M}, title = {Paroxysmal positional vertigo syndrome.}, journal = {The American journal of otology}, year = {1999}, volume = {20}, issue = {4}, pages = {465--470}, keywords = {Aged; Electromyography, methods; Eye Movements, physiology; Female; Head, physiology; Humans; Male; Movement, physiology; Nystagmus, Pathologic, diagnosis; Semicircular Canals, physiology; Time Factors; Vertigo, diagnosis, physiopathology; Vestibule, Labyrinth, physiopathology; Video Recording}, pmid = {10431888} }
Okumura, T., Imai, T., Higashi-Shingai, K., Ohta, Y., Morihana, T., Sato, T., Okazaki, S., Iwamoto, Y., Hanada, Y., Ozono, Y., Imai, R., Ohata, K. and Inohara, H.	Paroxysmal vertigo with nystagmus in children. [Abstract] [BibTeX]	2016	International journal of pediatric otorhinolaryngology Vol. 88, pp. 89-93	article	DOI
Abstract: A pathological nystagmus is an objective sign that a patient feels vertigo. However, there have been few opportunities to observe and record pathological nystagmus during a paroxysmal vertigo attack. Furthermore, it can be difficult to obtain cooperation in pediatric patients. We present two cases of paroxysmal vertigo in children in whom we successfully recorded and analyzed their pathological nystagmus during a vertigo attack. Of a total sample of 4349 patients seen at our hospital for dizziness in the last decade, a retrospective analysis revealed that 68 were children (<15 years old; 1.6%). Of these 68 children, we successfully identified pathological nystagmus during paroxysmal vertigo in only two (2.9%). Case 1 was a 4-year-old girl. She felt vertigo the strongest when her left ear was down in the supine position. We observed and recorded her nystagmus during a vertigo attack with her mother's permission. Her positional nystagmus in the supine position was horizontal persistent apogeotropic nystagmus. Rightward nystagmus in the left-ear-down supine position was stronger than leftward nystagmus in the right-ear-down supine position. Therefore, the diagnosis was right lateral canal type of benign paroxysmal positional vertigo, of which the pathophysiology was cupulolithiasis. The other patient was an 11-year-old boy. He had a family history of migraines. His vertigo attacks occurred after onset of a severe migraine and lasted between 2 and 48 h. During an attack that we observed, he showed nystagmus, which was direction-fixed right torsional and rightward in darkness. His mother had noticed that his eyes moved abnormally and that his left eye did not shift to the left side when he looked leftward. He was old enough to clearly express his own symptoms. Other neurological examinations were normal. The diagnosis was vestibular migraine. We analyzed a pathological nystagmus during paroxysmal vertigo in two children. We conclude that children can be diagnosed with a combination of careful history taking and accurate examinations of a pathological nystagmus.
BibTeX: @article{Okumura2016, author = {Okumura, Tomoko and Imai, Takao and Higashi-Shingai, Kayoko and Ohta, Yumi and Morihana, Tetsuo and Sato, Takashi and Okazaki, Suzuyo and Iwamoto, Yoriko and Hanada, Yukiko and Ozono, Yoshiyuki and Imai, Ryusuke and Ohata, Kazuya and Inohara, Hidenori}, title = {Paroxysmal vertigo with nystagmus in children.}, journal = {International journal of pediatric otorhinolaryngology}, year = {2016}, volume = {88}, pages = {89--93}, doi = {https://doi.org/10.1016/j.ijporl.2016.06.046}, keywords = {Benign Paroxysmal Positional Vertigo, complications, physiopathology; Child; Child, Preschool; Female; Humans; Male; Migraine Disorders, complications, diagnosis, physiopathology; Neurologic Examination; Nystagmus, Pathologic, diagnosis, etiology, physiopathology; Nystagmus, Physiologic; Retrospective Studies; Vestibular Function Tests; Benign paroxysmal positional vertigo; Children; Nystagmus; Vertigo; Vestibular migraine}, pmid = {27497392} }
Verma, A.	Particle dislodgement procedure: a prospective study of 100 consecutive cases of posterior canal Benign Paroxysmal Positional Vertigo. [Abstract] [BibTeX]	2010	Annals of neurosciences Vol. 17(4), pp. 176-181	article	DOI
Abstract: Benign Paroxysmal Positional Vertigo is a common cause of vertigo caused by dislodged otoconia. To study the therapeutic efficacy in Indian population and modify the Canalith repositioning procedure (CRP) into a simple, precise and easily reproducible out door procedure. All patients with Posterior canal BPPV were selected based on Dix Hallpike test and were subjected to CRP. 92% patients had type I response ie no vertigo and negative repeat D-H test. No complications were observed. CRP is highly effective, simple, bed side therapy for Posterior canal BPPV.
BibTeX: @article{Verma2010, author = {Verma, Ajit}, title = {Particle dislodgement procedure: a prospective study of 100 consecutive cases of posterior canal Benign Paroxysmal Positional Vertigo.}, journal = {Annals of neurosciences}, year = {2010}, volume = {17}, issue = {4}, pages = {176--181}, doi = {https://doi.org/10.5214/ans.0972.7531.1017406}, keywords = {BPPV; CRP; Rehabilitation; Vertigo}, pmid = {25205901} }
Epley, J.M.	Particle repositioning for benign paroxysmal positional vertigo. [Abstract] [BibTeX]	1996	Otolaryngologic clinics of North America Vol. 29(2), pp. 323-331	article
Abstract: Benign paroxysmal positional vertigo is a common condition that can be severely incapacitating. The causative mechanism is usually displaced dense particles (canaliths) in a semicircular canal. By means of canalith repositioning, these particles can be moved into the utricle and the symptoms completely resolved in a high percentage of cases. The protocol for procedure is discussed as well as the management of complications and recurrences.
BibTeX: @article{Epley1996, author = {Epley, J M}, title = {Particle repositioning for benign paroxysmal positional vertigo.}, journal = {Otolaryngologic clinics of North America}, year = {1996}, volume = {29}, issue = {2}, pages = {323--331}, keywords = {Follow-Up Studies; Humans; Otolithic Membrane, pathology; Posture; Recurrence; Saccule and Utricle, pathology; Semicircular Canals, pathology; Vertigo, complications, pathology, therapy}, pmid = {8860930} }
Parnes, L.S. and Price-Jones, R.G.	Particle repositioning maneuver for benign paroxysmal positional vertigo. [Abstract] [BibTeX]	1993	The Annals of otology, rhinology, and laryngology Vol. 102(5), pp. 325-331	article	DOI
Abstract: Benign paroxysmal positional vertigo is a common, most often self-limited, vestibular end organ disorder that in some cases may be quite disabling. Recent evidence suggests that some, if not most, cases result from free-floating posterior semicircular canal endolymph particles. We postulate that the particle repositioning maneuver displaces these particles from the posterior canal through the common crus into the utricle, where they no longer induce pathologic responses. Our report focuses on 38 consecutive patients treated with this simple bedside technique during a 10-month period. On follow-up, 26 patients (68.4%) were free of disease, 4 (10.5%) were significantly improved, 4(10.5%) remained unchanged, and 4(10.5%) were lost to follow-up. Of the 4 patients who remained unchanged, 2 underwent successful posterior semicircular canal occlusions. The direction of the nystagmus during the second stage of the maneuver appears important in predicting the efficacy, with reversal of nystagmus denoting a poor response. These findings provide additional insight into the pathophysiology of this disorder.
BibTeX: @article{Parnes1993, author = {Parnes, L S and Price-Jones, R G}, title = {Particle repositioning maneuver for benign paroxysmal positional vertigo.}, journal = {The Annals of otology, rhinology, and laryngology}, year = {1993}, volume = {102}, issue = {5}, pages = {325--331}, doi = {https://doi.org/10.1177/000348949310200501}, keywords = {Adult; Aged; Aged, 80 and over; Female; Follow-Up Studies; Humans; Labyrinth Diseases, complications, physiopathology; Male; Middle Aged; Nystagmus, Pathologic, physiopathology; Posture; Retrospective Studies; Semicircular Canals; Time Factors; Treatment Outcome; Vertigo, etiology, therapy}, pmid = {8489160} }
Welling, D.B. and Barnes, D.E.	Particle repositioning maneuver for benign paroxysmal positional vertigo. [Abstract] [BibTeX]	1994	The Laryngoscope Vol. 104(8 Pt 1), pp. 946-949	article	DOI
Abstract: The recent demonstration of free-floating particles in the endolymph of the posterior semicircular canal in patients with benign paroxysmal positional vertigo (BPPV) has renewed interest in the physiology and treatment of this entity. The particle repositioning maneuver (PRM) relocates the free-floating particles from the posterior semicircular canal back into the utricle, relieving the patient of bothersome, often long-standing vertigo. This report represents a prospective study of 27 consecutive patients seen with a diagnosis of BPPV. Eighty-four percent of the patients treated with the particle repositioning maneuver who had no other associated pathology were cured or significantly improved with this new technique. Two patients who failed conservative management went on to surgical intervention with the posterior semicircular canal occlusion. The authors find the particle repositioning maneuver effective for many patients with benign positional vertigo and recommend it as the first-line treatment modality for BPPV.
BibTeX: @article{Welling1994, author = {Welling, D B and Barnes, D E}, title = {Particle repositioning maneuver for benign paroxysmal positional vertigo.}, journal = {The Laryngoscope}, year = {1994}, volume = {104}, issue = {8 Pt 1}, pages = {946--949}, doi = {https://doi.org/10.1288/00005537-199408000-00007}, keywords = {Adult; Aged; Endolymph; Follow-Up Studies; Gravitation; Humans; Middle Aged; Nystagmus, Pathologic, physiopathology; Posture; Prospective Studies; Rotation; Saccule and Utricle; Supine Position; Vertigo, physiopathology, surgery, therapy}, pmid = {8052079} }
Amor-Dorado, J.C., Barreira-Fernández, M.P., Aran-Gonzalez, I., Casariego-Vales, E., Llorca, J. and González-Gay, M.A.	Particle repositioning maneuver versus Brandt-Daroff exercise for treatment of unilateral idiopathic BPPV of the posterior semicircular canal: a randomized prospective clinical trial with short- and long-term outcome. [Abstract] [BibTeX]	2012	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 33(8), pp. 1401-1407	article	DOI
Abstract: To compare the outcome and probability of recurrence in a series of patients with unilateral idiopathic benign paroxysmal positional vertigo of the posterior canal (PC-BPPV) that were randomly treated by Brandt-Daroff exercise (B-D exercise) or by particle repositioning maneuver (PRM). Randomized prospective clinical trial. Tertiary referral center. Patients were included in this study if they complained of vertigo and had been diagnosed as having unilateral idiopathic PC-BPPV for at least 1 week before Dix-Hallpike maneuver (DHM), remained for 30 days in the randomly assigned treatment, and had at least 48 months' follow-up. Forty-one patients were treated with a single PRM and 40 patients by B-D exercise. Resolution of benign paroxysmal positional nystagmus on the DHM. The probability of recurrence was also studied. At Day 7, DHM was negative in 80.5% of the PRM-treated patients and in 25% of those treated by B-D exercise (p < 0.001). At Month 1, the differences between both treatment groups remained statistically significant (92.7% in PRM versus 42.5% in the B-D exercise had a negative DHM; p < 0.001). The variable that influenced that DHM became negative was the PRM (RR = 4.8; 95% confidence interval, 2.5-9.2; p < 0.001). The number of recurrences in PRM and B-D exercise were 0.56 ± 0.8 and 0.48 ± 0.8, respectively (p = 0.48). The recurrence rate at 48 months was 35.5% (15/41) in B-D exercise and 36.6% (9/31) in the PRM group (p = 0.62). Although the time interval until the first recurrence was similar (p = 0.44), patients included in the PRM group showed a significantly longer time interval between the first and second recurrence (p = 0.04). PRM is more effective treatment and as safe as B-D exercise in the short term for unilateral and idiopathic PC-BPPV, and although it does not reduce the probability of recurrence in the 4-year follow-up period compared with B-D exercise, it may delay the second recurrence's onset in those patients who had already experienced a single recurrence. Our study supports the use of PRM as the treatment of choice in unilateral and idiopathic PC-BPPV, although exercise may be also considered as an alternative treatment in selected cases.
BibTeX: @article{Amor-Dorado2012, author = {Amor-Dorado, Juan Carlos and Barreira-Fernández, Maria Pilar and Aran-Gonzalez, Ismael and Casariego-Vales, Emilio and Llorca, Javier and González-Gay, Miguel Angel}, title = {Particle repositioning maneuver versus Brandt-Daroff exercise for treatment of unilateral idiopathic BPPV of the posterior semicircular canal: a randomized prospective clinical trial with short- and long-term outcome.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2012}, volume = {33}, issue = {8}, pages = {1401--1407}, doi = {https://doi.org/10.1097/MAO.0b013e318268d50a}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Cohort Studies; Eye Movements, physiology; Female; Follow-Up Studies; Humans; Kaplan-Meier Estimate; Magnetic Resonance Imaging; Male; Middle Aged; Neurologic Examination; Physical Therapy Modalities, adverse effects; Prospective Studies; Recurrence; Semicircular Canals; Single-Blind Method; Treatment Outcome; Vertigo, therapy; Young Adult}, pmid = {22935812} }
Fung, K. and Hall, S.F.	Particle repositioning maneuver: effective treatment for benign paroxysmal positional vertigo. [Abstract] [BibTeX]	1996	The Journal of otolaryngology Vol. 25(4), pp. 243-248	article
Abstract: To assess short-term and long-term outcomes of the particle repositioning maneuver (PRM). This is a prospective study of 68 cases of benign paroxysmal positional vertigo (BPPV) in 65 consecutive patients. Initially, 57 (83.8%) cases had no evidence of residual symptoms, 10 (14.7%) had a partial improvement, and only 1 (1.5%) failed treatment. In the long-term (18.7 month mean follow-up period), 43 (67.2%) cases had no history of recurrence, and 22 (34.4%) cases had recurrences, of which 14 (21.9%) experienced only mild symptoms, and 8 (12.5%) were no better than before the PRM. Of the eight who were no better, five had repeat PRMs that successfully relieved their symptoms. The final overall outcome was that 59 (95.2%) patients had either mild symptoms or no symptoms, and 3 (4.8%) patients were treatment failures. Factors that did not seem to be predictive of outcome were secondary nystagmus, gender, and duration of symptoms. In both the short and long terms, the self-limited form of BPPV was found to have the best outcome, the episodic type had an intermediate outcome, and the prolonged type had the worst outcome. We postulate that outcomes are best in those cases where free-floating canaliths are the mechanism of disease, which includes patients with self-limited BPPV. Patients with episodic or prolonged BPPV may have varying degrees of underlying cupulolithiasis that cannot be entirely corrected with PRM alone.
BibTeX: @article{Fung1996, author = {Fung, K and Hall, S F}, title = {Particle repositioning maneuver: effective treatment for benign paroxysmal positional vertigo.}, journal = {The Journal of otolaryngology}, year = {1996}, volume = {25}, issue = {4}, pages = {243--248}, keywords = {Adult; Aged; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nystagmus, Pathologic, diagnosis; Prospective Studies; Vertigo, diagnosis}, pmid = {8863212} }
Sridhar, S. and Panda, N.	Particle repositioning manoeuvre in benign paroxysmal positional vertigo: is it really safe? [Abstract] [BibTeX]	2005	The Journal of otolaryngology Vol. 34(1), pp. 41-45	article
Abstract: A prospective study to determine the safety of the particle repositioning manoeuvre (PRM) by analyzing the various complications of the procedure. Outpatient Department of Otorhinolaryngology, Nehru Hospital, Chandigarh, India. Thirty patients with the classic findings of benign paroxysmal positional vertigo (BPPV) were included in the study. Clinical symptoms prior to the procedure were noted. Twenty-nine of them were subjected to PRM, and postprocedural instructions were given to all patients. Various side effects during and following the procedure were recorded. They were classified into early and late based on the period and into major and minor based on severity. All patients were reviewed after 3 days, 7 days, and 1 month. Of the 29 patients, 19 patients (65.52%) had heaviness in the head, with 11 each (37.93%) reporting nausea and imbalance and 9 (31.03%) reporting instability during the procedure. A major complication, asystole, was noted in one patient. The percentage of side effects remained more or less the same in the early phase following the procedure. Only 5 of 29 patients were entirely asymptomatic. Ninety percent were relieved of symptoms by the end of 7 days, with no major complication recorded. PRM is an easy, effective, and relatively safe procedure. The risk of major complications with PRM, such as arrhythmias and asystole, highlights the need to consider other management modalities for BPPV in certain medically unfit patients.
BibTeX: @article{Sridhar2005, author = {Sridhar, Simhadri and Panda, Naresh}, title = {Particle repositioning manoeuvre in benign paroxysmal positional vertigo: is it really safe?}, journal = {The Journal of otolaryngology}, year = {2005}, volume = {34}, issue = {1}, pages = {41--45}, keywords = {Exercise Therapy, adverse effects; Female; Head Movements, physiology; Humans; Male; Middle Aged; Posture; Prospective Studies; Severity of Illness Index; Time Factors; Vertigo, diagnosis, etiology, therapy}, pmid = {15966476} }
Welling, D.B., Parnes, L.S., O'Brien, B., Bakaletz, L.O., Brackmann, D.E. and Hinojosa, R.	Particulate matter in the posterior semicircular canal. [Abstract] [BibTeX]	1997	The Laryngoscope Vol. 107(1), pp. 90-94	article
Abstract: The pathoetiology of benign paroxysmal positional vertigo (BPPV) is controversial. Particulate matter within the posterior semicircular canal has been identified intraoperatively in patients with BPPV but has also been reported in non-BPPV patients at the time of translabyrinthine surgery (Parnes LS, McClure JA. Free-floating endolymphatic particles: a new operative finding during posterior semicircular canal occlusion. Laryngoscope 1992;102:988-92; Schuknecht HF, Ruby RRF. Cupulolithiasis. Adv Otorhinolaryngol 1973;20: 434-43; Kveton JF, Kashgarian M. Particulate matter within the membranous labyrinth: pathologic or normal? Am J Otol 1994;15:173-6). The nature of the particulate matter remains unknown. The purpose of this study was to prospectively examine the posterior semicircular canal of patients with and without a clinical history of BPPV for the presence of particulate matter. Seventy-three patients without BPPV symptoms undergoing labyrinthine surgery (vestibular schwannoma excision or labyrinthectomy) and 26 patients with BPPV undergoing the posterior semicircular canal occlusion procedure were compared. Additionally, 70 archived temporal bones without a history of BPPV were examined microscopically for the presence of particulate matter within the lumen of the membranous labyrinth. No particles were observed intraoperatively in any of the 73 patients without a history of BPPV. Particulate matter was observed in 8 of 26 patients at the time of the posterior semicircular canal occlusion procedure for intractable BPPV. Of the 70 temporal bones examined, 31 did not show significant postmortem changes and also did not demonstrate cupulolithiasis or canalithiasis. Particulate matter from within the membranous posterior semicircular canal was removed from one patient at the time of posterior semicircular canal occlusion for intractable BPPV symptoms and was examined by scanning electron microscopy. The particulate matter appeared morphologically consistent with degenerating otoconia. These data show a statistically significant association between the presence of particles within the posterior semicircular canal in this study and the symptom complex of BPPV.
BibTeX: @article{Welling1997, author = {Welling, D B and Parnes, L S and O'Brien, B and Bakaletz, L O and Brackmann, D E and Hinojosa, R}, title = {Particulate matter in the posterior semicircular canal.}, journal = {The Laryngoscope}, year = {1997}, volume = {107}, issue = {1}, pages = {90--94}, keywords = {Ear, Inner, surgery; Female; Humans; Middle Aged; Otolithic Membrane, pathology; Photomicrography; Prospective Studies; Semicircular Canals, pathology, surgery; Temporal Bone, pathology; Vertigo, pathology, surgery}, pmid = {9001271} }
Anthony, P.F.	Partitioning of the labyrinth: application in benign paroxysmal positional vertigo. [Abstract] [BibTeX]	1991	The American journal of otology Vol. 12(5), pp. 388-393	article
Abstract: Partitioning of the labyrinth is a new laser technique that creates a fibrous band within the inner ear. The application of this technique to benign paroxysmal positional vertigo (BPPV) is described in the first two patients to undergo this procedure. The partitioning technique involves blue-lining the posterior semicircular canal near its ampulla and lasing the blue-lined area. The technique provides a prompt decrease and the ultimate elimination of BPPV. There is some mild motion sensitivity of 6 to 8 weeks duration, and some transient (3-week) sensorineural hearing loss. The use of immediate postoperative low dose steroids provides marked decrease in the motion sensitivity and elimination of the transient sensorineural hearing loss. Lasing two adjacent areas on the posterior semicircular canal may prevent transient recurrence of the positional vertigo during the healing process.
BibTeX: @article{Anthony1991, author = {Anthony, P F}, title = {Partitioning of the labyrinth: application in benign paroxysmal positional vertigo.}, journal = {The American journal of otology}, year = {1991}, volume = {12}, issue = {5}, pages = {388--393}, keywords = {Adult; Female; Hearing Loss, Sensorineural, etiology; Humans; Laser Therapy; Male; Mastoid, surgery; Postoperative Complications, etiology; Posture; Semicircular Canals; Time Factors; Vertigo, surgery, therapy}, pmid = {1789311} }
Anthony, P.F.	Partitioning the labyrinth for benign paroxysmal positional vertigo: clinical and histologic findings. [Abstract] [BibTeX]	1993	The American journal of otology Vol. 14(4), pp. 334-342	article
Abstract: The incidence of benign paroxysmal positional vertigo (BPPV) has been documented at 17 percent of all vertiginous patients. Partitioning of the labyrinth is a laser technique for resolution of BPPV. In 1991 Anthony partitioned the posterior semicircular canal of two patients and eliminated their BPPV in 24 hours, which was much sooner than anticipated. This paper presents an animal study that was undertaken to determine why laser partitioning of the posterior semicircular canal resolved BPPV so promptly. The histologic changes 24 hours post-partitioning in the guinea pig showed bony semicircular canal fistula creation, and constriction of the membranous semicircular canal. The constriction caused decreased endolymphatic flow and led to BPPV-resolving long-term obstruction of the membranous canal described by Wilpizeski. Also, the clinical study of the application of partitioning to 14 patients with BPPV is described. The technique under investigation provided the resolution of positional vertigo within 7 days in most cases, and within 8 weeks in all uncomplicated cases. Results included some temporary postoperative motion sensitivity for 6-8 weeks, a transient sensorineural hearing loss in 6 of 14 (43%) patients, and a permanent hearing loss in one (7%) insulin-dependent diabetic patient. Location of the partition on the posterior semicircular canal did not affect the resolution of BPPV, the incidence of transient hearing loss, or the motion sensitivity. Partitioning provided prompt, permanent resolution of BPPV and did not put the hearing at risk in nondiabetic patients.(ABSTRACT TRUNCATED AT 250 WORDS)
BibTeX: @article{Anthony1993, author = {Anthony, P F}, title = {Partitioning the labyrinth for benign paroxysmal positional vertigo: clinical and histologic findings.}, journal = {The American journal of otology}, year = {1993}, volume = {14}, issue = {4}, pages = {334--342}, keywords = {Adult; Aged; Animals; Ear, Inner, surgery; Female; Fistula, etiology; Guinea Pigs; Hearing Loss, Sensorineural, etiology; Humans; Male; Middle Aged; Postoperative Complications; Semicircular Canals, cytology, physiopathology, surgery; Vertigo, physiopathology}, pmid = {8238267} }
Yagi, T., Koizumi, Y., Kimura, M. and Aoyagi, M.	Pathological localization of so-called posterior canal BPPV. [Abstract] [BibTeX]	2006	Auris, nasus, larynx Vol. 33(4), pp. 391-395	article	DOI
Abstract: Based on the hypothesis that the origin of nystagmus is from the posterior canal (PC), the nystagmus in the head hanging and sitting position should be mirror images. To clarify the anatomical origin of positioning nystagmus in BPPV patients, we analyzed the positioning nystagmus of benign paroxysmal positioning vertigo (BPPV) patients three-dimensionally. Twenty-six patients with BPPV participated in this study. The positioning nystagmus was recorded in complete darkness from the patient's left eye by means of an infrared CCD camera. We performed three-dimensional analysis of nystagmus using video image analysis system (VIAS). Subsequently, the rotation axis of the 3D eye movements of the positioning nystagmus was calculated. Among the 26 patients tested, 20 patients demonstrated the axes of nystagmus in good or relatively good alignment to the PC axis. However, in 11 of these 20 patients there was poor alignment of the axis of nystagmus in the sitting position to the PC axis. In addition, six patients showed axes of nystagmus with poor alignment to the PC in the head hanging position. Among them, two patients exhibited axes of nystagmus in good alignment with the anterior canal, in spite of diagnosis of these patients as PC BPPV by experienced examiner based on the positioning nystagmus test. These results demonstrated that only one-third of patients who were diagnosed as BPPV, could be diagnosed as true BPPV which originates from a PC pathology. Besides the possibility that the pathology may originate from the AC, it is still unclear which part of the inner ear may be the candidate site of origin of the pathology of BPPV in the other 15 patients.
BibTeX: @article{Yagi2006, author = {Yagi, Toshiaki and Koizumi, Yasuo and Kimura, Maki and Aoyagi, Mio}, title = {Pathological localization of so-called posterior canal BPPV.}, journal = {Auris, nasus, larynx}, year = {2006}, volume = {33}, issue = {4}, pages = {391--395}, doi = {https://doi.org/10.1016/j.anl.2006.03.006}, keywords = {Adult; Aged; Darkness; Female; Humans; Imaging, Three-Dimensional; Infrared Rays; Male; Middle Aged; Nystagmus, Physiologic; Semicircular Canals, pathology; Vertigo, pathology; Video Recording}, pmid = {16876361} }
Gacek, R.R.	Pathology of benign paroxysmal positional vertigo revisited. [Abstract] [BibTeX]	2003	The Annals of otology, rhinology, and laryngology Vol. 112(7), pp. 574-582	article	DOI
Abstract: The pathophysiology of benign paroxysmal positional vertigo (BPPV) is not completely understood. Although the concept of degenerated otoconia transforming the posterior canal (PC) crista into a gravity-sensitive sense organ has gained popular support, several temporal bone (TB) series have revealed similar deposits in normal TBs, suggesting they are a normal change in the aging labyrinth. Furthermore, some TBs from patients with BPPV do not contain particles in the posterior canal. Five TBs from patients with BPPV were studied quantitatively and qualitatively. A small PC cupular deposit was found in 1 TB, while none was seen in the other 4 TBs. The major pathological changes were 1) a 50% loss of ganglion cells in the superior vestibular division of all 5 TBs and 2) a 50% loss of neurons in the inferior division of 3 TBs, and a 30% loss in 2 TBs that contained abnormal saccular ganglion cells. These observations support a concept in the pathophysiology of BPPV that includes loss of the inhibitory effect of otolith organs on canal sense organs.
BibTeX: @article{Gacek2003a, author = {Gacek, Richard R}, title = {Pathology of benign paroxysmal positional vertigo revisited.}, journal = {The Annals of otology, rhinology, and laryngology}, year = {2003}, volume = {112}, issue = {7}, pages = {574--582}, doi = {https://doi.org/10.1177/000348940311200702}, keywords = {Aged; Aged, 80 and over; Aging; Cell Count; Female; Humans; Male; Middle Aged; Posture; Temporal Bone, pathology; Vertigo, pathology; Vestibular Nerve, pathology; Vestibule, Labyrinth, pathology}, pmid = {12903676} }
Gacek, R.R.	Pathophysiology and management of cupulolithiasis. [Abstract] [BibTeX]	1985	American journal of otolaryngology Vol. 6(2), pp. 66-74	article
Abstract: Substantial support for the concept that the posterior semicircular canal is responsible for benign paroxysmal positional vertigo comes from four sources: clinical observations, temporal bone histopathology, experimental observations, and results of selective denervation of the posterior canal crista (singular neurectomy). The complete immediate relief of the positional vertigo and nystagmus that resulted from 39 of 40 singular neurectomies establishes this procedure as an effective management for patients with the chronic disabling form of cupulolithiasis. The ocular response in cupulolithiasis and the release nystagmus that follows singular neurectomy are explained by neural pathways that have been previously elucidated by anatomic and physiologic techniques. Although sensorineural hearing loss followed surgery three times among the first 15 patients, hearing loss has not occurred in the last 25 operations for cupulolithiasis.
BibTeX: @article{Gacek1985, author = {Gacek, R R}, title = {Pathophysiology and management of cupulolithiasis.}, journal = {American journal of otolaryngology}, year = {1985}, volume = {6}, issue = {2}, pages = {66--74}, keywords = {Adult; Aged; Calculi, pathology, physiopathology, surgery; Denervation, methods; Female; Hearing Loss, Sensorineural, physiopathology; Humans; Male; Middle Aged; Posture; Semicircular Canals; Temporal Bone, pathology; Vertigo, physiopathology}, pmid = {3993860} }
Sakata, E., Uchida, Y., Nakano, Y. and Takahashi, K.	Pathophysiology of positional vertigo of the malignant paroxysmal type. [Abstract] [BibTeX]	1984	Auris, nasus, larynx Vol. 11(2), pp. 79-90	article
Abstract: It is well known that paroxysmal positional vertigo is induced by change of head position and subsides immediately when the head is returned to the original position. There are two types of paroxysmal positional vertigo. One is what DIX and HALLPIKE (1952) call the benign type which is thought to be caused by otolith lesions. Another is a malignant type, in contrast to the former and is related to a lesion in the central nervous system. Otologists are usually familiar with the former, but the latter is not known among neurologists and neurosurgeons. We experienced 37 cases of the malignant type and found that this type of paroxysmal vertigo is induced by various diseases. Furthermore, we believe that the mechanism of this paroxysmal vertigo is the lack of inhibitory function of the vestibular cerebellum, and not abrupt malfunction of communication of the cerebrospinal fluid in the ventricular system. We also believe that this symptom is a very useful sign for diagnosing lesions of the cerebellar vermis.
BibTeX: @article{Sakata1984, author = {Sakata, E and Uchida, Y and Nakano, Y and Takahashi, K}, title = {Pathophysiology of positional vertigo of the malignant paroxysmal type.}, journal = {Auris, nasus, larynx}, year = {1984}, volume = {11}, issue = {2}, pages = {79--90}, keywords = {Adult; Aged; Atrophy; Cerebellar Diseases, complications, diagnosis; Cerebellar Neoplasms, complications; Cerebellum, pathology; Female; Head; Hematoma, complications; Humans; Male; Medulloblastoma, complications; Meningeal Neoplasms, complications; Meningioma, complications; Middle Aged; Movement; Posture; Vertigo, diagnosis, etiology}, pmid = {6487178} }
Pérez-Garrigues, H., Kuessner, D. and Benecke, H.	Patient baseline characteristics in an open-label multinational study of betahistine in recurrent peripheral vestibular vertigo: the OSVaLD study. [Abstract] [BibTeX]	2007	Current medical research and opinion Vol. 23(11), pp. 2753-2761	article	DOI
Abstract: OSVaLD (Observational Study in patients suffering from recurrent peripheral vestibular Vertigo to Assess the effect of betahistine 48 mg/day on quality of Life and Dizziness symptoms) is a 3-month, open-label, multi-national post-marketing surveillance study of betahistine 48 mg/day in the management of patients with vertigo of less than 5 years in duration. The aim of the study is to examine the burden of disease associated with vertigo, as determined by scores on the Dizziness Handicap Inventory (DHI), Short Form-36 (SF-36) questionnaire and the Hospital Anxiety and Depression Scale (HADS). Changes in DHI, SF-36 and HADS scores between baseline and 3 months are used to assess the therapeutic effects of betahistine. Participants (n = 2037) have been recruited from 13 countries in four continents (North and South America, Asia and Europe), representing a wide range of cultural and linguistic traditions. Approximately two-thirds of the patients are women. Sixty per cent of patients have diagnoses of peripheral vestibular vertigo of unknown pathology or benign paroxysmal positional vertigo; 13% have a diagnosis of Ménière's disease. All three of the instruments used characterize this as a population with extensive vertigo-attributable morbidity at baseline. The mean DHI score of the population is 63.7 +/- 15.7 (DHI scale: 0 = no handicap; 100 = major self-perceived handicap), SF-36 scores in all domains are below the population average for the USA and the HADS indicated that > 50% of patients exhibit symptoms of anxiety or depression or both, including 9% who have severe manifestations of either or both conditions. This report describes the design and implementation of OSVaLD and presents baseline demographic and clinical features of the patients. Full results of the study, anticipated in 2007, will provide more details about the manifestations of vertigo in routine practice and the response to betahistine.
BibTeX: @article{Perez-Garrigues2007, author = {Pérez-Garrigues, H and Kuessner, D and Benecke, H}, title = {Patient baseline characteristics in an open-label multinational study of betahistine in recurrent peripheral vestibular vertigo: the OSVaLD study.}, journal = {Current medical research and opinion}, year = {2007}, volume = {23}, issue = {11}, pages = {2753--2761}, doi = {https://doi.org/10.1185/03007X233016}, keywords = {Adult; Betahistine, therapeutic use; Female; Humans; Male; Middle Aged; Recurrence; Treatment Outcome; Vasodilator Agents, therapeutic use; Vertigo, drug therapy}, pmid = {17910803} }
Luryi, A.L., Lawrence, J., Bojrab, D., LaRouere, M., Babu, S., Hong, R., Zappia, J., Sargent, E., Chan, E., Naumann, I.C. and Schutt, C.A.	Patient, disease, and outcome characteristics of benign paroxysmal positional vertigo with and without Meniere's disease. [Abstract] [BibTeX]	2018	Acta oto-laryngologica Vol. 138(10), pp. 893-897	article	DOI
Abstract: Meniere's disease (MD)-associated benign paroxysmal positional vertigo (BPPV) is complex and difficult to diagnose, and reports of its prevalence, pathologic features and outcomes are sparse and conflicting. Report disease characteristics and outcomes associated with the presence of MD in patients with BPPV. A retrospective study of patients with BPPV between 2007 and 2017 at a single, high-volume institution. Of 1581 patients with BPPV identified, 7.1% had MD and 71.9% of those patients had BPPV in the same ear(s) as MD. Patients with MD were more likely to have lateral semicircular canalithiasis (11.6% vs. 5.5%, p = .009) and multiple canalithiasis (7.1% vs. 2.5%, p = .005). MD was associated with an increased rate of resolution of BPPV (p = .008) but also increased time to resolution (p = .007). There was no association between MD and recurrence of BPPV. MD is associated with lateral canalithiasis. Contrary to prior reports, BPPV in MD can affect either ear and was not associated with poorer outcomes than idiopathic BPPV. The largest series to date investigating disease and outcome characteristics for BPPV in MD is presented. These data inform diagnosis and expectations in the management of these complex patients.
BibTeX: @article{Luryi2018b, author = {Luryi, Alexander Leo and Lawrence, Juliana and Bojrab, Dennis and LaRouere, Michael and Babu, Seilesh and Hong, Robert and Zappia, John and Sargent, Eric and Chan, Eleanor and Naumann, Ilka C and Schutt, Christopher A}, title = {Patient, disease, and outcome characteristics of benign paroxysmal positional vertigo with and without Meniere's disease.}, journal = {Acta oto-laryngologica}, year = {2018}, volume = {138}, issue = {10}, pages = {893--897}, doi = {https://doi.org/10.1080/00016489.2018.1484566}, keywords = {Benign paroxysmal positional vertigo; Meniere’s disease; neurotology; vertigo}, pmid = {30016894} }
Rashad, U.M.	Patients with benign paroxysmal positional vertigo and cervical spine problems: is Epley's manoeuvre contraindicated, and is a proposed new manoeuvre effective and safer? [Abstract] [BibTeX]	2010	The Journal of laryngology and otology Vol. 124(11), pp. 1167-1171	article	DOI
Abstract: Benign paroxysmal positional vertigo is one of the commonest peripheral vestibular causes of vertigo. The particle repositioning manoeuvre (Epley's manoeuvre) has become the 'gold standard' treatment for this disorder. Benign paroxysmal positional vertigo can affect any age group but is commoner in older patients. Cervical spine problems (e.g. spondylosis and disc prolapse) are commoner in this age group. Epley's manoeuvre necessitates passive neck movements. Such movements may not be wise in patients at risk of cervical spine fracture. This study included 40 patients complaining of vertigo and diagnosed as having benign paroxysmal positional vertigo. A new particle repositioning manoeuvre was designed for these patients, as an alternative to Epley's manoeuvre. At one week review, 36 patients (90 per cent) reported total relief from vertigo. Three patients reported a major improvement in their vertigo, and their residual vertigo was relieved by performing the new manoeuvre again after two weeks. Further clinical reviews at one month, three months, six months and one year found that seven patients had suffered minor attacks of typical benign paroxysmal positional vertigo after three months. All seven were relieved of their symptoms after undergoing the new particle repositioning manoeuvre again. The proposed new manoeuvre is simple, effective and safe for treating patients with benign paroxysmal positional vertigo and cervical spine problems.
BibTeX: @article{Rashad2010, author = {Rashad, U M}, title = {Patients with benign paroxysmal positional vertigo and cervical spine problems: is Epley's manoeuvre contraindicated, and is a proposed new manoeuvre effective and safer?}, journal = {The Journal of laryngology and otology}, year = {2010}, volume = {124}, issue = {11}, pages = {1167--1171}, doi = {https://doi.org/10.1017/S0022215110000927}, keywords = {Age Factors; Aged; Benign Paroxysmal Positional Vertigo; Braces; Cervical Vertebrae; Dizziness, etiology; Female; Head Movements, physiology; Humans; Male; Middle Aged; Nystagmus, Pathologic, physiopathology; Physical Therapy Modalities; Posture, physiology; Rotation, adverse effects; Semicircular Canals; Spinal Diseases, complications; Treatment Outcome; Vertigo, complications, therapy}, pmid = {20412614} }
Tschan, R., Best, C., Beutel, M.E., Knebel, A., Wiltink, J., Dieterich, M. and Eckhardt-Henn, A.	Patients' psychological well-being and resilient coping protect from secondary somatoform vertigo and dizziness (SVD) 1 year after vestibular disease. [Abstract] [BibTeX]	2011	Journal of neurology Vol. 258(1), pp. 104-112	article	DOI
Abstract: Secondary somatoform dizziness and vertigo (SVD) is an underdiagnosed and handicapping psychosomatic disorder, leading to extensive utilization of health care and maladaptive coping. Few long-term follow-up studies have focused on the assessment of risk factors and little is known about protective factors. The aim of this 1-year follow-up study was to identify neurootological patients at risk for the development of secondary SVD with respect to individual psychopathological disposition, subjective well-being and resilient coping. In a prospective interdisciplinary study, we assessed mental disorders in n=59 patients with peripheral and central vestibular disorders (n=15 benign paroxysmal positional vertigo, n=15 vestibular neuritis, n=8 Menière's disease, n=24 vestibular migraine) at baseline (T0) and 1 year after admission (T1). Psychosomatic examinations included the structured clinical interview for DSM-IV, the Vertigo Symptom Scale (VSS), and a psychometric test battery measuring resilience (RS), sense of coherence (SOC), and satisfaction with life (SWLS). Subjective well-being significantly predicted the development of secondary SVD: Patients with higher scores of RS, SOC, and SWLS at T0 were less likely to acquire secondary SVD at T1. Lifetime mental disorders correlated with a reduced subjective well-being at T0. Patients with mental comorbidity at T0 were generally more at risk for developing secondary SVD at T1. Patients' dispositional psychopathology and subjective well-being play a major predictive role for the long-term prognosis of dizziness and vertigo. To prevent secondary SVD, patients should be screened for risk and preventive factors, and offered psychotherapeutic treatment in case of insufficient coping capacity.
BibTeX: @article{Tschan2011, author = {Tschan, Regine and Best, Christoph and Beutel, Manfred E and Knebel, Achim and Wiltink, Jörg and Dieterich, Marianne and Eckhardt-Henn, Annegret}, title = {Patients' psychological well-being and resilient coping protect from secondary somatoform vertigo and dizziness (SVD) 1 year after vestibular disease.}, journal = {Journal of neurology}, year = {2011}, volume = {258}, issue = {1}, pages = {104--112}, doi = {https://doi.org/10.1007/s00415-010-5697-y}, keywords = {Adaptation, Psychological; Adult; Diagnostic and Statistical Manual of Mental Disorders; Dizziness, etiology, psychology; Female; Humans; Male; Meniere Disease, complications; Mental Disorders, complications, psychology; Middle Aged; Neurologic Examination; Personal Satisfaction; Psychometrics; Quality of Life; Resilience, Psychological; Risk Factors; Vertigo, etiology, psychology; Vestibular Diseases, complications, psychology; Vestibular Neuronitis, complications}, pmid = {20717689} }
Schulz, K.A., Esmati, E., Godley, F.A., Hill, C.L., Monfared, A., Teixido, M., Tucci, D.L. and Witsell, D.L.	Patterns of Migraine Disease in Otolaryngology: A CHEER Network Study. [Abstract] [BibTeX]	2018	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 159(1), pp. 42-50	article	DOI
Abstract: Objective To evaluate the prevalence of migraine disease in an otolaryngologic cohort and migraine-related otologic and sinonasal symptoms in this population. Study Design Cross-sectional study utilizing the CHEER (Creating Healthcare Excellence through Education and Research) network for recruitment. Setting Patients were recruited in a cross-sectional and pragmatic manner in 14 CHEER sites between June 2015 and March 2017 (9 academic, 5 community based). Subjects and Methods Patients were included if they were aged ≥18 years and seen for any concern that was not head and neck cancer. Patients with any history of brain abnormality or headaches that began within 2 weeks of a medical illness, trauma, or head injury were excluded. Patients were screened for migraine with a validated instrument. If they screened positive on the Migraine Assessment Tool (MAT+), the subjects also filled out validated and custom questionnaires for sinonasal, otologic, and migraine-specific symptoms. Results Of 1458 patients screened, 235 (16.1%) screened positive for migraine (MAT+), which is higher than general population (13%, P < .001). The MAT+ group was significantly younger (47.2 vs 55.6 years of age, P < .001) and predominantly women (80.0% vs 55.9%, P < .001). The MAT+ cohort commonly reported ear- and sinus-related symptoms, such as tinnitus (70.5%), ear pressure (61.9%), balance problems (82%), facial pressure (85%), and rhinorrhea (49.9%). There were significantly higher levels of sinus burden with higher levels of dizziness handicap, Jonckheere-Terpstra test = 11,573.00, z = 7.471, P < .001. Conclusion Migraine disease has a higher prevalence in an otolaryngologic cohort than in the general population, presenting with a high rate of sinonasal and otologic symptoms that may be due to or exacerbated by migraines.
BibTeX: @article{Schulz2018, author = {Schulz, Kristine A and Esmati, Elnaz and Godley, Frederick A and Hill, Claude L and Monfared, Ashkan and Teixido, Michael and Tucci, Debara L and Witsell, David L}, title = {Patterns of Migraine Disease in Otolaryngology: A CHEER Network Study.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2018}, volume = {159}, issue = {1}, pages = {42--50}, doi = {https://doi.org/10.1177/0194599818764387}, keywords = {CHEER; Ménière’s disease; benign paroxysmal positional vertigo; dizziness; headache; migraine; rhinosinusitis; sinus headache; sinusitis; vestibular migraine}, pmid = {29558248} }
Kim, C.-H., Choi, H.R., Choi, S., Lee, Y.S. and Shin, J.E.	Patterns of nystagmus conversion in sudden sensorineural hearing loss with vertigo. [Abstract] [BibTeX]	2018	Medicine Vol. 97(43), pp. e12982	article	DOI
Abstract: The patients with sudden sensorineural hearing loss (SSNHL) may complain of vertigo. Although there have been many reports on SSNHL with vertigo (SSNHL_V), changes in the pattern of nystagmus have not been studied as yet. This study is a retrospective study and aims to investigate the characteristic changes in type of nystagmus and clinical features in patients with SSNHL_V who experienced a change in their nystagmus pattern during follow-up. Among 50 patients with SSNHL_V between January 2012 and December 2015, we identified 15 patients with SSNHL_V whose pattern of nystagmus changed. Initial nystagmus was classified into 5 subgroups: paretic type, irritative type, persistent geotropic direction-changing positional nystagmus (PG-DCPN), persistent apogeotropic direction-changing positional nystagmus (PA-DCPN), and posterior semicircular canal benign paroxysmal positional vertigo. The most common pattern of initial nystagmus was PG-DCPN (n = 7). The change of initial nystagmus pattern occurred on day 2 to 75 from symptom onset, and 2 (of 15) patients showed further conversion. The most common pattern of final nystagmus was PA-DCPN (n = 9). Hearing improvement after treatment was not significantly different (P = .59) between SSNHL_V patients with nystagmus change (25 ± 17 dB, n = 15) and those without nystagmus change (28 ± 18 dB, n = 35). In conclusion, clinician's attention is required in evaluating the vertigo symptom in patients with SSNHL_V because the initial patterns of nystagmus can be converted to another type of nystagmus. The presence of nystagmus change during follow-up may not be a prognosticator for hearing recovery in patients with SSNHL_V.
BibTeX: @article{Kim2018b, author = {Kim, Chang-Hee and Choi, Hye Rang and Choi, Seongjun and Lee, Yong Sik and Shin, Jung Eun}, title = {Patterns of nystagmus conversion in sudden sensorineural hearing loss with vertigo.}, journal = {Medicine}, year = {2018}, volume = {97}, issue = {43}, pages = {e12982}, doi = {https://doi.org/10.1097/MD.0000000000012982}, keywords = {Adult; Aged; Female; Follow-Up Studies; Hearing Loss, Sensorineural, complications, diagnosis; Hearing Loss, Sudden, complications, diagnosis; Humans; Male; Middle Aged; Nystagmus, Pathologic, complications, diagnosis; Nystagmus, Physiologic; Retrospective Studies; Vertigo, complications, diagnosis}, pmid = {30412127} }
Miyamoto, R.C. and Miyamoto, R.T.	Pediatric neurotology. [Abstract] [BibTeX]	2003	Seminars in pediatric neurology Vol. 10(4), pp. 298-303	article
Abstract: Pediatric neurotology is a subspecialty encompassing the medical and surgical treatment of conditions involving the middle ear, inner ear and lateral skull base. Multiple otologic and neurotologic diseases exist. In the pediatric patient the most common neurotologic conditions are vertigo, complications of otitis media, cholesteatoma, hearing loss and facial paralysis. Vertigo is differentiated into peripheral and central vestibular abnormalities. Peripheral vestibular causes include Meniere's disease, benign paroxysmal positional vertigo, vestibular neuronitis, otitis media and labyrinthitis. The predominant lesions in our field causing central vestibular disorders are brainstem and posterior fossa tumors. Mastoiditis, meningitis, petrositis, sigmoid sinus thrombosis, extradural abscess, brain abscess, otitic hydrocephalus, cholesteatoma and cholesterol granuloma are complications of otitis media and middle ear disease. Sensorineural hearing loss is now readily treated with cochlear implantation. Facial nerve paralysis may result from infectious and other etiologies.
BibTeX: @article{Miyamoto2003, author = {Miyamoto, R Christopher and Miyamoto, Richard T}, title = {Pediatric neurotology.}, journal = {Seminars in pediatric neurology}, year = {2003}, volume = {10}, issue = {4}, pages = {298--303}, keywords = {Child; Cochlear Implantation, methods; Facial Paralysis, surgery; Hearing Loss, Sensorineural, surgery; Humans; Neurology; Otitis Media, complications, surgery; Otolaryngology; Pediatrics; Vertigo, classification, physiopathology, surgery, therapy}, pmid = {14992462} }
Ikiz, M.A., Cetin, I.I., Ekici, F., Güven, A., Değerliyurt, A. and Köse, G.	Pediatric syncope: is detailed medical history the key point for differential diagnosis? [Abstract] [BibTeX]	2014	Pediatric emergency care Vol. 30(5), pp. 331-334	article	DOI
Abstract: Syncope is a transient loss of consciousness as a result of global cerebral hypoperfusion. It is generally benign but may be a sign of pathology. The purpose of this study was to analyze the frequency of syncope due to cardiac, neurocardiogenic, neurologic, situational, psychiatric, and other causes and make a differential diagnosis of syncope types according to detailed medical history and further investigations. We examined prospectively 268 children presented to pediatric polyclinics as well as cardiology and neurology departments (age range, 1-18 years) with a primary complaint of syncope for the study. Cardiac syncope was diagnosed in 12 patients, neurocardiogenic syncope in 232, neurologic syncope in 9, psychiatric syncope in 9, situational in 4, and benign paroxysmal positional vertigo in 2. The neurologic syncope group consists of patients diagnosed with epilepsy after evaluation. Eight patients in the cardiac syncope group were found to have diseases such as long QT syndrome, and the remaining patients had hypertrophic cardiomyopathy, atrioventricular nodal reentry tachycardia, ventricular tachycardia, and a second-degree heart block that can cause sudden death. In conclusion, syncope is a common problem in childhood that requires hospitalization. Because it may be the first finding of an underlying malignant cardiac or neurologic disease, clinicians must be very careful during medical evaluation. An electrocardiogram and a medical history including the details of the event, chronic diseases, and familial diseases are among the most important steps for the right diagnosis and prognosis. Instead of a routine procedure, further diagnostic workup should be directed according to medical history for high yield. Convulsive movements may be defined in all types of syncope related with cerebral hypoxia, and this may lead to a misdiagnosis of seizure by the clinician.
BibTeX: @article{Ikiz2014, author = {Ikiz, Mehmet Alper and Cetin, Ibrahim Ilker and Ekici, Filiz and Güven, Alev and Değerliyurt, Aydan and Köse, Gülşen}, title = {Pediatric syncope: is detailed medical history the key point for differential diagnosis?}, journal = {Pediatric emergency care}, year = {2014}, volume = {30}, issue = {5}, pages = {331--334}, doi = {https://doi.org/10.1097/PEC.0000000000000123}, keywords = {Adolescent; Child; Child, Preschool; Diagnosis, Differential; Echocardiography; Electrocardiography; Electroencephalography; Female; Humans; Infant; Male; Prospective Studies; Risk Factors; Syncope, diagnosis, etiology}, pmid = {24759488} }
Saxena, A. and Prabhakar, M.C.	Performance of DHI score as a predictor of benign paroxysmal positional vertigo in geriatric patients with dizziness/vertigo: a cross-sectional study. [Abstract] [BibTeX]	2013	PloS one Vol. 8(3), pp. e58106	article	DOI
Abstract: Dizziness/vertigo is one of the most common complaint and handicapping condition among patients aged 65 years and older (Geriatric patients). This study was conducted to assess the impact of dizziness/vertigo on the quality of life in the geriatric patients attending a geriatric outpatient clinic. A cross-sectional study was performed in a geriatric outpatient clinic of a rural teaching tertiary care hospital in central India. In all consecutive geriatric patients with dizziness/vertigo attending geriatric outpatient clinic, DHI questionnaire was applied to assess the impact of dizziness/vertigo and dizziness associated handicap in the three areas of a patients' life: physical, functional and emotional domain. Later, each patient was evaluated and underwent Dix-Hallpike maneuver by the physician who was blind of the DHI scoring of the patient. We compared means and proportions of variables across two categories of benign paroxysmal positional vertigo (BPPV) and non-BPPV. For these comparisons we used Student's t-test to test for continuous variables, chi-square test for categorical variables and Fisher's exact test in the case of small cell sizes (expected value<5). The magnitude of dizziness/vertigo was 3%. Of the 88 dizziness/vertigo patients, 19 (22%) and 69(78%) cases, respectively, were attributed to BPPV and non-BPPV group. The association of DHI score ≥50 with the BPPV was found to be statistically significant with x(2) value = 58.2 at P<0.01. DHI Score is a useful tool for the prediction of benign paroxysmal positional vertigo. Correct diagnosis of BPPV is 16 times greater if the DHI Score is greater than or equal to 50. The physical, functional and emotional investigation of dizziness, through the DHI, has demonstrated to be a valuable and useful instrument in the clinical routine.
BibTeX: @article{Saxena2013, author = {Saxena, Amrish and Prabhakar, Manish Chandra}, title = {Performance of DHI score as a predictor of benign paroxysmal positional vertigo in geriatric patients with dizziness/vertigo: a cross-sectional study.}, journal = {PloS one}, year = {2013}, volume = {8}, issue = {3}, pages = {e58106}, doi = {https://doi.org/10.1371/journal.pone.0058106}, keywords = {Aged; Benign Paroxysmal Positional Vertigo; Cross-Sectional Studies; Dizziness, diagnosis; Female; Humans; India; Male; Models, Statistical; Outpatients; Predictive Value of Tests; Quality of Life; ROC Curve; Reproducibility of Results; Severity of Illness Index; Vertigo, diagnosis}, pmid = {23472142} }
Brodsky, J.R., Shoshany, T.N., Lipson, S. and Zhou, G.	Peripheral Vestibular Disorders in Children and Adolescents with Concussion. [Abstract] [BibTeX]	2018	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 159(2), pp. 365-370	article	DOI
Abstract: Objective To review peripheral vestibular disorders in pediatric patients with dizziness following concussion. Study Design Case series with chart review. Setting Pediatric vestibular clinic and pediatric multidisciplinary concussion clinic at a tertiary level pediatric hospital. Subjects and Methods We retrospectively reviewed 109 patients seen for dizziness following a concussion between September 2012 and July 2015. Patients were ≤20 years of age at the time of concussion. Incidences of specific peripheral vestibular disorders were assessed along with timing of diagnosis relative to the date of injury, diagnostic test findings, and treatment interventions associated with those diagnoses. Results Twenty-eight patients (25.7%) were diagnosed with peripheral vestibular disorders. None of these disorders were diagnosed prior to evaluation in our pediatric vestibular clinic or our multidisciplinary concussion clinic, which occurred a mean of 133 days (95% confidence interval, 89.2-177.3) after injury. Benign paroxysmal positioning vertigo was diagnosed in 19 patients, all of whom underwent successful canalith repositioning maneuvers. Other diagnoses included temporal bone fracture (n = 3), labyrinthine concussion (n = 2), perilymphatic fistula (n = 2), and superior semicircular canal dehiscence (n = 2). Both patients with perilymphatic fistula and 1 patient with superior semicircular canal dehiscence underwent successful surgical management, while 1 patient with superior semicircular canal dehiscence was managed nonsurgically. Conclusion Peripheral vestibular disorders may occur in pediatric patients with dizziness following concussion, but these disorders may not be recognized until symptoms have persisted for several weeks. An algorithm is proposed to guide the diagnosis and management of peripheral vestibular disorders in pediatric patients with concussion.
BibTeX: @article{Brodsky2018, author = {Brodsky, Jacob R and Shoshany, Talia N and Lipson, Sophie and Zhou, Guangwei}, title = {Peripheral Vestibular Disorders in Children and Adolescents with Concussion.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2018}, volume = {159}, issue = {2}, pages = {365--370}, doi = {https://doi.org/10.1177/0194599818770618}, keywords = {BPPV; benign paroxysmal positional vertigo; concussion; pediatric; postconcussion syndrome; vertigo}, pmid = {29685082} }
Hülse, R., Biesdorf, A., Hörmann, K., Stuck, B., Erhart, M., Hülse, M. and Wenzel, A.	Peripheral Vestibular Disorders: An Epidemiologic Survey in 70 Million Individuals. [Abstract] [BibTeX]	2019	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 40(1), pp. 88-95	article	DOI
Abstract: Dizziness is a common complaint in medicine. Nevertheless, there is a lack of valid data concerning the age and gender distribution of dizziness disorders within a larger population. Therefore, the aim of the present study is to undertake a representative epidemiological survey that examines all age groups of an entire population and describes the age and gender distribution of the most common peripheral vestibular disorders. A population-based epidemiological survey based on confirmed ICD-10 codes, of an entire national population was performed. The population-based data of 70,315,919 patients were leveraged, as provided by 123 statutory health insurance companies in Germany. Patients of all age groups were analyzed. Outcome measures were age and gender distribution and the prevalence of unspecific vertigo, Meniere's disease, benign paroxysmal positional vertigo, vestibular neuritis, and other peripheral vestibular disorders. The prevalence among the recorded diagnoses was 6.5% (6,461/100,000 individuals), with women (N = 2,973,323; 65.4%) being significantly more frequently affected by vertigo than men (N = 1,570,240; 34.6%; p < 0.001). Vertigo is rare in childhood (i.e., up to 10-14 yr of age). Subsequently, the prevalence of the analyzed diseases increases with age, up to a peak between 74 and 94 years. The results demonstrate that peripheral vestibular disorders are common in a developed country, across all age groups and a specific distribution of these disorders can be identified for every age group and gender. The impact of these disorders on the German healthcare system is currently underestimated.
BibTeX: @article{Huelse2019, author = {Hülse, Roland and Biesdorf, Andreas and Hörmann, Karl and Stuck, Boris and Erhart, Michael and Hülse, Manfred and Wenzel, Angela}, title = {Peripheral Vestibular Disorders: An Epidemiologic Survey in 70 Million Individuals.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2019}, volume = {40}, issue = {1}, pages = {88--95}, doi = {https://doi.org/10.1097/MAO.0000000000002013}, pmid = {30289843} }
Strupp, M., Mandalà, M. and López-Escámez, J.A.	Peripheral vestibular disorders: an update. [Abstract] [BibTeX]	2019	Current opinion in neurology Vol. 32(1), pp. 165-173	article	DOI
Abstract: To provide an update on the most frequent peripheral vestibular disorders. The on-going classification of vestibular disorders by the Bárány Society represents major progress. The diagnosis of bilateral vestibulopathy (BVP) requires quantitative testing of vestibular function. 'Acute unilateral peripheral vestibulopathy' (AUPVP) is now preferred over 'vestibular neuritis.' Menière's disease is a set of disorders with a significant genetic contribution. The apogeotropic variant of horizontal canal benign paroxysmal positional vertigo (hcBPPV) and anterior canal BPPV (acBPPV) can be distinguished from a central vestibular lesion. Vestibular paroxysmia is now an internationally accepted clinical entity. The diagnosis of SCDS is based on conclusive findings. Diagnosis of BVP requires significantly reduced vestibular function. The clinical picture of AUPVP depends on how much the vestibular end organs or their innervation are affected. Menière's disease phenotype is a constellation of symptoms. Although diagnostic and therapeutic criteria for pc and hcBPPV are well defined, a number of less frequent and controversial are increasingly diagnosed and can be treated. Diagnosis of vestibular paroxysmia requires that a patient responds to treatment with a sodium channel blocker. The diagnosis of SCDS requires conclusive findings with various methods. There is still a great need for state-of-the-art randomized controlled treatment trials in most peripheral vestibular disorders.
BibTeX: @article{Strupp2019, author = {Strupp, Michael and Mandalà, Marco and López-Escámez, Jose A}, title = {Peripheral vestibular disorders: an update.}, journal = {Current opinion in neurology}, year = {2019}, volume = {32}, issue = {1}, pages = {165--173}, doi = {https://doi.org/10.1097/WCO.0000000000000649}, pmid = {30562267} }
Brodsky, J.R., Cusick, B.A., Kawai, K., Kenna, M. and Zhou, G.	Peripheral vestibular loss detected in pediatric patients using a smartphone-based test of the subjective visual vertical. [Abstract] [BibTeX]	2015	International journal of pediatric otorhinolaryngology Vol. 79(12), pp. 2094-2098	article	DOI
Abstract: Detection of peripheral vestibular loss (PVL) in children with dizziness is an important and challenging task. The static subjective visual vertical (SVV) test can effectively detect PVL, but requires specialized equipment. The goal of this study was to determine the efficacy of a smartphone-based SVV test at detecting PVL in pediatric patients. Thirty-nine patients between 7 and 18 years old (mean=14.0±2.70) underwent conventional SVV (conv-SVV) and smartphone-based SVV (ip-SVV) testing. Subjects included 6 with PVL (based on clinical history and other vestibular tests), 6 with benign paroxysmal positioning vertigo (BPPV), 11 with central causes of vertigo (CV), 8 with non-vestibular dizziness (NVD), and 8 controls. Mean ip-SVV score in the PVL group (2.77±1.45) was significantly higher than in each of the other groups (BPPV=0.89±0.55; CV=1.08±0.68; NVD=1.45±1.19; Control=1.08±0.73; one-way analysis of variance, p=0.008), and remained significant after adjusting for age and gender by multiple linear regression analysis. Receiver operating characteristic analysis predicted an optimal ip-SVV cut-off score of >2.13° with a sensitivity of 66.7%, specificity of 97.0%, positive predictive value (PPV) of 80%, and negative predictive value of 94.1% for detecting PVL. Sensitivity and PPV improved to 75% and 100%, respectively, when subjects tested >1 month after symptom onset (n=24) were excluded. Smartphone-based SVV testing is a simple and useful office-based method for detecting PVL in children with dizziness.
BibTeX: @article{Brodsky2015, author = {Brodsky, Jacob R and Cusick, Brandon A and Kawai, Kosuke and Kenna, Margaret and Zhou, Guangwei}, title = {Peripheral vestibular loss detected in pediatric patients using a smartphone-based test of the subjective visual vertical.}, journal = {International journal of pediatric otorhinolaryngology}, year = {2015}, volume = {79}, issue = {12}, pages = {2094--2098}, doi = {https://doi.org/10.1016/j.ijporl.2015.09.020}, keywords = {Adolescent; Benign Paroxysmal Positional Vertigo, complications, diagnosis; Case-Control Studies; Child; Dizziness, etiology; Female; Humans; Male; Mobile Applications; Predictive Value of Tests; ROC Curve; Smartphone; Vestibular Function Tests, instrumentation; Visual Perception; Pediatric vestibular testing; Peripheral vestibular loss; Smartphone; Subjective visual vertical (SVV)}, pmid = {26434547} }
Alessandrini, M., Micarelli, A., Pavone, I., Viziano, A., Micarelli, D. and Bruno, E.	Persistent benign paroxysmal positional vertigo: our experience and proposal for an alternative treatment. [Abstract] [BibTeX]	2013	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 270(10), pp. 2769-2774	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo. Despite the great efficacy of canalith repositioning procedures (CRPs), BPPV may persist (PBPPV). The aim of the study was to evaluate whether a prolonged and self-assessed temporal bone vibration (TBV) could change the outcome of PBPPV after 12 months of repeated treatments, in order to avoid further invasive and/or drug therapies. This evaluation was also conducted with respect to the entire BPPV population treated with CRPs. Seventy-two patients affected by PBPPV were enrolled in the study: 51 and 21 of them suffering from posterior semicircular canal (PSC) and lateral semicircular canal (LSC), respectively. PBPPV patients underwent a twice-a-day self-assessed TBV, using a common low-intensity massaging cushion. Patients were re-tested 1 week later and they were considered free from disease as the results of the positioning tests continued to be negative after 1 month. 70.6 % of PSC PBPPV and 61.9 % of LSC PBPPV patients had positive and statistically significant (P < 0.01) outcomes not biased by "age" and "gender" variables. The recurrence rate of BPPV (RBPPV) was also studied in the BPPV and PBPPV groups after a 12/24-month follow-up and any statistically significant result was found in multiple regression analysis between nuisance variables and RBPPV patients previously treated by CRPs or TBV. The present study suggests that the self-assessed and prolonged TBV could be an alternative treatment in patients affected by PBPPV otherwise addressed to undergo more invasive procedures and pharmacological treatment that are not completely side effects free.
BibTeX: @article{Alessandrini2013, author = {Alessandrini, Marco and Micarelli, Alessandro and Pavone, Isabella and Viziano, Andrea and Micarelli, Domenico and Bruno, Ernesto}, title = {Persistent benign paroxysmal positional vertigo: our experience and proposal for an alternative treatment.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2013}, volume = {270}, issue = {10}, pages = {2769--2774}, doi = {https://doi.org/10.1007/s00405-013-2620-z}, keywords = {Benign Paroxysmal Positional Vertigo; Cohort Studies; Female; Humans; Male; Middle Aged; Prospective Studies; Recurrence; Regression Analysis; Temporal Bone; Treatment Outcome; Vertigo, rehabilitation; Vibration, therapeutic use}, pmid = {23818117} }
Chang, Y.-S., Choi, J. and Chung, W.-H.	Persistent Direction-Fixed Nystagmus Following Canalith Repositioning Maneuver for Horizontal Canal BPPV: A Case of Canalith Jam. [Abstract] [BibTeX]	2014	Clinical and experimental otorhinolaryngology Vol. 7(2), pp. 138-141	article	DOI
Abstract: The authors report a 64-year-old man who developed persistent direction fixed nystagmus after a canalith repositioning maneuver for horizontal canal benign paroxysmal positional vertigo (HC-BPPV). The patient was initially diagnosed with right HC-BPPV given that the Dix-Hallpike test showed geotropic horizontal nystagmus that was more pronounced on the right side, although the roll test did not show any positional nystagmus. The patient was treated with a canalith repositioning maneuver (Lempert maneuver). The next day, the patient experienced a different character of dizziness, and left-beating spontaneous nystagmus regardless of head position was observed. After a forced prolonged left decubitus and frequent head shaking, his symptoms and nystagmus resolved. This condition, referred to as canalith jam, can be a complication after the repositioning maneuver in patients with BPPV. Atypical positional tests suggest that abnormal canal anatomy could be the underlying cause of canalith jam.
BibTeX: @article{Chang2014, author = {Chang, Young-Soo and Choi, Jeesun and Chung, Won-Ho}, title = {Persistent Direction-Fixed Nystagmus Following Canalith Repositioning Maneuver for Horizontal Canal BPPV: A Case of Canalith Jam.}, journal = {Clinical and experimental otorhinolaryngology}, year = {2014}, volume = {7}, issue = {2}, pages = {138--141}, doi = {https://doi.org/10.3342/ceo.2014.7.2.138}, keywords = {Benign paroxysmal positional vertigo; Canalith jam; Repositioning maneuver}, pmid = {24917912} }
Kim, C.-H., Kim, M.-B. and Ban, J.H.	Persistent geotropic direction-changing positional nystagmus with a null plane: the light cupula. [Abstract] [BibTeX]	2014	The Laryngoscope Vol. 124(1), pp. E15-E19	article	DOI
Abstract: The aim of this study was to characterize the clinical features and typical positional nystagmus in patients with persistent geotropic direction-changing positional nystagmus (DCPN) and address the possible pathophysiology of the disease. Furthermore, the proportion of light cupula among the patients showing geotropic DCPN was investigated to assume the incidence of light cupula in those patients. Prospective case series. We conducted a prospective case series study in 19 patients with persistent geotropic DCPN. Positional nystagmus during the bow and lean test and the supine head roll test was analyzed using videonystagmography. All of the 19 patients showed persistent geotropic DCPN without latency. A null plane in which the nystagmus ceases was identified in all of 19 patients, and the intensity of nystagmus was stronger on one side in13 patients (68%) on supine head roll test. Overall, the affected side could be identified in 18 patients (95%). About 14.2% (19 of 134) of patients with geotropic DCPN could be diagnosed as having light cupula in the horizontal semicircular canal. The patients with light cupula show persistent geotropic DCPN without latency. Affected side(s) can be determined by the direction and intensity of the characteristic positional nystagmus and the side of the null plane. The pathophysiology and treatment of light cupula still remain to be elucidated.
BibTeX: @article{Kim2014d, author = {Kim, Chang-Hee and Kim, Min-Beom and Ban, Jae Ho}, title = {Persistent geotropic direction-changing positional nystagmus with a null plane: the light cupula.}, journal = {The Laryngoscope}, year = {2014}, volume = {124}, issue = {1}, pages = {E15--E19}, doi = {https://doi.org/10.1002/lary.24048}, keywords = {Adult; Aged; Eye Movement Measurements; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, physiopathology; Prospective Studies; Benign paroxysmal positional vertigo; direction-changing positional nystagmus; geotropic nystagmus; head roll test; null plane}, pmid = {24166487} }
Choi, J.-Y., Lee, E.-S., Kim, H.-J. and Kim, J.-S.	Persistent geotropic positional nystagmus after meningitis: Evidence for light cupula. [BibTeX]	2017	Journal of the neurological sciences Vol. 379, pp. 279-280	article	DOI
BibTeX: @article{Choi2017, author = {Choi, Jeong-Yoon and Lee, Eek-Sung and Kim, Hyo-Jung and Kim, Ji-Soo}, title = {Persistent geotropic positional nystagmus after meningitis: Evidence for light cupula.}, journal = {Journal of the neurological sciences}, year = {2017}, volume = {379}, pages = {279--280}, doi = {https://doi.org/10.1016/j.jns.2017.06.036}, keywords = {Benign paroxysmal positional vertigo; Light cupula; Nystagmus}, pmid = {28716260} }
Kim, E.-J., Oh, S.-Y., Kim, J.S., Yang, T.-H. and Yang, S.-Y.	Persistent otolith dysfunction even after successful repositioning in benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2015	Journal of the neurological sciences Vol. 358(1-2), pp. 287-293	article	DOI
Abstract: To evaluate utricular and saccular function during the acute and resolved phases of BPPV, ocular and cervical vestibular evoked myogenic potentials (VEMPs) were studied in 112 patients with BPPV and 50 normal controls in a referral-based University Hospital. Ocular (oVEMPs) and cervical VEMPs (cVEMPs) were induced using air-conducted sound (1000Hz tone burst, 100dB normal hearing level) at the time of initial diagnosis and 2 months after successful repositioning in patients with BPPV, and the results were compared with those of the controls. Abnormalities of cVEMPs and oVEMPs in patients with BPPV were prevalent and significantly higher compare to the healthy control group (p<0.01 in each VEMP by chi-square test). In the patient group, difference between the proportions of abnormal responses of cVEMP and oVEMP was not significant in both affected (p=0.37, chi-squared test) and non-affected (p=1.00) ears. The abnormalities were more likely reduced or absent responses rather than delayed ones; reduced or absent responses are 17.6% in cVEMPs (p=0.04, chi-square) and 21.6% in oVEMPs (p<0.01). The non-affected ear in the BPPV group also showed significantly higher abnormalities of cVEMP and oVEMP when compared to the control group. The follow-up VEMPs after repositioning maneuvers were not significantly different compared to the initial values from both stimulated affected and non-affected ears. Although most patients had unilateral BPPV, bilateral otolithic dysfunction was often shown by persistently reduced or absent cervical and ocular VEMPs, suggesting that BPPV may be caused by significant bilateral damage to the otolith organs.
BibTeX: @article{Kim2015, author = {Kim, Eui-Joong and Oh, Sun-Young and Kim, Ji Soo and Yang, Tae-Ho and Yang, Si-Young}, title = {Persistent otolith dysfunction even after successful repositioning in benign paroxysmal positional vertigo.}, journal = {Journal of the neurological sciences}, year = {2015}, volume = {358}, issue = {1-2}, pages = {287--293}, doi = {https://doi.org/10.1016/j.jns.2015.09.012}, keywords = {Aged; Benign Paroxysmal Positional Vertigo, physiopathology; Female; Humans; Male; Middle Aged; Otolithic Membrane, physiopathology; Vestibular Evoked Myogenic Potentials, physiology; BPPV=benign paroxysmal positional vertigo; Cervical VEMPs; Ocular VEMPs; Saccule; Utricle; VEMPs=vestibular evoked myogenic potentials}, pmid = {26371697} }
Heidenreich, K.D., Kerber, K.A., Carender, W.J., Basura, G.J. and Telian, S.A.	Persistent positional nystagmus: a case of superior semicircular canal benign paroxysmal positional vertigo? [Abstract] [BibTeX]	2011	The Laryngoscope Vol. 121(8), pp. 1818-1820	article	DOI
Abstract: Involvement of the superior semicircular canal (SSC) in benign paroxysmal positional vertigo (BPPV) is rare. SSC BPPV is distinguished from the more common posterior semicircular canal (PSC) variant by the pattern of nystagmus triggered by the Dix-Hallpike position: down-beating torsional nystagmus in SSC BPPV versus up-beating torsional nystagmus in PSC BPPV. SSC BPPV may be readily treated at the bedside, which is a key component in excluding central causes of down-beating nystagmus. We present an unusual video case report believed to represent refractory SSC BPPV based on the pattern of nystagmus and the absence of any other central signs.
BibTeX: @article{Heidenreich2011, author = {Heidenreich, Katherine D and Kerber, Kevin A and Carender, Wendy J and Basura, Gregory J and Telian, Steven A}, title = {Persistent positional nystagmus: a case of superior semicircular canal benign paroxysmal positional vertigo?}, journal = {The Laryngoscope}, year = {2011}, volume = {121}, issue = {8}, pages = {1818--1820}, doi = {https://doi.org/10.1002/lary.21848}, keywords = {Benign Paroxysmal Positional Vertigo; Female; Humans; Middle Aged; Semicircular Canals, physiopathology; Vertigo, diagnosis, physiopathology, therapy}, pmid = {21792975} }
Ko, K.M., Song, M.H., Kim, J.H. and Shim, D.B.	Persistent spontaneous nystagmus following a canalith repositioning procedure in horizontal semicircular canal benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2014	JAMA otolaryngology-- head & neck surgery Vol. 140(3), pp. 250-252	article	DOI
Abstract: Nystagmus can occur spontaneously from multiple causes. Direction-changing positional nystagmus on the supine roll test is a characteristic clinical feature in horizontal semicircular canal benign paroxysmal positional vertigo. One of several mechanisms of spontaneous nystagmus is plugging of the otoconia, which has been described as a canalith jam. We evaluated a 52-year-old woman with a history of geotropic variant of horizontal semicircular canal benign paroxysmal positional vertigo on the right side who had been treated with a modified Lempert maneuver 3 months earlier. The patient had persistent spontaneous nystagmus, despite a positional change after the canalith repositioning procedure. A bithermal caloric test result demonstrated unilateral canal paresis on the right side. The following day, the patient's symptoms and nystagmus had subsided. On a repeated bithermal caloric test, a normal response was demonstrated on both sides. To our knowledge, this is the first report of a case that shows on video persistent nystagmus findings consistent with a canalith jam. We discuss a possible mechanism underlying this phenomenon.
BibTeX: @article{Ko2014, author = {Ko, Kyung Min and Song, Mee Hyun and Kim, Ji Hong and Shim, Dae Bo}, title = {Persistent spontaneous nystagmus following a canalith repositioning procedure in horizontal semicircular canal benign paroxysmal positional vertigo.}, journal = {JAMA otolaryngology-- head & neck surgery}, year = {2014}, volume = {140}, issue = {3}, pages = {250--252}, doi = {https://doi.org/10.1001/jamaoto.2013.6207}, keywords = {Adult; Benign Paroxysmal Positional Vertigo; Electronystagmography; Female; Humans; Nystagmus, Pathologic, diagnosis, etiology, physiopathology; Physical Therapy Modalities, adverse effects; Posture; Semicircular Canals, physiopathology; Vertigo, physiopathology, therapy; Vestibular Function Tests}, pmid = {24384872} }
Rupa, V.	Persistent vertigo following particle repositioning maneuvers: an analysis of causes. [Abstract] [BibTeX]	2004	Archives of otolaryngology--head & neck surgery Vol. 130(4), pp. 436-439	article	DOI
Abstract: To analyze the causes of persistent vertigo following treatment with particle repositioning maneuvers (PRMs) in patients with benign paroxysmal positional vertigo. Prospective study of outcomes in patients with benign paroxysmal positional vertigo. Outpatient clinic of a tertiary care referral center. A sample of 90 consecutive patients with documented benign paroxysmal positional vertigo of the posterior semicircular canal who had persistent vertigo after at least 3 sessions of PRMs during a period of 2 weeks. Particle repositioning using a modified Epley maneuver. Persistent vertigo following at least 3 sessions of PRMs over a period of 2 weeks. Seven patients showed partial or no improvement following treatment. The causes subsequently determined included coincident horizontal canal positional vertigo (2 cases), Ménière's disease (2 cases), persistent posterior canal benign paroxysmal positional vertigo in association with cervical spondylosis (2 cases), and a posterior fossa meningioma (1 case). Patients with persistent or frequently recurring positional vertigo following treatment with PRMs should undergo detailed investigation to exclude coincidental pathology for which specific treatment is required. In patients in whom no coincident pathology requiring therapy is identified, treatment options other than the PRM already instituted should be considered.
BibTeX: @article{Rupa2004, author = {Rupa, Vedantam}, title = {Persistent vertigo following particle repositioning maneuvers: an analysis of causes.}, journal = {Archives of otolaryngology--head & neck surgery}, year = {2004}, volume = {130}, issue = {4}, pages = {436--439}, doi = {https://doi.org/10.1001/archotol.130.4.436}, keywords = {Aged; Audiometry, Pure-Tone; Electronystagmography; Female; Follow-Up Studies; Humans; Male; Middle Aged; Outcome Assessment (Health Care); Physical Therapy Modalities; Recurrence; Remission, Spontaneous; Vertigo, diagnosis, etiology, rehabilitation; Vibration, therapeutic use}, pmid = {15096426} }
Hain, T.C. and Uddin, M.	Pharmacological treatment of vertigo. [Abstract] [BibTeX]	2003	CNS drugs Vol. 17(2), pp. 85-100	article	DOI
Abstract: This review discusses the physiology and pharmacological treatment of vertigo and related disorders. Classes of medications useful in the treatment of vertigo include anticholinergics, antihistamines, benzodiazepines, calcium channel antagonists and dopamine receptor antagonists. These medications often have multiple actions. They may modify the intensity of symptoms (e.g. vestibular suppressants) or they may affect the underlying disease process (e.g. calcium channel antagonists in the case of vestibular migraine). Most of these agents, particularly those that are sedating, also have a potential to modulate the rate of compensation for vestibular damage. This consideration has become more relevant in recent years, as vestibular rehabilitation physical therapy is now often recommended in an attempt to promote compensation. Accordingly, therapy of vertigo is optimised when the prescriber has detailed knowledge of the pharmacology of medications being administered as well as the precise actions being sought. There are four broad causes of vertigo, for which specific regimens of drug therapy can be tailored. Otological vertigo includes disorders of the inner ear such as Ménière's disease, vestibular neuritis, benign paroxysmal positional vertigo (BPPV) and bilateral vestibular paresis. In both Ménière's disease and vestibular neuritis, vestibular suppressants such as anticholinergics and benzodiazepines are used. In Ménière's disease, salt restriction and diuretics are used in an attempt to prevent flare-ups. In vestibular neuritis, only brief use of vestibular suppressants is now recommended. Drug treatments are not presently recommended for BPPV and bilateral vestibular paresis, but physical therapy treatment can be very useful in both. Central vertigo includes entities such as vertigo associated with migraine and certain strokes. Prophylactic agents (L-channel calcium channel antagonists, tricyclic antidepressants, beta-blockers) are the mainstay of treatment for migraine-associated vertigo. In individuals with stroke or other structural lesions of the brainstem or cerebellum, an eclectic approach incorporating trials of vestibular suppressants and physical therapy is recommended. Psychogenic vertigo occurs in association with disorders such as panic disorder, anxiety disorder and agoraphobia. Benzodiazepines are the most useful agents here. Undetermined and ill-defined causes of vertigo make up a large remainder of diagnoses. An empirical approach to these patients incorporating trials of medications of general utility, such as benzodiazepines, as well as trials of medication withdrawal when appropriate, physical therapy and psychiatric consultation is suggested.
BibTeX: @article{Hain2003, author = {Hain, Timothy C and Uddin, Mohammed}, title = {Pharmacological treatment of vertigo.}, journal = {CNS drugs}, year = {2003}, volume = {17}, issue = {2}, pages = {85--100}, doi = {https://doi.org/10.2165/00023210-200317020-00002}, keywords = {Antiemetics, therapeutic use; Benzodiazepines, therapeutic use; Calcium Channel Blockers, therapeutic use; Cholinergic Antagonists, therapeutic use; Histamine H1 Antagonists; Humans; Meniere Disease, etiology, therapy; Vertigo, classification, drug therapy, etiology, physiopathology}, pmid = {12521357} }
Strupp, M., Zwergal, A., Feil, K., Bremova, T. and Brandt, T.	Pharmacotherapy of vestibular and cerebellar disorders and downbeat nystagmus: translational and back-translational research. [Abstract] [BibTeX]	2015	Annals of the New York Academy of Sciences Vol. 1343, pp. 27-36	article	DOI
Abstract: There are currently eight groups of drugs for the pharmacotherapy of vertigo, nystagmus, and cerebellar disorders: antiemetics; anti-inflammatories, antimenieres, and antimigraineous medications; antidepressants, anticonvulsants, aminopyridines, and acetyl-DL-leucine ("the eight A's"). In acute unilateral vestibulopathy, corticosteroids improve the recovery of peripheral vestibular function, but there is not sufficient current evidence for a general recommendation. There is also insufficient evidence that 48 or 144 mg/day betahistine has an effect in Ménière's disease. Therefore, higher dosages are currently recommended; in animal studies, it was shown that betahistine increases cochlear blood flow. In vestibular paroxysmia, oxcarbazepine was effective (one yet not randomized controlled trial (RCT)). Aminopyridines are recommended for the treatment of downbeat nystagmus (two RCTs) and episodic ataxia type 2 (EA2, one RCT). There are so far no RCTs on vestibular migraine, so currently no treatment can be recommended. Acetyl-dl-leucine improves cerebellar ataxia (three observational studies); it also accelerates central compensation in an animal model of acute unilateral lesion, but RCTs were negative. There are ongoing RCTs on vestibular paroxysmia with carbamazepine (VESPA), acute unilateral vestibulopathy with betahistine (BETAVEST), vestibular migraine with metoprolol (PROVEMIG), benign paroxysmal positional vertigo with vitamin D (VitD@BPPV), EA2 with 4-aminopyridine versus acetazolamide (EAT-2-TREAT), and cerebellar ataxias with acetyl-DL-leucine (ALCAT).
BibTeX: @article{Strupp2015a, author = {Strupp, Michael and Zwergal, Andreas and Feil, Katharina and Bremova, Tatiana and Brandt, Thomas}, title = {Pharmacotherapy of vestibular and cerebellar disorders and downbeat nystagmus: translational and back-translational research.}, journal = {Annals of the New York Academy of Sciences}, year = {2015}, volume = {1343}, pages = {27--36}, doi = {https://doi.org/10.1111/nyas.12774}, keywords = {Aminopyridines, therapeutic use; Animals; Betahistine, therapeutic use; Humans; Nystagmus, Pathologic, drug therapy; Postural Balance, drug effects; Translational Medical Research; Vestibular Diseases, drug therapy; Vestibule, Labyrinth, physiopathology; Ménière's disease; acute unilateral vestibulopathy; aminopyridines; central vestibular disorders; cerebellar ataxias; downbeat nystagmus; episodic ataxia type 2; vestibular migraine; vestibular paroxysmia}, pmid = {25903394} }
Bazoni, J.A., Mendes, W.S., Meneses-Barriviera, C.L., Melo, J.J., Costa, V.d.S.P., Teixeira, D.d.C. and Marchiori, L.L.d.M.	Physical activity in the prevention of benign paroxysmal positional vertigo: probable association. [Abstract] [BibTeX]	2014	International archives of otorhinolaryngology Vol. 18(4), pp. 387-390	article	DOI
Abstract: Introduction Physical inactivity is an important risk factor for many age-related diseases and symptoms such as dizziness and vertigo. Objective The aim of the study was to investigate the possible association between benign paroxysmal positional vertigo (BPPV) and regular physical activity in elderly subjects. Methods This cross-sectional study included 491 elderly individuals who lived independently. Physical exercise was assessed through a questionnaire and BPPV by history and the Dix-Hallpike maneuver. Results The present study indicates no significant association between BPPV with lack of physical activity in men and in the total population. We have confirmed associations between BPPV with lack of physical activity in women (p = 0.01). Women with a sedentary lifestyle who do not practice physical activity are 2.62 more likely to have BPPV than those with regular physical activity. Conclusion These results highlight the importance of identifying risk factors for BPPV that can be modified through specific interventions. Regular physical activity is a lifestyle with potential to decrease the risk of vertigo in women.
BibTeX: @article{Bazoni2014, author = {Bazoni, Jéssica Aparecida and Mendes, William Siqueira and Meneses-Barriviera, Caroline Luiz and Melo, Juliana Jandre and Costa, Viviane de Souza Pinho and Teixeira, Denilson de Castro and Marchiori, Luciana Lozza de Moraes}, title = {Physical activity in the prevention of benign paroxysmal positional vertigo: probable association.}, journal = {International archives of otorhinolaryngology}, year = {2014}, volume = {18}, issue = {4}, pages = {387--390}, doi = {https://doi.org/10.1055/s-0034-1384815}, keywords = {aging; dizziness; exercise}, pmid = {25992128} }
Reneker, J.C., Cheruvu, V.K., Yang, J., James, M.A. and Cook, C.E.	Physical examination of dizziness in athletes after a concussion: A descriptive study. [Abstract] [BibTeX]	2018	Musculoskeletal science & practice Vol. 34, pp. 8-13	article	DOI
Abstract: Dizziness is commonly reported after concussion. With the forces experienced at the time of the injury, several anatomical locations may have been altered, causing dizziness. Describe an objective examination and the types of impairment/dysfunction implicated by the results of clinical examination tests in subjects with dizziness after a concussion. Cross-Sectional. Athletes between ages 10-23 were enrolled with a diagnosis of concussion. An examination was completed to identify areas potentially contributing to dizziness, including tests of oculomotor control, the vestibular system, neuromotor control, and musculoskeletal components of the cervical spine. Descriptive analyses were completed to define the anatomical areas/types of dysfunction identified by positive findings of the examination tests. All (n = 41; 100%) subjects had examination findings consistent with central dysfunction. Of these, 36 (97.8%) had oculomotor control deficits; 29 (70.7%) demonstrated motion sensitivity; and 6 (15%) had central vestibular deficits. Nineteen (46.3%) had peripheral dysfunction, including 18 (43.9%) with unilateral hypofunction, and 2 (4.9%) with Benign Paroxysmal Positional Vertigo. Thirty-four (82.9%) had cervical dysfunction, with 11 (26.8%) presenting with cervicogenic dizziness, and 31 (75.6%) with altered neuromotor control. Functional injury to centrally-mediated pathways, specifically oculomotor control, and afferent and efferent pathways in the cervical spine are commonly identified through clinical examination tests in individuals with a complaint of dizziness post-concussion. According to results presented here, a high majority (90%) of the participants demonstrated dizziness that appeared to be multifactorial in nature and was not attributable to one main type of dysfunction. The common pathways between the systems make it difficult to isolate only one anatomical area as a contributor to dizziness.
BibTeX: @article{Reneker2018, author = {Reneker, Jennifer C and Cheruvu, Vinay K and Yang, Jingzhen and James, Mark A and Cook, Chad E}, title = {Physical examination of dizziness in athletes after a concussion: A descriptive study.}, journal = {Musculoskeletal science & practice}, year = {2018}, volume = {34}, pages = {8--13}, doi = {https://doi.org/10.1016/j.msksp.2017.11.012}, keywords = {Adolescent; Adult; Athletes, statistics & numerical data; Benign Paroxysmal Positional Vertigo, diagnosis, etiology; Brain Concussion, complications, physiopathology; Child; Cross-Sectional Studies; Dizziness, diagnosis; Female; Humans; Male; Physical Examination, methods; Postural Balance, physiology; Young Adult; Concussion; Differential diagnosis; Dizziness; Physical examination}, pmid = {29197811} }
Pollak, L., Kushnir, M. and Goldberg, H.S.	Physical inactivity as a contributing factor for onset of idiopathic benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2011	Acta oto-laryngologica Vol. 131(6), pp. 624-627	article	DOI
Abstract: Despite limitations arising from a questionnaire-performed study, it seems that nonspecific physical activity can protect against benign paroxysmal positional vertigo (BPPV), possibly by relocating loosened otoconia from the semicircular canals. Mechanical factors might play a role in the onset of the idiopathic form of BPPV. We performed a structured questionnaire study of physical activity in patients with BPPV and controls. Sixty-three consecutive patients with idiopathic BPPV participated in the study. Their mean age was 59.2 ± 14.5 years; 14 were men and 49 were women. Sixty-four age- and sex-matched generally healthy individuals served as controls. Levels of physical activity were assessed by the PASE questionnaire, which consists of 12 items quantifying physical activity during leisure, household, and occupational activities over a 7-day period. The total physical score activity was significantly lower in BPPV patients than in controls. Differences were found mainly in household and leisure activity, while occupational activity was similar in both groups, regardless of gender. Patients older than 60 years had significantly lower PASE scores than controls, whereas patients aged 60 years or younger reported similar physical activity to controls. No differences were found between physical activity scores in different types of BPPV or in patients with a first versus recurrent attack of vertigo.
BibTeX: @article{Pollak2011, author = {Pollak, Lea and Kushnir, Mark and Goldberg, Hadassah Stern}, title = {Physical inactivity as a contributing factor for onset of idiopathic benign paroxysmal positional vertigo.}, journal = {Acta oto-laryngologica}, year = {2011}, volume = {131}, issue = {6}, pages = {624--627}, doi = {https://doi.org/10.3109/00016489.2011.552524}, keywords = {Activities of Daily Living, classification; Adult; Age Factors; Aged; Female; Humans; Male; Middle Aged; Otolithic Membrane, physiopathology; Recurrence; Risk Factors; Sedentary Behavior; Surveys and Questionnaires; Vertigo, etiology, physiopathology}, pmid = {21332295} }
Bashir, K., Alessai, G.S., Salem, W.A., Irfan, F.B. and Cameron, P.A.	Physical maneuvers: effective but underutilized treatment of benign paroxysmal positional vertigo in the ED. [BibTeX]	2014	The American journal of emergency medicine Vol. 32(1), pp. 95-96	article	DOI
BibTeX: @article{Bashir2014, author = {Bashir, Khalid and Alessai, Galal S and Salem, Waleed Awad and Irfan, Furqan B and Cameron, Peter A}, title = {Physical maneuvers: effective but underutilized treatment of benign paroxysmal positional vertigo in the ED.}, journal = {The American journal of emergency medicine}, year = {2014}, volume = {32}, issue = {1}, pages = {95--96}, doi = {https://doi.org/10.1016/j.ajem.2013.10.012}, keywords = {Benign Paroxysmal Positional Vertigo; Cross-Sectional Studies; Emergency Service, Hospital, statistics & numerical data; Female; Humans; Male; Physical Therapy Modalities, statistics & numerical data; Posture; Qatar, epidemiology; Surveys and Questionnaires; Vertigo, epidemiology, therapy}, pmid = {24211278} }
Sato, S., Ohashi, T. and Koizuka, I.	Physical therapy for benign paroxysmal positional vertigo patients with movement disability. [Abstract] [BibTeX]	2003	Auris, nasus, larynx Vol. 30 Suppl, pp. S53-S56	article
Abstract: Particle repositioning manoeuvres are broadly recognized effective for benign paroxysmal positional vertigo (BPPV), however, we think that these therapies are not suitable for all BPPV patients. In this study we investigate whether these manoeuvres can be used for BPPV patients with the movement disability. In addition, we introduce our habituation training (HT) and report the results of treatment with it. Nine BPPV patients with the movement disability due to orthopedic disease were examined. For each patient we determined their movement disabilities, and assessed the suitability of particle repositioning manoeuvres, Brandt-Daroff (B-D) manoeuvre and HT for them. All of these nine patients had neck or trunk movement disabilities due to orthopedic disease, and we judged that particle repositioning manoeuvres and B-D manoeuvre were impossible or too risky to be employed in them. Although HT was suitable for them and symptoms and signs of them improved within a short period of time. Particle repositioning manoeuvres were not suitable for BPPV patients with the movement disability because these manoeuvres required various movements. These patients were able to perform HT depending on their capabilities. We think that HT is caused by the fatigability of BPPV, and it accelerates the natural curing process.
BibTeX: @article{Sato2003, author = {Sato, Shigeki and Ohashi, Toru and Koizuka, Izumi}, title = {Physical therapy for benign paroxysmal positional vertigo patients with movement disability.}, journal = {Auris, nasus, larynx}, year = {2003}, volume = {30 Suppl}, pages = {S53--S56}, keywords = {Aged; Aged, 80 and over; Calculi, physiopathology, rehabilitation; Cohort Studies; Contraindications; Female; Habituation, Psychophysiologic, physiology; Head Movements, physiology; Humans; Male; Middle Aged; Movement Disorders, physiopathology, rehabilitation; Physical Therapy Modalities; Semicircular Canals, physiopathology; Vertigo, physiopathology, rehabilitation}, pmid = {12543161} }
Brandt, T. and Daroff, R.B.	Physical therapy for benign paroxysmal positional vertigo. [Abstract] [BibTeX]	1980	Archives of otolaryngology (Chicago, Ill. : 1960) Vol. 106(8), pp. 484-485	article
Abstract: We treated 67 patients with the symptoms of benign paroxysmal positional vertigo (BPPV) by challenging them with the precipitating head positions on a repeated and serial basis. Sixty-six of the patients experienced complete relief of the vertigo within three to 14 days; in two patients, the vertigo recurred but responded to a second course of therapy. The one patient whose condition did not respond was found to have a perilymphatic fistula that mimicked BPPV. The presumed mechanism for this therapy is the loosening and ultimate dispersion of degenerated otolithic particles from the cupula of the posterior semicircular canal.
BibTeX: @article{Brandt1980, author = {Brandt, T and Daroff, R B}, title = {Physical therapy for benign paroxysmal positional vertigo.}, journal = {Archives of otolaryngology (Chicago, Ill. : 1960)}, year = {1980}, volume = {106}, issue = {8}, pages = {484--485}, keywords = {Humans; Physical Therapy Modalities; Recurrence; Vertigo, therapy}, pmid = {7396795} }
Rodrigues, D.L., Ledesma, A.L.L., de Oliveira, C.A.P. and Bahamad Júnior, F.	Physical Therapy for Posterior and Horizontal Canal Benign Paroxysmal Positional Vertigo: Long-term Effect and Recurrence: A Systematic Review. [Abstract] [BibTeX]	2018	International archives of otorhinolaryngology Vol. 22(4), pp. 455-459	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo, and it is characterized by episodes of vertigo roundabout when the head is moved. A systematic review was performed using the most important scientific databases. This review included studies published in English in the last ten years, performed in adults, with emphasis on the diagnosis and treatment of BPPV. To investigate the long-term effectiveness of vestibular rehabilitation (VR) in patients with BPPV and the rate of recurrence of symptoms. A total of 38 studies were identified, of which only 12 met the inclusion criteria. The majority of the studies stated that VR is effective in decreasing the symptoms, with a short-term efficacy of 84.7%, and 89.2% in the long term in the reviewed studies. Valuable studies show the beneficial effects of the maneuvers for the treatment of BPPV and their long-term effectiveness. This strengthens the conclusion that this treatment is effective in resolving symptoms and decreasing recurrences.
BibTeX: @article{Rodrigues2018, author = {Rodrigues, Daniele Leite and Ledesma, Alleluia Lima Losno and de Oliveira, Carlos Augusto Pires and Bahamad Júnior, Fayez}, title = {Physical Therapy for Posterior and Horizontal Canal Benign Paroxysmal Positional Vertigo: Long-term Effect and Recurrence: A Systematic Review.}, journal = {International archives of otorhinolaryngology}, year = {2018}, volume = {22}, issue = {4}, pages = {455--459}, doi = {https://doi.org/10.1055/s-0037-1604345}, keywords = {benign paroxysmal positional vertigo; idiopathic recurrent vertigo; rehabilitation; vertigo}, pmid = {30357032} }
Kane, A.W., Diaz, D.S. and Moore, C.	Physical Therapy Management of Adults with Mild Traumatic Brain Injury. [Abstract] [BibTeX]	2019	Seminars in speech and language Vol. 40(1), pp. 36-47	article	DOI
Abstract: Rehabilitation for individuals after mild traumatic brain injury (mTBI) or concussion requires emphasis on both cognitive and physical rest, with a gradual return to activity including sports. As the client becomes more active, the rehabilitation professional should pay close attention to symptoms associated with mTBI, such as headache, dizziness, nausea, and difficulty concentrating. The systematic approach to return to play provided by the Berlin Consensus Statement on Concussion in Sport can apply to adults with mTBI. This protocol calls for gradually increasing the intensity of physical activity while attending to postconcussion symptoms. During the incident that led to an mTBI, the injured individual may incur injuries to the vestibular and balance system that are best addressed by professionals with specific training in vestibular rehabilitation, most commonly physical therapists. Benign paroxysmal positional vertigo is a condition in which otoconia particles in the inner ear dislodge into the semicircular canals, resulting in severe vertigo and imbalance. This condition frequently resolves in a few sessions with a vestibular physical therapist. In conditions such as gaze instability, motion sensitivity, impaired postural control, and cervicogenic dizziness, improvement is more gradual and requires longer follow-up with a physical therapist and a home exercise program. In all of the above-stated conditions, it is essential to consider that a patient with protracted symptoms of mTBI or postconcussion syndrome will recover more slowly than others and should be monitored for symptoms throughout the intervention.
BibTeX: @article{Kane2019, author = {Kane, Ashley W and Diaz, Deborah S and Moore, Carolyn}, title = {Physical Therapy Management of Adults with Mild Traumatic Brain Injury.}, journal = {Seminars in speech and language}, year = {2019}, volume = {40}, issue = {1}, pages = {36--47}, doi = {https://doi.org/10.1055/s-0038-1676652}, pmid = {30616293} }
Uematu, M. and Umeda, Y.	Physical treatment of benign paroxysmal positional vertigo. [BibTeX]	1991	Acta oto-laryngologica. Supplementum Vol. 481, pp. 624-625	article
BibTeX: @article{Uematu1991, author = {Uematu, M and Umeda, Y}, title = {Physical treatment of benign paroxysmal positional vertigo.}, journal = {Acta oto-laryngologica. Supplementum}, year = {1991}, volume = {481}, pages = {624--625}, keywords = {Adult; Aged; Exercise Therapy; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, drug therapy; Recurrence; Vertigo, therapy}, pmid = {1927486} }
Ciniglio Appiani, G., Gagliardi, M. and Magliulo, G.	Physical treatment of horizontal canal benign positional vertigo. [Abstract] [BibTeX]	1997	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 254(7), pp. 326-328	article
Abstract: In recent years many methods of physical therapy have been proposed for the treatment of benign paroxysmal positional vertigo due to otolithic debris in the horizontal semicircular canal. All these methods have attempted to promote displacement of debris from the canal to the utricle. This paper reports our experiences with maneuvers advocated by Lempert and Vannucchi et al. Eighteen patients suffering from benign paroxysmal positional vertigo of the horizontal canal were evaluated in the present study. All seven patients treated with the Vannucchi maneuvers resolved their vertigos. Ten of the remaining patients were managed with Lempert's maneuver and responded successfully. The physical therapy used failed in only one patient. Current experience has shown that both maneuvers are particularly valid and efficacious.
BibTeX: @article{CiniglioAppiani1997, author = {Ciniglio Appiani, G and Gagliardi, M and Magliulo, G}, title = {Physical treatment of horizontal canal benign positional vertigo.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {1997}, volume = {254}, issue = {7}, pages = {326--328}, keywords = {Adult; Aged; Female; Humans; Male; Middle Aged; Physical Therapy Modalities, methods; Retrospective Studies; Semicircular Canals, pathology; Vertigo, etiology, therapy; Vestibular Diseases}, pmid = {9298668} }
Bhattacharyya, N., Hollingsworth, D.B., Mahoney, K. and O'Connor, S.	Plain Language Summary: Benign Paroxysmal Positional Vertigo. [Abstract] [BibTeX]	2017	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 156(3), pp. 417-425	article	DOI
Abstract: This plain language summary serves as an overview in explaining benign paroxysmal positional vertigo, abbreviated BPPV. This summary applies to patients ≥18 years old with a suspected or potential diagnosis of BPPV and is based on the 2017 "Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update)." The evidence-based guideline includes research to support more effective diagnosis and treatment of BPPV. The guideline was developed as a quality improvement opportunity for managing BPPV by creating clear recommendations to use in medical practice.
BibTeX: @article{Bhattacharyya2017a, author = {Bhattacharyya, Neil and Hollingsworth, Deena B and Mahoney, Kathryn and O'Connor, Sarah}, title = {Plain Language Summary: Benign Paroxysmal Positional Vertigo.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2017}, volume = {156}, issue = {3}, pages = {417--425}, doi = {https://doi.org/10.1177/0194599816689671}, keywords = {Adult; Benign Paroxysmal Positional Vertigo, diagnosis, therapy; Humans; Patient Education as Topic; Practice Guidelines as Topic; benign paroxysmal positional vertigo; vertigo}, pmid = {28248608} }
Valko, Y., Werth, E., Bockisch, C.J., Valko, P.O. and Weber, K.P.	Polysomnography reveals nystagmus from benign paroxysmal positional vertigo. [BibTeX]	2014	Sleep medicine Vol. 15(7), pp. 840-842	article	DOI
BibTeX: @article{Valko2014, author = {Valko, Yulia and Werth, Esther and Bockisch, Christopher J and Valko, Philipp O and Weber, Konrad P}, title = {Polysomnography reveals nystagmus from benign paroxysmal positional vertigo.}, journal = {Sleep medicine}, year = {2014}, volume = {15}, issue = {7}, pages = {840--842}, doi = {https://doi.org/10.1016/j.sleep.2013.12.018}, keywords = {Benign Paroxysmal Positional Vertigo, complications, diagnosis; Electrooculography; Female; Humans; Middle Aged; Nystagmus, Pathologic, diagnosis, etiology; Polysomnography; Awakening; Benign paroxysmal positional vertigo; Electrooculography; Nystagmus; Polysomnography; Repositioning maneuver}, pmid = {24891076} }
Lopez-Escámez, J.A., Gámiz, M.J., Fiñana, M.G., Perez, A.F. and Canet, I.S.	Position in bed is associated with left or right location in benign paroxysmal positional vertigo of the posterior semicircular canal. [Abstract] [BibTeX]	2002	American journal of otolaryngology Vol. 23(5), pp. 263-266	article
Abstract: To determine if position during bedrest is related to the canal affected in posterior canal benign paroxysmal positional vertigo (BPPV). Fifty-five individuals with posterior canal BPPV were investigated. Diagnosis was established if a consistent clinical history was found with vertigo and induced positional nystagmus elicited on the Dix-Hallpike test (DHT). Preference for left or right position during bed rest was determined before performing the DHT. All patients were treated by a single particle repositioning procedure, and relapses were investigated at the seventh and 30 days posttreatment. Forty-five individuals always slept on the same side (29 on the right, 16 on the left side), and 10 patients preferred to change sides during bed rest. Among those patients able to maintain a constant position during bed rest, 27 and 18 presented a positive DHT on the right and left sides, respectively. The canal affected was found to be significantly associated with side during bed rest (relative risk = 2.75; P = 0.01, Fisher exact test). DHT was negative in 86% of patients at 30 days. No differences were found between individuals who presented a constant position in bed and those who changed positions. Lateral supine position during bed rest is associated with the canal affected in BPPV. We speculate that gravity might facilitate the deposition of particulate material on the posterior semicircular near the ampulla canal during bed rest.
BibTeX: @article{Lopez-Escamez2002, author = {Lopez-Escámez, José Antonio and Gámiz, María José and Fiñana, Manuel Gomez and Perez, Antonío Fernandez and Canet, Isabel Sanchez}, title = {Position in bed is associated with left or right location in benign paroxysmal positional vertigo of the posterior semicircular canal.}, journal = {American journal of otolaryngology}, year = {2002}, volume = {23}, issue = {5}, pages = {263--266}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Bed Rest; Female; Functional Laterality, physiology; Humans; Male; Middle Aged; Prospective Studies; Risk Factors; Semicircular Canals, physiopathology; Supine Position, physiology; Vertigo, etiology, physiopathology, therapy}, pmid = {12239689} }
Ogawa, Y., Suzuki, M., Otsuka, K., Shimizu, S., Inagaki, T., Hayashi, M., Hagiwara, A. and Kitajima, N.	Positional and positioning down-beating nystagmus without central nervous system findings. [Abstract] [BibTeX]	2009	Auris, nasus, larynx Vol. 36(6), pp. 698-701	article	DOI
Abstract: We report the clinical features of 4 cases with positional or positioning down-beating nystagmus in a head-hanging or supine position without any obvious central nervous system disorder. The 4 cases had some findings in common. There were no abnormal findings on neurological tests or brain MRI. They did not have gaze nystagmus. Their nystagmus was observed only in a supine or head-hanging position and it was never observed upon returning to a sitting position and never reversed. The nystagmus had no or little torsional component, had latency and tended to decrease with time. The positional DBN (p-DBN) is known to be indicative of a central nervous system disorder. Recently there were some reports that canalithiasis of the anterior semicircular canal (ASC) causes p-DBN and that patients who have p-DBN without obvious CNS dysfunction are dealt with anterior semicircular canal (ASC) benign paroxysmal positional vertigo (BPPV). There are some doubts as to the validity of making a diagnosis of ASC-BPPV in a case of p-DBN without CNS findings. It is hard to determine the cause of p-DBN in these cases.
BibTeX: @article{Ogawa2009, author = {Ogawa, Yasuo and Suzuki, Mamoru and Otsuka, Koji and Shimizu, Shigetaka and Inagaki, Taro and Hayashi, Mami and Hagiwara, Akira and Kitajima, Naoharu}, title = {Positional and positioning down-beating nystagmus without central nervous system findings.}, journal = {Auris, nasus, larynx}, year = {2009}, volume = {36}, issue = {6}, pages = {698--701}, doi = {https://doi.org/10.1016/j.anl.2009.04.001}, keywords = {Adult; Brain Diseases, diagnosis, physiopathology; Diagnosis, Differential; Female; Head Movements, physiology; Humans; Labyrinth Diseases, diagnosis, physiopathology; Male; Nystagmus, Pathologic, diagnosis, physiopathology; Nystagmus, Physiologic, physiology; Otolithic Membrane, physiopathology; Semicircular Canals, physiopathology; Supine Position, physiology; Vertigo, diagnosis, physiopathology; Young Adult}, pmid = {19398178} }
Brandt, T.	Positional and positioning vertigo and nystagmus. [Abstract] [BibTeX]	1990	Journal of the neurological sciences Vol. 95(1), pp. 3-28	article
Abstract: Positional and positioning vertigo and nystagmus syndromes can be attributed to either peripheral or central vestibular dysfunction. The most common form is benign paroxysmal positioning vertigo which is caused by cupulolithiasis into the posterior semicircular canal. Other labyrinthine manifestations such as positional alcohol nystagmus, positional nystagmus with macroglobulinaemia and "heavy water" or glycerol ingestion occur because of a specific gravity differential between the cupula and the endolymph (buoyancy mechanism). Neurovascular compression of the vestibular nerve may be a causative factor for "disabling positional vertigo" which is an insufficiently described entity. Hesitation is highly justifiable since retromastoid craniectomy for microvascular decompression is the recommended management. Central positional vertigo is either induced by head movements which result in a transient ischaemia of the ponto-medullary brainstem, or by a change in head position relative to the gravitational vector. The latter is comprised of at least three forms: positional downbeat nystagmus (nodulus), positional nystagmus without concurrent vertigo, and positional vertigo with nystagmus. The site of the lesion is always near the fourth ventricle and the vestibular nuclei. The most probable explanation for the positional response is a vestibular tone imbalance caused by disinhibition of the vestibular reflexes on perception, eye, head and body position.
BibTeX: @article{Brandt1990, author = {Brandt, T}, title = {Positional and positioning vertigo and nystagmus.}, journal = {Journal of the neurological sciences}, year = {1990}, volume = {95}, issue = {1}, pages = {3--28}, keywords = {Humans; Nystagmus, Pathologic, etiology, physiopathology; Posture; Vertigo, etiology, physiopathology}, pmid = {2187057} }
Gordon, C.R. and Almog, Y.	Positional convergence spasm mimicking benign paroxysmal positional vertigo. [BibTeX]	2012	Neurology Vol. 78(9), pp. 681-682	article	DOI
BibTeX: @article{Gordon2012, author = {Gordon, Carlos R and Almog, Yehoshua}, title = {Positional convergence spasm mimicking benign paroxysmal positional vertigo.}, journal = {Neurology}, year = {2012}, volume = {78}, issue = {9}, pages = {681--682}, doi = {https://doi.org/10.1212/WNL.0b013e318248df04}, keywords = {Diagnosis, Differential; Female; Humans; Male; Middle Aged; Ocular Motility Disorders, diagnosis; Spasm, diagnosis; Vertigo, diagnosis}, pmid = {22345223} }
Fife, T.D.	Positional dizziness. [Abstract] [BibTeX]	2012	Continuum (Minneapolis, Minn.) Vol. 18(5 Neuro-otology), pp. 1060-1085	article	DOI
Abstract: This article reviews the most common conditions that are caused by changes in head or body positions. Practical clinical methods to help distinguish vestibular from nonvestibular and central from peripheral vestibular positional dizziness are discussed. This article also reviews the treatment methods of selected canal variants of benign paroxysmal positional vertigo (BPPV). Two recent evidence-based guidelines have established canalith repositioning maneuvers (Epley and Semont maneuvers) as safe and highly effective in the treatment of posterior canal BPPV. Recent studies suggest the Gufoni and the Lempert roll (barbecue) maneuvers are effective in treating lateral canal forms of BPPV. Most cases of positional vertigo are of peripheral vestibular origin and can be effectively treated by simple positioning maneuvers. This article reviews the variants of BPPV encountered in clinical practice, including mechanistic cause, differential diagnosis, prognosis, and treatment. Generous use of figures is intended to aid in understanding the most effective treatment maneuver techniques for the more common forms of BPPV. Clinicians who can recognize the types of nystagmus associated with the various canal types of BPPV can usually recognize CNS causes as distinct.
BibTeX: @article{Fife2012a, author = {Fife, Terry D}, title = {Positional dizziness.}, journal = {Continuum (Minneapolis, Minn.)}, year = {2012}, volume = {18}, issue = {5 Neuro-otology}, pages = {1060--1085}, doi = {https://doi.org/10.1212/01.CON.0000418376.80099.24}, keywords = {Acute Disease; Adult; Aged; Benign Paroxysmal Positional Vertigo; Craniocerebral Trauma, complications; Diagnosis, Differential; Dizziness, etiology; Female; Forecasting; Humans; Labyrinthitis, complications; Magnetic Resonance Imaging; Male; Medical History Taking, methods; Middle Aged; Nystagmus, Pathologic, etiology; Patient Positioning; Physical Examination, methods; Posture; Tomography, X-Ray Computed; Vertigo, therapy}, pmid = {23042060} }
Bertholon, P., Bronstein, A.M., Davies, R.A., Rudge, P. and Thilo, K.V.	Positional down beating nystagmus in 50 patients: cerebellar disorders and possible anterior semicircular canalithiasis. [Abstract] [BibTeX]	2002	Journal of neurology, neurosurgery, and psychiatry Vol. 72(3), pp. 366-372	article
Abstract: To clarify the clinical significance of positional down beat nystagmus (pDBN). A discussion of the neuro-otological findings in 50 consecutive patients with pDBN. In 38 patients there was evidence of CNS disease (central group) but in 12 there was not (idiopathic group). In the CNS group, presenting symptoms were gait, speech, and autonomic dysfunction whereas in the idiopathic group patients mostly reported positional vertigo. The main neurological and oculomotor signs in the CNS group were explained by cerebellar dysfunction, including 13 patients with multiple system atrophy. In patients with multiple system atrophy with a prominent extrapyramidal component, the presence of pDBN was helpful in the differential diagnosis of atypical parkinsonism. No patient with pDBN had the Arnold-Chiari malformation, a common cause of constant down beat nystagmus (DBN). In the idiopathic group, the pDBN had characteristics which suggested a peripheral labyrinthine disorder: vertigo, adaptation, and habituation. In six patients an additional torsional component was found (concurrently with the pDBN in three). Features unusual for peripheral disorder were: bilateral positive Dix-Hallpike manoeuvre in nine of 12 patients and selective provocation by the straight head-hanging manoeuvre in two. It is argued that some patients with idiopathic pDBN have benign paroxysmal positional vertigo (BPPV) with lithiasis of the anterior canal. The torsional component may be weak, because of the predominantly sagittal orientation of the anterior canal, and may not be readily seen clinically. Nystagmus provocation by bilateral Dix-Hallpike and straight head-hanging may be explained by the vertical upwards orientation of the ampullary segment of the anterior canal in the normal upright head position. Such orientation makes right-left specificity with the Dix-Hallpike manoeuvre less important than for posterior canal BPPV. This orientation requires a further downwards movement of the head, often achieved with the straight head-hanging position, to provoke migration of the canaliths. The straight head-hanging manoeuvre should be carried out in all patients with a history of positional vertigo and a negative Dix-Hallpike manoeuvre.
BibTeX: @article{Bertholon2002a, author = {Bertholon, P and Bronstein, A M and Davies, R A and Rudge, P and Thilo, K V}, title = {Positional down beating nystagmus in 50 patients: cerebellar disorders and possible anterior semicircular canalithiasis.}, journal = {Journal of neurology, neurosurgery, and psychiatry}, year = {2002}, volume = {72}, issue = {3}, pages = {366--372}, keywords = {Adult; Aged; Calculi, diagnosis; Cerebellar Diseases, diagnosis; Diagnosis, Differential; Female; Humans; Labyrinth Diseases, diagnosis; Male; Middle Aged; Neurologic Examination; Nystagmus, Pathologic, diagnosis; Semicircular Canals; Vertigo, diagnosis; Vestibular Function Tests}, pmid = {11861698} }
Johkura, K., Momoo, T. and Kuroiwa, Y.	Positional nystagmus in patients with chronic dizziness. [Abstract] [BibTeX]	2008	Journal of neurology, neurosurgery, and psychiatry Vol. 79(12), pp. 1324-1326	article	DOI
Abstract: In elderly people, chronic dizziness is endemic. However, chronic dizziness of unknown origin is difficult to assess. To investigate whether mild unrecognised benign paroxysmal positional vertigo (BPPV) is a cause of isolated chronic dizziness in the elderly. The prevalence of extremely weak, horizontal, direction changing apogeotropic positional nystagmus (HAPN) that had not been detected by conventional examination was evaluated in 200 patients with isolated chronic dizziness and in 155 age matched control subjects without dizziness. A high prevalence of weak HAPN was found in patients with isolated chronic dizziness (98/200 (49.0%)) compared with the prevalence in control subjects without dizziness (25/155 (16.1%); p<0.0001). Symptoms improved in some patients by daily positional exercise for BPPV. Because BPPV is the most common cause of dizziness in the elderly, and HAPN is a characteristic of horizontal canal BPPV, our findings suggest that mild persistent BPPV is a possible cause of chronic dizziness of otherwise unknown origin in the elderly.
BibTeX: @article{Johkura2008, author = {Johkura, K and Momoo, T and Kuroiwa, Y}, title = {Positional nystagmus in patients with chronic dizziness.}, journal = {Journal of neurology, neurosurgery, and psychiatry}, year = {2008}, volume = {79}, issue = {12}, pages = {1324--1326}, doi = {https://doi.org/10.1136/jnnp.2008.147801}, keywords = {Aged; Aged, 80 and over; Case-Control Studies; Dizziness, complications, diagnosis, epidemiology; Female; Humans; Male; Middle Aged; Neurology, methods; Nystagmus, Physiologic; Prevalence; Treatment Outcome; Vertigo; Vestibular Function Tests, methods}, pmid = {18550630} }
Sakata, E., Ohtsu, K., Shimura, H. and Sakai, S.	Positional nystagmus of benign paroxysmal type (BPPN) due to cerebellar vermis lesions. Pseudo-BPPN. [Abstract] [BibTeX]	1987	Auris, nasus, larynx Vol. 14(1), pp. 17-21	article
Abstract: Positioning nystagmus accompanied by severe vertigo had been reported in patients with partial lesions of the inner ear, especially otolith lesions. Typically this type of nystagmus represents a latent period and subsequent fatiguability. We concur with this finding and have constantly emphasized the significance of this phenomenon in clinical diagnosis. Since we started to use CT-scanning, this type of nystagmus has been noted in 20 patients, all of whom had cerebellar vermis lesions. Attention should be focused on this association. A simple coincidence could not be excluded if such a combination were seen in only 1 or 2 patients, it could be attributed to simple coincidence. But its occurrence in as many as 20 patients a causal role of cerebellar vermis lesions. Its mechanism may be explained by incomplete inhibition of the vestibulo-oculomotor system including the cerebellar flocculonodular lobe or vestiburo-cerebellum.
BibTeX: @article{Sakata1987, author = {Sakata, E and Ohtsu, K and Shimura, H and Sakai, S}, title = {Positional nystagmus of benign paroxysmal type (BPPN) due to cerebellar vermis lesions. Pseudo-BPPN.}, journal = {Auris, nasus, larynx}, year = {1987}, volume = {14}, issue = {1}, pages = {17--21}, keywords = {Arachnoid; Astrocytoma, complications; Cerebellar Diseases, complications; Cerebellar Neoplasms, complications; Cerebellum, blood supply; Cerebral Infarction, complications; Cerebral Ventricle Neoplasms, complications; Cranial Fossa, Posterior; Cysts, complications; Humans; Nystagmus, Pathologic, etiology}, pmid = {3632481} }
Sakata, E., Ohtsu, K. and Itoh, Y.	Positional nystagmus of benign paroxysmal type (BPPN) due to cerebellar vermis lesions. Pseudo-BPPN. [Abstract] [BibTeX]	1991	Acta oto-laryngologica. Supplementum Vol. 481, pp. 254-257	article
Abstract: Positioning nystagmus accompanied by severe vertigo has been reported in patients with partial lesions of the inner ear, especially otolith lesions. Typically, this type of nystagmus shows a latent period and subsequent fatiguability. We concur with this finding and have constantly emphasized the significance of this phenomenon in clinical diagnosis. Since we started using CT-scanning, this type of nystagmus has been noted in 47 patients, all of whom had cerebellar vermis lesions. Attention should be focused on this association; if such a combination were seen in only 1 or 2 patients, it could simply be attributed to coincidence. But its occurrence in as many as 47 patients indicates a causal role of cerebellar vermis lesions. Its mechanism may be explained by incomplete inhibition of the vestibulo-oculomotor system including the cerebellar flocculonodular lobe or vestibulo-cerebellum.
BibTeX: @article{Sakata1991, author = {Sakata, E and Ohtsu, K and Itoh, Y}, title = {Positional nystagmus of benign paroxysmal type (BPPN) due to cerebellar vermis lesions. Pseudo-BPPN.}, journal = {Acta oto-laryngologica. Supplementum}, year = {1991}, volume = {481}, pages = {254--257}, keywords = {Cerebellar Diseases, complications, diagnostic imaging, physiopathology; Humans; Male; Middle Aged; Nystagmus, Pathologic, etiology, physiopathology; Tomography, X-Ray Computed; Vertigo, etiology, physiopathology}, pmid = {1927387} }
Rodríguez Gutiérrez, C. and Rodríguez Gómez, E.	Positional vertigo afterwards maxillary dental implant surgery with bone regeneration. [Abstract] [BibTeX]	2007	Medicina oral, patologia oral y cirugia bucal Vol. 12(2), pp. E151-E153	article
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most common form of vertigo. It is caused by loose otoconia from the utricle which, in certain positions, displaced the cupula of the posterior semicircular canal. BPPV most often is a result of aging. It also can occur after a blow to the head. Less common causes include a prolonged positioning on the back (supine) during some surgical procedures. Additionally one can include in this ethiopathogenesis the positioning required during the maxillary dental implant surgery with bone regeneration related to a forced head positioning and inner ear trauma induced by dental turbine noise working in the maxillary bone. Two cases of patients who suffered BPPV after undergoing maxillary dental implant with bone regeneration procedures are reported. Diagnosis and treatment are also described.
BibTeX: @article{RodriguezGutierrez2007, author = {Rodríguez Gutiérrez, Carlos and Rodríguez Gómez, Enrique}, title = {Positional vertigo afterwards maxillary dental implant surgery with bone regeneration.}, journal = {Medicina oral, patologia oral y cirugia bucal}, year = {2007}, volume = {12}, issue = {2}, pages = {E151--E153}, keywords = {Adult; Bone Regeneration; Caloric Tests; Dental Implantation, adverse effects; Female; Humans; Male; Maxillary Sinus, surgery; Middle Aged; Vertigo, diagnosis, etiology}, pmid = {17322805} }
Viccaro, M., Mancini, P., La Gamma, R., De Seta, E., Covelli, E. and Filipo, R.	Positional vertigo and cochlear implantation. [Abstract] [BibTeX]	2007	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 28(6), pp. 764-767	article	DOI
Abstract: To identify patients developing positional vertigo after cochlear implantation. Prospective study on a cohort of patients undergoing cochlear implantation. Academic tertiary referral center. The study included 70 consecutive patients who underwent vestibular evaluation before and after cochlear implantation. Medical record review. Recorded vestibular symptoms after cochlear implantation. Patients with positional vertigo were considered case subjects, whereas those without vestibular symptoms were considered case controls. Benign paroxysmal positional vertigo (BPPV) occurred in 8 patients (on the cochlear implant [CI] side in 7 patients, and in the other ear in 1). One patient had BPPV of the lateral semicircular canal on the implanted side, and 7 patients had BPPV of the posterior semicircular canal (on the same CI side in 6 patients, and on the opposite side in 1), which were detected and presented during the last examination. In 5 patients, the onset of symptoms varied from 7 to 130 days after implant activation; in 2 patients, the onset occurred before activation. Three different mechanisms are proposed for the occurrence of BPPV in patients with CI. The first focuses on the fall of bone dust particles into the cochlea during cochleostomy. In the second, the vibration caused by drilling the cochlea would be sufficient to dislodge otoconia into the labyrinth. The third hypothesis suggests dislodging of an otolith because of the electric stimulation. In our patients, conservative approaches have been used with a minimal invasive cochleostomy and without perilymph suction. Thus, the vibratory trauma affecting the cochlea during cochleostomy seems to play a fundamental role in the development of paroxysmal vertigo in patients with implant.
BibTeX: @article{Viccaro2007, author = {Viccaro, Marika and Mancini, Patrizia and La Gamma, Raffaella and De Seta, Elio and Covelli, Edoardo and Filipo, Roberto}, title = {Positional vertigo and cochlear implantation.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2007}, volume = {28}, issue = {6}, pages = {764--767}, doi = {https://doi.org/10.1097/MAO.0b013e318064e8d4}, keywords = {Adolescent; Aged; Cochlear Implantation, adverse effects; Cohort Studies; Female; Functional Laterality, physiology; Humans; Male; Middle Aged; Prospective Studies; Semicircular Canals, physiology; Treatment Outcome; Vertigo, etiology; Vestibular Function Tests}, pmid = {17721364} }
Watson, P., Barber, H.O., Deck, J. and Terbrugge, K.	Positional vertigo and nystagmus of central origin. [Abstract] [BibTeX]	1981	The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques Vol. 8(2), pp. 133-137	article
Abstract: Four cases are described illustrating the clinical features of positional vertigo and nystagmus due to posterior fossa tumors and a case of obstructive hydrocephalus. In these cases positional vertigo was the first and only presenting symptom of central nervous system disease. One case of subependymoma of the fourth ventricle and one with hydrocephalus had characteristic symptoms of benign positional vertigo; each showed positional nystagmus of the benign paroxysmal type.
BibTeX: @article{Watson1981, author = {Watson, P and Barber, H O and Deck, J and Terbrugge, K}, title = {Positional vertigo and nystagmus of central origin.}, journal = {The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques}, year = {1981}, volume = {8}, issue = {2}, pages = {133--137}, keywords = {Adult; Brain Neoplasms, complications, diagnosis; Diagnosis, Differential; Female; Humans; Hydrocephalus, complications, diagnosis; Labyrinth Diseases, diagnosis; Male; Middle Aged; Nystagmus, Pathologic, diagnosis, etiology; Posture; Tomography, X-Ray Computed; Vertigo, diagnosis, etiology; Vestibule, Labyrinth}, pmid = {6975152} }
Beynon, G.J., Baguley, D.M., Moffat, D.A. and Irving, R.M.	Positional vertigo as a first symptom of a cerebellopontine angle cholesteatoma: case report. [Abstract] [BibTeX]	2000	Ear, nose, & throat journal Vol. 79(7), pp. 508-510	article
Abstract: We report a case of a cerebellopontine angle cholesteatoma whose initial sign was benign paroxysmal positional vertigo (BPPV). Positional vertigo caused by a central pathology is extremely rare and is usually accompanied by other suspicious features. In this case, there were no additional neurotologic symptoms or signs. The only abnormalities were seen on Dix-Hallpike testing, but because they were not consistent with a diagnosis of BPPV, the decision was made to proceed to imaging. Diagnostic rigor is required when evaluating positional vertigo, as with all symptoms of imbalance, if such cases are not to be overlooked.
BibTeX: @article{Beynon2000, author = {Beynon, G J and Baguley, D M and Moffat, D A and Irving, R M}, title = {Positional vertigo as a first symptom of a cerebellopontine angle cholesteatoma: case report.}, journal = {Ear, nose, & throat journal}, year = {2000}, volume = {79}, issue = {7}, pages = {508--510}, keywords = {Adult; Cerebellar Diseases, diagnosis; Cerebellopontine Angle, pathology; Cholesteatoma, diagnosis; Diagnosis, Differential; Female; Humans; Magnetic Resonance Imaging; Meniere Disease, diagnosis, etiology}, pmid = {10935302} }
Epley, J.M.	Positional vertigo related to semicircular canalithiasis. [Abstract] [BibTeX]	1995	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 112(1), pp. 154-161	article	DOI
Abstract: My clinical and laboratory observations support the theoretical concept that the mechanism of typical nystagmus, and most forms of atypical transient nystagmus, is hydrodynamic drag by gravitating free densities--most commonly displaced otoconia--in the endolymph of a semicircular canal; and that these "canaliths" have a significant mechanical advantage, by virture of the canal/ampulla cross-sectional differential, over densities acting directly on the cupula. Positional vertigo related to apparent canalithiasis (benign paroxysmal positional vertigo) is a common cause of incapacitation. The profile of the concomitant nystagmus localizes the semicircular canal involved. The canalith repositioning procedure, appropriately administered and targeted according to the observed nystagmus, provides a highly effective means for control of symptoms and a valuable resource for diagnostic evaluation of the more complex case. Surgery is rarely indicated.
BibTeX: @article{Epley1995, author = {Epley, J M}, title = {Positional vertigo related to semicircular canalithiasis.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {1995}, volume = {112}, issue = {1}, pages = {154--161}, doi = {https://doi.org/10.1016/S0194-59989570315-2}, keywords = {Ear Canal, physiology; Humans; Nystagmus, Pathologic, diagnosis, etiology, physiopathology, therapy; Vertigo, etiology}, pmid = {7816450} }
Cho, E.I. and White, J.A.	Positional vertigo: as occurs across all age groups. [Abstract] [BibTeX]	2011	Otolaryngologic clinics of North America Vol. 44(2), pp. 347-60, viii	article	DOI
Abstract: This article reviews the pathophysiology, diagnosis, and treatment of benign paroxysmal positional vertigo of the posterior and lateral semicircular canals and summarizes the evidence-based outcome data. The authors discuss this common cause of vertigo, its cause and prevalence across the life span, and efficacy of treatment through both physical repositioning maneuvers and surgery.
BibTeX: @article{Cho2011, author = {Cho, Edward I and White, Judith A}, title = {Positional vertigo: as occurs across all age groups.}, journal = {Otolaryngologic clinics of North America}, year = {2011}, volume = {44}, issue = {2}, pages = {347--60, viii}, doi = {https://doi.org/10.1016/j.otc.2011.01.006}, keywords = {Aged; Benign Paroxysmal Positional Vertigo; Humans; Male; Nystagmus, Pathologic, physiopathology; Semicircular Canals, physiopathology; Vertigo, diagnosis, epidemiology, physiopathology, therapy}, pmid = {21474009} }
Wang, E.	Possible errors in the article "clinical features of recurrent or persistent benign paroxysmal positional vertigo". [BibTeX]	2013	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 149(5), pp. 796	article	DOI
BibTeX: @article{Wang2013a, author = {Wang, Entong}, title = {Possible errors in the article "clinical features of recurrent or persistent benign paroxysmal positional vertigo".}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2013}, volume = {149}, issue = {5}, pages = {796}, doi = {https://doi.org/10.1177/0194599813505837}, keywords = {Female; Humans; Male; Vertigo, diagnosis}, pmid = {24190892} }
Gacek, R.R.	Posterior ampullary nerve transection for benign paroxysmal positional vertigo. [BibTeX]	1978	Transactions - Pennsylvania Academy of Ophthalmology and Otolaryngology Vol. 31(2), pp. 190-193	article
BibTeX: @article{Gacek1978a, author = {Gacek, R R}, title = {Posterior ampullary nerve transection for benign paroxysmal positional vertigo.}, journal = {Transactions - Pennsylvania Academy of Ophthalmology and Otolaryngology}, year = {1978}, volume = {31}, issue = {2}, pages = {190--193}, keywords = {Humans; Methods; Semicircular Canals, innervation, surgery; Vertigo, surgery}, pmid = {725985} }
Vannucchi, P., Pecci, R. and Giannoni, B.	Posterior semicircular canal benign paroxysmal positional vertigo presenting with torsional downbeating nystagmus: an apogeotropic variant. [Abstract] [BibTeX]	2012	International journal of otolaryngology Vol. 2012, pp. 413603	article	DOI
Abstract: The aim of this study is to verify the hypothesis that free-floating particles could sometimes localize into the distal portion of the non ampullary arm of the posterior semicircular canal (PSC) so that assuming the Dix-Hallpike's positions, the clot could move towards the ampulla eliciting a inhibitory torsional-down beating paroxysmal positional nystagmus (PPNy), instead of typical excitatory torsional-up beating PPNy. Among 45 patients with vestibular signs suggesting anterior semicircular canal paroxysmal positional vertigo (PPV), collected from February 2003 to August 2006, we detected a group of 6 subjects whose clinical findings showed a singular behaviour during follow-up. At the first check-up, all patients were submitted to different types of physical manoeuvres for ASC canalolithiasis. Patients were controlled during the same session and after one week. When we found that nystagmus was qualitatively changed we adopted the appropriate physical therapies for that sign. At a next check-up, after having performed some physical therapies, all patients had a typical PSC PPNy of the opposite side, with respect to that of the ASC initially diagnosed. Basing on these observations we conclude that PSC PPV, similarly to lateral semicircular canal PPV, could manifests in a apogeotropic variant.
BibTeX: @article{Vannucchi2012, author = {Vannucchi, Paolo and Pecci, Rudi and Giannoni, Beatrice}, title = {Posterior semicircular canal benign paroxysmal positional vertigo presenting with torsional downbeating nystagmus: an apogeotropic variant.}, journal = {International journal of otolaryngology}, year = {2012}, volume = {2012}, pages = {413603}, doi = {https://doi.org/10.1155/2012/413603}, pmid = {22969807} }
Cremer, P.D., Migliaccio, A.A., Pohl, D.V., Curthoys, I.S., Davies, L., Yavor, R.A. and Halmagyi, G.M.	Posterior semicircular canal nystagmus is conjugate and its axis is parallel to that of the canal. [Abstract] [BibTeX]	2000	Neurology Vol. 54(10), pp. 2016-2020	article
Abstract: A patient with a postoperative fistula of the left posterior semicircular canal is presented. Negative pressure in the external ear canal produced upbeat-torsional nystagmus, which was recorded in three dimensions using binocular scleral search coils. The nystagmus was conjugate, without skew deviation, and its trajectory corresponded to the anatomic axis of the left posterior canal. The current study helps validate Ewald's first law in humans: the axis of nystagmus should match the anatomic axis of the semicircular canal that generated it. This law is clinically useful in diagnosing pathology of the vestibular end-organ, such as benign paroxysmal positional vertigo or the superior semicircular canal dehiscence syndrome.
BibTeX: @article{Cremer2000, author = {Cremer, P D and Migliaccio, A A and Pohl, D V and Curthoys, I S and Davies, L and Yavor, R A and Halmagyi, G M}, title = {Posterior semicircular canal nystagmus is conjugate and its axis is parallel to that of the canal.}, journal = {Neurology}, year = {2000}, volume = {54}, issue = {10}, pages = {2016--2020}, keywords = {Aged; Electronystagmography; Female; Humans; Magnetic Resonance Imaging; Meniere Disease, diagnosis, physiopathology; Nystagmus, Pathologic, diagnosis, physiopathology; Semicircular Canals, physiopathology; Tomography, X-Ray Computed; Vestibule, Labyrinth, physiopathology}, pmid = {10822450} }
Zappia, J.J.	Posterior semicircular canal occlusion for benign paroxysmal positional vertigo. [Abstract] [BibTeX]	1996	The American journal of otology Vol. 17(5), pp. 749-754	article
Abstract: For the small group of patients with benign paroxysmal positional vertigo that does not resolve with time or conservative treatment measures, posterior semicircular canal occlusion is considered. In the past 2 years, eight patients have undergone posterior semicircular canal occlusion at the Chicago Otology Group. All patients noted resolution of their positional vertigo. No complications were observed, particularly no sensorineural hearing loss was noted. A several-week period of disequilibrium is typical and appears to be the most bothersome aspect of the surgery to the patient.
BibTeX: @article{Zappia1996, author = {Zappia, J J}, title = {Posterior semicircular canal occlusion for benign paroxysmal positional vertigo.}, journal = {The American journal of otology}, year = {1996}, volume = {17}, issue = {5}, pages = {749--754}, keywords = {Adult; Female; Humans; Male; Middle Aged; Semicircular Canals, physiopathology, surgery; Vertigo, physiopathology, surgery}, pmid = {8892572} }
Kartush, J.M. and Sargent, E.W.	Posterior semicircular canal occlusion for benign paroxysmal positional vertigo--CO2 laser-assisted technique: preliminary results. [Abstract] [BibTeX]	1995	The Laryngoscope Vol. 105(3 Pt 1), pp. 268-274	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is a common vestibular end-organ disorder that in the majority of patients resolves with conservative management. In the occasional patient who has unremitting BPPV despite conservative treatment, posterior semicircular canal occlusion (PCO) may be effective in eliminating symptoms. In an attempt to minimize the risk of hearing loss, a modified procedure was developed that uses the CO2 laser to shrink the membranous vestibular posterior semicircular canal prior to mechanically plugging the canal. Preliminary results of this CO2 laser-assisted occlusion technique used in four patients are presented.
BibTeX: @article{Kartush1995, author = {Kartush, J M and Sargent, E W}, title = {Posterior semicircular canal occlusion for benign paroxysmal positional vertigo--CO2 laser-assisted technique: preliminary results.}, journal = {The Laryngoscope}, year = {1995}, volume = {105}, issue = {3 Pt 1}, pages = {268--274}, doi = {https://doi.org/10.1288/00005537-199503000-00009}, keywords = {Aged; Female; Fenestration, Labyrinth; Humans; Laser Coagulation; Male; Middle Aged; Posture, physiology; Semicircular Canals, surgery; Vertigo, surgery}, pmid = {7877415} }
Parnes, L.S. and McClure, J.A.	Posterior semicircular canal occlusion for intractable benign paroxysmal positional vertigo. [Abstract] [BibTeX]	1990	The Annals of otology, rhinology, and laryngology Vol. 99(5 Pt 1), pp. 330-334	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is most often a self-limited disorder arising from the posterior semicircular canal of the undermost ear in the Hallpike position. Some individuals with this disorder have severe and protracted symptoms requiring more than expectant therapy. We describe two patients with intractable BPPV and profound sensorineural hearing loss in the affected ear treated by transmastoid posterior semicircular canal occlusion. Postoperatively, both were relieved of their BPPV and demonstrated preserved lateral semicircular canal function as measured by electronystagmography. We feel this new procedure provides a simpler and possibly safer alternative to singular neurectomy and should be given future consideration in the treatment of intractable BPPV in a normal-hearing ear.
BibTeX: @article{Parnes1990, author = {Parnes, L S and McClure, J A}, title = {Posterior semicircular canal occlusion for intractable benign paroxysmal positional vertigo.}, journal = {The Annals of otology, rhinology, and laryngology}, year = {1990}, volume = {99}, issue = {5 Pt 1}, pages = {330--334}, doi = {https://doi.org/10.1177/000348949009900502}, keywords = {Adult; Aged; Caloric Tests; Electronystagmography; Female; Head; Hearing Loss, Sensorineural, diagnosis, diagnostic imaging, etiology; Humans; Movement; Posture; Semicircular Canals, surgery; Tomography, X-Ray Computed; Vertigo, classification, complications, surgery}, pmid = {2337310} }
Ahmed, R.M., Pohl, D.V., MacDougall, H.G., Makeham, T. and Halmagyi, G.M.	Posterior semicircular canal occlusion for intractable benign positional vertigo: outcome in 55 ears in 53 patients operated upon over 20 years. [Abstract] [BibTeX]	2012	The Journal of laryngology and otology Vol. 126(7), pp. 677-682	article	DOI
Abstract: To report the outcome of posterior semicircular canal occlusion surgery for intractable benign positional vertigo, regarding vertigo cure rate and hearing and balance outcomes. Retrospective review of 53 patients presenting with benign positional vertigo, unresponsive to repositioning manoeuvres, who eventually underwent posterior canal occlusion, over a 20 year period. From 1991 to 2011, 5364 benign positional vertigo patients were treated in our balance disorders clinic; 53 of those who failed to respond to repositioning underwent posterior canal occlusion. All 53 were cured of their benign positional vertigo. Nine suffered some symptomatic permanent hearing loss (>20 dB at low and >25 dB at high frequencies). Ten patients suffered caloric vestibular function deterioration, with mild but permanent subjective imbalance in five; a further 10 patients with no post-operative caloric test changes also had some permanent imbalance. Benign positional vertigo later developed in the operated ear lateral canal in two patients and in the opposite ear posterior canal in eight patients. Two patients needed bilateral sequential posterior canal occlusion. Posterior canal occlusion is a highly effective treatment for intractable benign positional vertigo, with what is probably an acceptable risk to hearing and balance: five of six patients will have no hearing problem and nine of 10 no balance problem after surgery.
BibTeX: @article{Ahmed2012, author = {Ahmed, R M and Pohl, D V and MacDougall, H G and Makeham, T and Halmagyi, G M}, title = {Posterior semicircular canal occlusion for intractable benign positional vertigo: outcome in 55 ears in 53 patients operated upon over 20 years.}, journal = {The Journal of laryngology and otology}, year = {2012}, volume = {126}, issue = {7}, pages = {677--682}, doi = {https://doi.org/10.1017/S0022215112000758}, keywords = {Adult; Aged; Aged, 80 and over; Audiometry, Pure-Tone; Benign Paroxysmal Positional Vertigo; Bone Conduction; Caloric Tests, statistics & numerical data; Female; Hearing Loss, Sensorineural, etiology; Humans; Male; Middle Aged; Otologic Surgical Procedures, adverse effects, methods, statistics & numerical data; Patient Positioning; Postural Balance; Recurrence; Reoperation; Retrospective Studies; Semicircular Canals, surgery; Sensation Disorders, etiology; Therapeutic Occlusion, adverse effects, methods; Treatment Outcome; Vertigo, surgery}, pmid = {22583830} }
Parnes, L.S. and McClure, J.A.	Posterior semicircular canal occlusion in the normal hearing ear. [Abstract] [BibTeX]	1991	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 104(1), pp. 52-57	article	DOI
Abstract: This report outlines our experience with posterior semicircular canal occlusion, a new operative procedure for intractable benign paroxysmal positional vertigo (BPPV). We postulate that the resulting solid canal "plug" prevents endolymph movement within the posterior canal, which effectively fixes the cupula. This selectively abolishes the receptivity of the posterior canal to both angular acceleration and gravity without influencing the other inner ear receptors. We previously reported the success of this procedure in two patients with BPPV and a co-existing profound sensorineural hearing loss in the affected ear. Since that report, a slightly modified technique has been used to occlude six more posterior canals--five in normal hearing ears. While our follow-up times range from only 3 to 18 months, all eight patients continue to be relieved of their BPPV. Temporary mixed hearing losses occurred in three of the five ears with normal preoperative hearing. Hearing in all five patients ultimately returned to the preoperative state. We believe this procedure is a simpler and safer alternative to singular neurectomy for the treatment of intractable benign paroxysmal positional vertigo.
BibTeX: @article{Parnes1991, author = {Parnes, L S and McClure, J A}, title = {Posterior semicircular canal occlusion in the normal hearing ear.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {1991}, volume = {104}, issue = {1}, pages = {52--57}, doi = {https://doi.org/10.1177/019459989110400111}, keywords = {Aged; Animals; Evoked Potentials, Auditory, Brain Stem; Female; Guinea Pigs; Hearing Loss, Sensorineural, complications, etiology, surgery; Humans; Male; Methods; Middle Aged; Semicircular Canals, pathology, surgery; Surgical Procedures, Operative, adverse effects; Vertigo, complications, surgery}, pmid = {1900630} }
Rapoport, A. and Sadeh, M.	Posterior semicircular canal type benign paroxysmal positioning vertigo with ageotropic paroxysmal positioning nystagmus. [Abstract] [BibTeX]	2001	Audiology & neuro-otology Vol. 6(1), pp. 50-53	article	DOI
Abstract: We report on 3 patients with typical benign paroxysmal positioning vertigo (BPPV) and atypical, paroxysmal positioning nystagmus. When the Dix-Hallpike test was performed, the patients exhibited an ageotropic nystagmus, different from that classically described in posterior semicircular canal BPPV. It was torsional-vertical with the vertical component beating downwards, and the torsional component was beating away from the lowermost ear. In both left and right Dix-Hallpike positions, the upper poles of the eyes were turning away from the lowermost ear. The atypical ageotropic paroxysmal positional nystagmus of the posterior semicircular canal was observed in the evolution of the BPPV in 2 patients and on the first examination in the third. Two patients had changing patterns of paroxysmal positioning nystagmus.
BibTeX: @article{Rapoport2001, author = {Rapoport, A and Sadeh, M}, title = {Posterior semicircular canal type benign paroxysmal positioning vertigo with ageotropic paroxysmal positioning nystagmus.}, journal = {Audiology & neuro-otology}, year = {2001}, volume = {6}, issue = {1}, pages = {50--53}, doi = {https://doi.org/10.1159/000046808}, keywords = {Adult; Aged; Female; Humans; Male; Middle Aged; Nystagmus, Physiologic, physiology; Semicircular Canals, physiopathology; Vertigo, physiopathology}, pmid = {11173775} }
Devaiah, A.K. and Andreoli, S.	Postmaneuver restrictions in benign paroxysmal positional vertigo: an individual patient data meta-analysis. [Abstract] [BibTeX]	2010	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 142(2), pp. 155-159	article	DOI
Abstract: Treatment of benign paroxysmal positional vertigo (BPPV) with the Epley and Semont maneuvers has been used with and without postmaneuver postural restrictions. Studies examining these restrictions have yielded differing results. This study sought to examine the studies for a more uniform conclusion. Controlled studies with objective identification of unilateral posterior semicircular canal BPPV and symptom resolution were analyzed. A PubMed search identified six studies totaling 523 patients meeting all inclusion criteria. Cohorts treated with and without restrictions were compared. Individual patient pooled analyses in a one-stage comparison were used for the meta-analysis. Pooled results of all restriction types showed no advantage over no restriction. Studies including each individual restriction were examined against the pooled population to look for technique differences. No restriction was found to be statistically significant. The restrictions examined in controlled trials did not differ significantly in clinical outcomes, which suggests that restrictions do not appear to significantly affect the efficacy of BPPV maneuvers.
BibTeX: @article{Devaiah2010, author = {Devaiah, Anand K and Andreoli, Steven}, title = {Postmaneuver restrictions in benign paroxysmal positional vertigo: an individual patient data meta-analysis.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2010}, volume = {142}, issue = {2}, pages = {155--159}, doi = {https://doi.org/10.1016/j.otohns.2009.09.013}, keywords = {Algorithms; Controlled Clinical Trials as Topic; Evidence-Based Medicine; Head Movements; Humans; Kinesiology, Applied, methods; Semicircular Canals, physiopathology; Severity of Illness Index; Treatment Outcome; Vertigo, diagnosis, physiopathology, rehabilitation}, pmid = {20115966} }
Ralli, G., Giovanni, R., Atturo, F., Francesca, A., Lamberti, A., Antonio, L., Nola, G. and Giuseppe, N.	Post-traumatic camel-related benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2010	Travel medicine and infectious disease Vol. 8(4), pp. 207-209	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is a common form of dizziness. The causes of BPPV are not yet known but a relationship between the onset of vertigo and head trauma has been found. Among the causes of head injury related to BPPV, dropping off a camel has not been reported in literature yet. We describe two cases of persons that fell off a camel during a safari in Middle East countries. After the fall they reported vertigo symptoms that were not interpreted as BPPV. When they returned to Italy, due to symptoms persistence, they were referred to our ENT practice: we found evidence of BPPV. In a case it was a bilateral BPPV (bBPPV). Falling off a camel may be a relevant cause of BPPV. We suggest a correct evaluation of the labyrinth for BPPV with the appropriate diagnostic maneuvers and, if necessary, a treatment with repositioning maneuvers.
BibTeX: @article{Ralli2010, author = {Ralli, Giovanni and Giovanni, Ralli and Atturo, Francesca and Francesca, Atturo and Lamberti, Antonio and Antonio, Lamberti and Nola, Giuseppe and Giuseppe, Nola}, title = {Post-traumatic camel-related benign paroxysmal positional vertigo.}, journal = {Travel medicine and infectious disease}, year = {2010}, volume = {8}, issue = {4}, pages = {207--209}, doi = {https://doi.org/10.1016/j.tmaid.2010.07.002}, keywords = {Accidental Falls; Adult; Animals; Camelus; Craniocerebral Trauma, etiology, physiopathology; Female; Humans; Male; Middle Aged; Middle East; Travel; Vertigo, diagnosis, etiology, physiopathology}, pmid = {20970722} }
Lerut, B., De Vuyst, C., Ghekiere, J., Vanopdenbosch, L. and Kuhweide, R.	Post-traumatic pulsatile tinnitus: the hallmark of a direct carotico-cavernous fistula. [Abstract] [BibTeX]	2007	The Journal of laryngology and otology Vol. 121(11), pp. 1103-1107	article	DOI
Abstract: Following trauma to her right frontal region, a 68-year-old woman suffered bilateral, benign, paroxysmal, positional vertigo and a left-sided, longitudinal petrosal bone fracture, with secondary facial palsy and ossicular luxation. From the onset, the patient complained of pulsatile, left-sided tinnitus. After eight weeks, she developed left-sided ocular symptoms, progressing from conjunctival hyperaemia and orbital oedema to an abducens nerve palsy, and ultimately to heart failure. The case and the final diagnosis of carotico-cavernous fistula are discussed. Guidelines are proposed for a diagnostic approach to pulsatile tinnitus and for the optimal management of patients presenting with pulsatile tinnitus associated with ocular symptoms.
BibTeX: @article{Lerut2007, author = {Lerut, B and De Vuyst, C and Ghekiere, J and Vanopdenbosch, L and Kuhweide, R}, title = {Post-traumatic pulsatile tinnitus: the hallmark of a direct carotico-cavernous fistula.}, journal = {The Journal of laryngology and otology}, year = {2007}, volume = {121}, issue = {11}, pages = {1103--1107}, doi = {https://doi.org/10.1017/S0022215107005890}, keywords = {Aged; Angiography; Balloon Occlusion; Carotid-Cavernous Sinus Fistula, complications, diagnostic imaging, surgery; Eye Diseases, diagnostic imaging, etiology; Facial Paralysis, etiology; Female; Humans; Petrous Bone, injuries; Skull Fractures, complications; Tinnitus, etiology; Vertigo, etiology}, pmid = {17295936} }
Dundar, M.A., Derin, S., Aricigil, M., Eryilmaz, M.A. and Arbag, H.	Post-traumatic refractory multiple canal benign paroxysmal positional vertigo: a case report. [Abstract] [BibTeX]	2016	Northern clinics of Istanbul Vol. 3(3), pp. 229-232	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most prevalent form of peripheral vertigo and is seen in a significant number of patients who present at neurology and ear, nose, and throat clinics. Various maneuvers may be used to determine the affected canal based on observation of specific nystagmus signs, and may also be used for treatment. Multiple canal pathology can make diagnosis and treatment more difficult. Presently described is case of BPPV with multiple canal pathology and traumatic etiology that was resistant to treatment.
BibTeX: @article{Dundar2016, author = {Dundar, Mehmet Akif and Derin, Serhan and Aricigil, Mitat and Eryilmaz, Mehmet Akif and Arbag, Hamdi}, title = {Post-traumatic refractory multiple canal benign paroxysmal positional vertigo: a case report.}, journal = {Northern clinics of Istanbul}, year = {2016}, volume = {3}, issue = {3}, pages = {229--232}, doi = {https://doi.org/10.14744/nci.2015.36349}, keywords = {Head trauma; multiple canal benign paroxysmal positional vertigo; refractory}, pmid = {28275757} }
Fife, T.D. and Giza, C.	Posttraumatic vertigo and dizziness. [Abstract] [BibTeX]	2013	Seminars in neurology Vol. 33(3), pp. 238-243	article	DOI
Abstract: Dizziness and vertigo are common symptoms following minor head trauma. Although these symptoms resolve within a few weeks in many patients, in some the symptoms may last much longer and impede ability to return to work and full functioning. Causes of persisting or recurrent dizziness may include benign paroxysmal positional vertigo, so-called labyrinthine concussion, unilateral vestibular nerve injury or damage to the utricle or saccule, perilymphatic fistula, or less commonly traumatic endolymphatic hydrops. Some dizziness after head trauma is due to nonlabyrinthine causes that may be related to structural or microstructural central nervous system injury or to more complicated interactions between migraine, generalized anxiety, and issues related to patients self-perception, predisposing psychological states, and environmental and stress-related factors. In this article, the authors review both the inner ear causes of dizziness after concussion and also the current understanding of chronic postconcussive dizziness when no peripheral vestibular cause can be identified.
BibTeX: @article{Fife2013, author = {Fife, Terry D and Giza, Christopher}, title = {Posttraumatic vertigo and dizziness.}, journal = {Seminars in neurology}, year = {2013}, volume = {33}, issue = {3}, pages = {238--243}, doi = {https://doi.org/10.1055/s-0033-1354599}, keywords = {Athletic Injuries, physiopathology; Brain Injuries, complications, physiopathology; Dizziness, etiology, therapy; Ear, Inner, injuries; Humans; Migraine Disorders, etiology; Post-Concussion Syndrome, physiopathology; Spinal Cord Injuries, complications, physiopathology; Vertigo, etiology, therapy; Vestibule, Labyrinth, injuries, pathology; Wounds and Injuries, complications}, pmid = {24057827} }
Massoud, E.A. and Ireland, D.J.	Post-treatment instructions in the nonsurgical management of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	1996	The Journal of otolaryngology Vol. 25(2), pp. 121-125	article
Abstract: Benign paroxysmal positional vertigo (BPPV) is the commonest peripheral vestibular disorder seen in dizziness clinics. It was long believed that the condition was caused by inorganic particles in the cupula of the posterior semicircular canal (PSC). More recently it has been suggested that BPPV may result from free-floating densities in the endolymph of the long arm of the PSC. Among the various treatment modalities used, two maneuvers, each based on a different theory of pathogenesis, have reported equally high success in the control of this disorder. These maneuvers are customarily followed by strict post-treatment instructions. We studied patients with BPPV prospectively by comparing the therapeutic effectiveness of these two modalities and studying the importance of post-treatment instructions in affecting the final outcome in each modality. We showed that both maneuvers were equally successful in controlling the symptoms and that post-treatment instructions were not necessary.
BibTeX: @article{Massoud1996, author = {Massoud, E A and Ireland, D J}, title = {Post-treatment instructions in the nonsurgical management of benign paroxysmal positional vertigo.}, journal = {The Journal of otolaryngology}, year = {1996}, volume = {25}, issue = {2}, pages = {121--125}, keywords = {Adult; Aged; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic; Posture; Prospective Studies; Vertigo, therapy}, pmid = {8683652} }
Oliva Domínguez, M., Bartual Magro, J., Dañino González, J.L., Dañino González, G., Roquette Gaona, J. and Bartual Pastor, J.	Postural control according to the age in patients with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2005	Revue de laryngologie - otologie - rhinologie Vol. 126(4), pp. 267-270	article
Abstract: To study the relationship between age and postural control in patients with benign paroxysmal positional vertigo. Prospective study performed in 65 diagnosed patients with benign paroxysmal positional vertigo (BPPV) in any of its variants. The results of the Sensory Organization Test are compared with their equivalent in a control group by means of scatterplot and regression lines. For the statistical study the Mann-Whitney's U test was used. In the NORMAL group, the regression line for composite has a 0.0934 slope; in the BPPV group, 0.4284. This difference is due to conditions 5 and 6 fundamentally, the results being statistically significant. The patients with BPPV have a worse postural control than the group control. This difference is much more pronounced the older the patient, and is of vestibular origin.
BibTeX: @article{OlivaDominguez2005, author = {Oliva Domínguez, M and Bartual Magro, J and Dañino González, J L and Dañino González, G and Roquette Gaona, J and Bartual Pastor, J}, title = {Postural control according to the age in patients with benign paroxysmal positional vertigo.}, journal = {Revue de laryngologie - otologie - rhinologie}, year = {2005}, volume = {126}, issue = {4}, pages = {267--270}, keywords = {Adult; Age Factors; Aged; Aged, 80 and over; Case-Control Studies; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, physiopathology; Posture; Prospective Studies; Severity of Illness Index; Vertigo, diagnosis, physiopathology}, pmid = {16496556} }
Di Girolamo, S., Paludetti, G., Briglia, G., Cosenza, A., Santarelli, R. and Di Nardo, W.	Postural control in benign paroxysmal positional vertigo before and after recovery. [Abstract] [BibTeX]	1998	Acta oto-laryngologica Vol. 118(3), pp. 289-293	article
Abstract: Thirty-two patients affected by idiopathic benign paroxysmal positional vertigo (BPPV) of the posterior semicircular canal were studied before, 3 days and I month after a resolutive Semont manoeuvre by means of dynamic posturography. The overall postural control in BPPV patients was shown to be impaired, as demonstrated by the pathological equilibrium scores. Data obtained before treatment showed a specific pattern of vestibular involvement and a pathological composite score. After the liberatory manoeuvre the Sensory Organization Test indicated a significant improvement in the pathological composite and vestibular scores. However, significant differences from controls were still detected 3 days and 1 month after clinical recovery from BPPV. The results clearly show that, in BPPV patients, there is an impairment of the vestibular system, which seems unable to maintain a normal postural balance. This deficit can be particularly detected when dynamic posturography evaluates the vestibular cues. After the liberatory manoeuvre a consistent improvement in the overall postural control has been observed but the residual differences from controls seem to suggest that damage to the otoconial maculae influences postural control, even when there is significant improvement in the clinical signs.
BibTeX: @article{DiGirolamo1998, author = {Di Girolamo, S and Paludetti, G and Briglia, G and Cosenza, A and Santarelli, R and Di Nardo, W}, title = {Postural control in benign paroxysmal positional vertigo before and after recovery.}, journal = {Acta oto-laryngologica}, year = {1998}, volume = {118}, issue = {3}, pages = {289--293}, keywords = {Analysis of Variance; Electronystagmography; Female; Humans; Male; Middle Aged; Postural Balance; Posture, physiology; Proprioception; Vertigo, complications, diagnosis, physiopathology; Vestibular Diseases, complications, diagnosis}, pmid = {9655200} }
Di Girolamo, S., Ottaviani, F., Scarano, E., Picciotti, P. and Di Nardo, W.	Postural control in horizontal benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2000	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 257(7), pp. 372-375	article
Abstract: Sixteen patients affected by benign paroxysmal positional vertigo of the horizontal semicircular canal (BPPV-HSC) were investigated by means of dynamic posturography (DP) and during bithermal caloric stimulation. Data were compared to data from 40 patients with benign paroxysmal positional vertigo of the posterior semicircular canal (BPPV-PSC) and 20 healthy controls. No postural deficit was observed before or after a liberative Lempert's manoeuvre when patients were compared to control subjects. BPPV-PSC postural scores were significantly impaired compared to scores from the BPPV-HSC group. A residual significant postural impairment was also observed after a successful liberative manoeuvre in the BPPV-PSC group. Electronystagmographic recordings before recovery revealed significant hypoexcitability of the affected ear in 8/16 patients of the BPPV-HSC group. After the liberative manoeuvre, a symmetric bilateral response to caloric stimulation was recorded in all patients. Three main conclusions can be drawn from the present data. First, disorders of the horizontal semicircular canal do not change postural control. Second, dynamic posturography can detect the postural imbalance due to posterior semicircular canal dysfunction even after resolution of paroxysmal vertigo attacks. Third, utricular dysfunction can be ruled out as a cause of the residual postural deficit observed in BPPV-PSC patients. Therefore the recovery delay observed even 1 month after the liberative manoeuvre in the BPPV-PSC-group might be due to the persistence of small amounts of residual debris in the canal, to paralysis of ampullar receptors, or to the time needed for central vestibular re-adaptation.
BibTeX: @article{DiGirolamo2000, author = {Di Girolamo, S and Ottaviani, F and Scarano, E and Picciotti, P and Di Nardo, W}, title = {Postural control in horizontal benign paroxysmal positional vertigo.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2000}, volume = {257}, issue = {7}, pages = {372--375}, keywords = {Caloric Tests; Electronystagmography; Female; Humans; Male; Middle Aged; Posture, physiology; Saccule and Utricle, physiopathology; Semicircular Canals, physiopathology; Vertigo, diagnosis, physiopathology}, pmid = {11052247} }
Kasse, C.A., Santana, G.G., Branco-Barreiro, F.C.A., Scharlach, R.C., Gazzola, J.M., Ganança, F.F. and Doná, F.	Postural control in older patients with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2012	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 146(5), pp. 809-815	article	DOI
Abstract: To evaluate the effectiveness of a canalith-repositioning procedure in postural control of older patients with idiopathic benign paroxysmal positional vertigo (BPPV). Prospective clinical trial. A tertiary referral center. A 9-month follow-up survey with a prospective design was conducted among 33 older patients with BPPV. Patients underwent static posturography (Balance Rehabilitation Unit [BRU]) and were administered the Dizziness Handicap Inventory (DHI) before and after the maneuver. After the treatment, they were compared with 33 healthy older subjects. The posturography parameters were the limit of stability (LOS), the center of body-pressure area (COP), and the velocity of oscillation (VOS) under conditions of visual, somatosensory, and visual-vestibular conflict. One canalith-repositioning procedure relieved most patients' complaints (54.5%), and 100% were relieved with 1 to 3 maneuvers. Total DHI score and all subscales improved after treatment (P < .01). The LOS values pretreatment (mean [SD] 134.27 [55.32] cm(2)) and posttreatment (181.03 [47.79] cm(2)) were significantly different (P < .01). Comparative analysis of COP values showed a relevant statistical difference in 8 of 10 postmaneuver conditions (P < .01). The postmaneuver VOS showed a significant difference under 7 conflict conditions. There were no differences between the healthy older subjects and treated patients for all VOS values under all conditions and for COP values under 9 conditions. The canalith-repositioning procedure promotes remission of symptoms, an increase in LOS, and improvement in postural control under conditions of somatosensory and visual conflict and visual-vestibular interaction.
BibTeX: @article{Kasse2012, author = {Kasse, Cristiane Akemi and Santana, Graziela Gaspar and Branco-Barreiro, Fátima Cristina Alves and Scharlach, Renata Coelho and Gazzola, Juliana Maria and Ganança, Fernando Freitas and Doná, Flávia}, title = {Postural control in older patients with benign paroxysmal positional vertigo.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2012}, volume = {146}, issue = {5}, pages = {809--815}, doi = {https://doi.org/10.1177/0194599811434388}, keywords = {Aged; Aged, 80 and over; Analysis of Variance; Benign Paroxysmal Positional Vertigo; Female; Humans; Male; Middle Aged; Postural Balance, physiology; Prospective Studies; Statistics, Nonparametric; Treatment Outcome; Vertigo, physiopathology, therapy}, pmid = {22247515} }
Black, F.O. and Nashner, L.M.	Postural disturbance in patients with benign paroxysmal positional nystagmus. [Abstract] [BibTeX]	1984	The Annals of otology, rhinology, and laryngology Vol. 93(6 Pt 1), pp. 595-599	article	DOI
Abstract: Abnormal vestibular function disrupts postural and ocular muscle control system references to gravity (earth) vertical. Vestibular disorders also prevent satisfactory resolution of normally redundant, but often conflicting, visual and somatosensory spatial references required for normal postural control during active and passive body motion. Using a moving platform and visual surrounds posturography technique to systematically interact visual, somatosensory, and vestibular inputs, it was clearly demonstrated that patients with the benign paroxysmal positional nystagmus type of distorted vestibular function employ an unstable, visually dependent postural sway distinct from the postural instability associated with unilateral or bilateral vestibular functional deficits. These findings have important clinical implications for diagnosis and management of patients with vestibular disorders.
BibTeX: @article{Black1984, author = {Black, F O and Nashner, L M}, title = {Postural disturbance in patients with benign paroxysmal positional nystagmus.}, journal = {The Annals of otology, rhinology, and laryngology}, year = {1984}, volume = {93}, issue = {6 Pt 1}, pages = {595--599}, doi = {https://doi.org/10.1177/000348948409300612}, keywords = {Adult; Age Factors; Fixation, Ocular; Humans; Labyrinth Diseases, physiopathology; Middle Aged; Nystagmus, Pathologic, physiopathology; Orientation; Posture; Proprioception; Rotation; Vertigo, physiopathology; Visual Perception}, pmid = {6508132} }
Marciano, E. and Marcelli, V.	Postural restrictions in labyrintholithiasis. [Abstract] [BibTeX]	2002	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 259(5), pp. 262-265	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most frequent labyrinthopathy in humans. Treatment consists mainly of liberatory maneuvers aiming to remove otolithic debris and subsequent postural restrictions in order to prevent debris from returning into the canal. The reappearance of symptoms after an effective liberatory maneuver was studied in a group subjected to restrictions and in a second group free from restrictions. The effects of these restrictions were evaluated. No statistically significant difference was found between the groups. Accordingly, restrictions seem to have no effect upon symptom recurrence. The slight supremacy of the Semont maneuver and the prevalence of subsequent relapse compared with the Epley maneuver suggests that these maneuvers could operate on different disorders (cupulolithiasis versus canalolithiasis). Finally, late recognition of relapse in patients who undergo restrictions might even make the liberatory maneuver less effective.
BibTeX: @article{Marciano2002, author = {Marciano, Elio and Marcelli, Vincenzo}, title = {Postural restrictions in labyrintholithiasis.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2002}, volume = {259}, issue = {5}, pages = {262--265}, doi = {https://doi.org/10.1007/s00405-001-0445-7}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Ear Canal, physiopathology; Female; Humans; Labyrinth Diseases, complications, physiopathology, prevention & control; Lithiasis, complications, physiopathology, prevention & control; Male; Middle Aged; Posture, physiology; Secondary Prevention; Vertigo, etiology, physiopathology, prevention & control}, pmid = {12107530} }
Stambolieva, K. and Angov, G.	Postural stability in patients with different durations of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2006	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 263(2), pp. 118-122	article	DOI
Abstract: Postural stability maintenance was investigated in patients with "idiopathic" benign paroxysmal positional vertigo of the posterior semicircular canal (BPPV-PSC) and compared to healthy subjects. To measure the postural stability during a quiet upright stance, we used static posturography in two conditions: with open and with closed eyes. The effect of the repositioning Epley's maneuver on the recovery of postural stability in patients with different durations of BPPV-PSC less than 60 days after the first attack of positioning vertigo (group I) and more than 60 days (group II) was examined. The investigation was made 1 h after the positive Dix-Hallpike test and 7 days after treatment with the Epley maneuver. "Sway velocity" (SV) and "relative power spectrum" (RPS) of the stabilograms were calculated to evaluate the postural stability for each subject and each experimental condition. We found a pronounced spectral density peak in the frequency range of 1.0-2.0 Hz and smaller spectral density in the range of 0.15-0.5 Hz compared to that in healthy subjects. Our results showed that the postural maintenance in BPPV-PSC patients depended on the disease duration. Patients with a duration of BPPV symptoms less than 60 days after the first attack demonstrated a high dependence on the visual input for postural stability. One week after the Epley maneuver, differences in the recovery of postural control in both groups of patients were also found. We assume that the disturbed otolith function together with the impaired dynamics of the semicircular canal generate a particular pattern of postural maintenance. The different degree of restoration of postural stability 1 week after the EM treatment in BPPV-PSC patients with different durations of the disease gives us reason to believe that after removing the otoconia from the semicircular canal, some stimulation of other sensory subsystems and adaptation mechanisms occur that lead to a new pattern of postural maintenance.
BibTeX: @article{Stambolieva2006, author = {Stambolieva, Katerina and Angov, Georgi}, title = {Postural stability in patients with different durations of benign paroxysmal positional vertigo.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2006}, volume = {263}, issue = {2}, pages = {118--122}, doi = {https://doi.org/10.1007/s00405-005-0971-9}, keywords = {Follow-Up Studies; Humans; Middle Aged; Posture, physiology; Semicircular Canals, physiopathology; Severity of Illness Index; Vertigo, physiopathology}, pmid = {16267685} }
D'Silva, L.J., Kluding, P.M., Whitney, S.L., Dai, H. and Santos, M.	Postural sway in individuals with type 2 diabetes and concurrent benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2017	The International journal of neuroscience Vol. 127(12), pp. 1065-1073	article	DOI
Abstract: diabetes has been shown to affect the peripheral vestibular end organs and is associated with an increase in the frequency of benign paroxysmal positional vertigo (BPPV). People with diabetes have higher postural sway; however, the impact of symptomatic BPPV on postural sway in individuals with diabetes is unclear. The purpose of this cross-sectional study was to examine postural sway in people with type 2 diabetes who have symptomatic, untreated BPPV (BPPVDM). fifty-two participants (mean age 56.9 ± 5.6 years) were enrolled: controls (n = 14), diabetes (n = 14), BPPV only (n = 13) and BPPVDM (n = 11). An inertial motion sensor was used to detect pelvic acceleration across five standing conditions with eyes open/closed on firm/foam surfaces. Range of acceleration (cm/s ), peak velocity (cm/s) and variability of sway [root mean square (RMS)] in the anterior-posterior (AP) and medial-lateral (ML) directions were used to compare postural sway between groups across conditions. participants with BPPVDM had higher ranges of acceleration in the AP (p = 0.02) and ML (p = 0.02) directions, as well as higher peak velocity (p < 0.001) and RMS values (p = 0.006) in the AP direction compared to the control and diabetes groups. Standing on foam with eyes closed and tandem stance were challenging conditions for people with BPPVDM. clinicians may consider using standing on foam with eyes closed and tandem standing with eyes open to assess postural control in people with BPPVDM to identify postural instability.
BibTeX: @article{DSilva2017a, author = {D'Silva, Linda J and Kluding, Patricia M and Whitney, Susan L and Dai, Hongying and Santos, Marcio}, title = {Postural sway in individuals with type 2 diabetes and concurrent benign paroxysmal positional vertigo.}, journal = {The International journal of neuroscience}, year = {2017}, volume = {127}, issue = {12}, pages = {1065--1073}, doi = {https://doi.org/10.1080/00207454.2017.1317249}, keywords = {Accelerometry; Adult; Benign Paroxysmal Positional Vertigo, etiology, physiopathology; Cross-Sectional Studies; Diabetes Mellitus, Type 2, complications, physiopathology; Female; Humans; Male; Middle Aged; Postural Balance, physiology; Postural sway; accelerometry; benign paroxysmal positional vertigo; symptomatic; type 2 diabetes}, pmid = {28385058} }
Simoceli, L., Bittar, R.S.M. and Greters, M.E.	Posture restrictions do not interfere in the results of canalith repositioning maneuver. [Abstract] [BibTeX]	2005	Brazilian journal of otorhinolaryngology Vol. 71(1), pp. 55-59	article	DOI
Abstract: Benign Paroxysmal Positional Vertigo (BPPV) is a frequent cause of dizziness and despite of the excellent results with its treatment, there is some controversy about management. To assess the efficacy of Epley Maneuver with and without post-maneuver restrictions. Prospective randomized. Fifty patients presenting BPPV of the posterior semicircular canal, treated with Epley Maneuver and divided into two groups: study group--23 patients--with post-maneuver restrictions, and control group--27 patients--without post-maneuver restrictions. No significant difference was found between the studied and the control group. Post-maneuver restrictions do not influence the efficacy of Epley Maneuver for BPPV management.
BibTeX: @article{Simoceli2005, author = {Simoceli, Lucinda and Bittar, Roseli Saraiva Moreira and Greters, Mário Edvin}, title = {Posture restrictions do not interfere in the results of canalith repositioning maneuver.}, journal = {Brazilian journal of otorhinolaryngology}, year = {2005}, volume = {71}, issue = {1}, pages = {55--59}, doi = {S0034-72992005000100010}, keywords = {Adult; Age Distribution; Aged; Chi-Square Distribution; Dizziness, etiology, physiopathology, therapy; Electronystagmography, methods; Female; Functional Laterality; Head Movements, physiology; Humans; Male; Middle Aged; Physical Therapy Modalities, standards; Posture; Prospective Studies; Semicircular Canals, physiopathology; Sex Distribution; Vertigo, complications, physiopathology, therapy}, pmid = {16446892} }
Yoon, J., Lee, J.B., Lee, H.Y., Lee, B.D., Lee, C.K. and Choi, S.J.	Potential Risk Factors Affecting Repeated Canalith Repositioning Procedures in Benign Paroxysmal Positional Vertigo. [Abstract] [BibTeX]	2018	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 39(2), pp. 206-211	article	DOI
Abstract: To define the risk factors and adverse effects associated with repeated canalith repositioning procedures (CRPs). A case series featuring chart review. An academic university hospital. We retrospectively reviewed 1900 patients (average age, 54.9 years; range, 11-88 years) diagnosed with benign paroxysmal positional vertigo (BPPV). All underwent repeated CRPs. We recorded clinical features including age, gender, BPPV cause (idiopathic or secondary), symptom duration, the canal involved, the number of sessions of CRP, recurrence, follow-up duration, and complications. We compared these factors using Pearson's chi-squared test and multiple linear regression analysis with dummy variables. BPPV was diagnosed based on the results of the head roll and Dix-Hallpike tests. The overall BPPV resolution rate for patients treated with repeated CRPs was 96.4%. The risk factors for the need for multiple CRPs in BPPV were the duration of vertigo before treatment (β = 0.326, p < 0.001), the type of canal involved (β = 0.130, p < 0.001), and age (β = 0.040, p = 0.040). The explanatory power of the regression model attained 46.0% (F = 172.510, p < 0.001). The failure rate of repeated CRPs was 3.6% and complications included canal conversion (3.1%), nausea (46.4%), vomiting (4.9%), head heaviness (50.8%), imbalance (31.9%), and hypotension or palpitations (8.6%). However, almost all patients recovered. The risk factors associated with the need for Multiple CRPs were as follows: longer duration of vertigo before treatment, bilateral or multiple canal involved, and age >50 years.
BibTeX: @article{Yoon2018, author = {Yoon, Junghee and Lee, Jong Bin and Lee, Ho Yun and Lee, Byung Don and Lee, Chi Kyou and Choi, Seong Jun}, title = {Potential Risk Factors Affecting Repeated Canalith Repositioning Procedures in Benign Paroxysmal Positional Vertigo.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2018}, volume = {39}, issue = {2}, pages = {206--211}, doi = {https://doi.org/10.1097/MAO.0000000000001634}, pmid = {29227441} }
Welgampola, M.S., Bradshaw, A. and Halmagyi, G.M.	Practical neurology--4: Dizziness on head movement. [Abstract] [BibTeX]	2011	The Medical journal of Australia Vol. 195(9), pp. 518-522	article
Abstract: Benign positional vertigo (BPV) is the most common cause of episodic vertigo. It results from activation of semicircular canal receptors by the movement of calcium carbonate particles (otoconia) which dislodge from the otolith membranes. During changes in head position, the otoconia either float freely within the semicircular canal duct (canalithiasis) or adhere to and move with the cupula of the canal (cupulolithiasis). BPV from canalithiasis evokes brief spells of vertigo lasting seconds and can be diagnosed at the bedside by provoking paroxysmal vertigo and nystagmus on tilting the head in the plane of the affected canal. The nystagmus has a unique rotational axis perpendicular to the affected canal. The Dix-Hallpike test is a simple means of confirming the diagnosis in patients presenting with episodic vertigo or imbalance. Audiovestibular tests are only indicated if a symptomatic primary underlying inner ear disease is suspected. In over 80% of patients, BPV can be treated successfully with a single bedside Epley (particle-repositioning) manoeuvre, which can be performed by any medical practitioner.
BibTeX: @article{Welgampola2011, author = {Welgampola, Miriam S and Bradshaw, Andrew and Halmagyi, G Michael}, title = {Practical neurology--4: Dizziness on head movement.}, journal = {The Medical journal of Australia}, year = {2011}, volume = {195}, issue = {9}, pages = {518--522}, keywords = {Eye Movement Measurements; Female; Humans; Lithiasis, complications, diagnosis, therapy; Middle Aged; Nystagmus, Pathologic, diagnosis; Posture; Vertigo, diagnosis, etiology, therapy; Vestibular Function Tests}, pmid = {22060084} }
Fife, T.D., Colebatch, J.G., Kerber, K.A., Brantberg, K., Strupp, M., Lee, H., Walker, M.F., Ashman, E., Fletcher, J., Callaghan, B. and Gloss, D.S.	Practice guideline: Cervical and ocular vestibular evoked myogenic potential testing: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. [Abstract] [BibTeX]	2017	Neurology Vol. 89(22), pp. 2288-2296	article	DOI
Abstract: To systematically review the evidence and make recommendations with regard to diagnostic utility of cervical and ocular vestibular evoked myogenic potentials (cVEMP and oVEMP, respectively). Four questions were asked: Does cVEMP accurately identify superior canal dehiscence syndrome (SCDS)? Does oVEMP accurately identify SCDS? For suspected vestibular symptoms, does cVEMP/oVEMP accurately identify vestibular dysfunction related to the saccule/utricle? For vestibular symptoms, does cVEMP/oVEMP accurately and substantively aid diagnosis of any specific vestibular disorder besides SCDS? The guideline panel identified and classified relevant published studies (January 1980-December 2016) according to the 2004 American Academy of Neurology process. Level C positive: Clinicians may use cVEMP stimulus threshold values to distinguish SCDS from controls (2 Class III studies) (sensitivity 86%-91%, specificity 90%-96%). Corrected cVEMP amplitude may be used to distinguish SCDS from controls (2 Class III studies) (sensitivity 100%, specificity 93%). Clinicians may use oVEMP amplitude to distinguish SCDS from normal controls (3 Class III studies) (sensitivity 77%-100%, specificity 98%-100%). oVEMP threshold may be used to aid in distinguishing SCDS from controls (3 Class III studies) (sensitivity 70%-100%, specificity 77%-100%). Level U: Evidence is insufficient to determine whether cVEMP and oVEMP can accurately identify vestibular function specifically related to the saccule/utricle, or whether cVEMP or oVEMP is useful in diagnosing vestibular neuritis or Ménière disease. Level C negative: It has not been demonstrated that cVEMP substantively aids in diagnosing benign paroxysmal positional vertigo, or that cVEMP or oVEMP aids in diagnosing/managing vestibular migraine.
BibTeX: @article{Fife2017, author = {Fife, Terry D and Colebatch, James G and Kerber, Kevin A and Brantberg, Krister and Strupp, Michael and Lee, Hyung and Walker, Mark F and Ashman, Eric and Fletcher, Jeffrey and Callaghan, Brian and Gloss, David S}, title = {Practice guideline: Cervical and ocular vestibular evoked myogenic potential testing: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology.}, journal = {Neurology}, year = {2017}, volume = {89}, issue = {22}, pages = {2288--2296}, doi = {https://doi.org/10.1212/WNL.0000000000004690}, keywords = {Acoustic Stimulation; Humans; Neurology, methods, standards; Practice Guidelines as Topic, standards; Societies, Medical, standards; United States; Vestibular Diseases, diagnosis; Vestibular Evoked Myogenic Potentials, physiology}, pmid = {29093067} }
Pérez-Vázquez, P., Franco-Gutiérrez, V., Soto-Varela, A., Amor-Dorado, J.C., Martín-Sanz, E., Oliva-Domínguez, M. and Lopez-Escamez, J.A.	Practice Guidelines for the Diagnosis and Management of Benign Paroxysmal Positional Vertigo Otoneurology Committee of Spanish Otorhinolaryngology and Head and Neck Surgery Consensus Document. [Abstract] [BibTeX]	2018	Acta otorrinolaringologica espanola Vol. 69(6), pp. 345-366	article	DOI
Abstract: Benign Paroxysmal Positional Vertigo is the most frequent episodic vestibular disorder. The purpose of this guide, requested by the committee on otoneurology of the Spanish Society of Otolaryngology and Head and Neck Surgery, is to supply a consensus document providing practical guidance for the management of BPPV. It is based on the Barany Society criteria for the diagnosis of BPPV. This guideline provides recommendations on each variant of BPPV, with a description of the different diagnostic tests and the therapeutic manoeuvres. For this purpose, we have selected the tests and manoeuvres supported by evidence-based studies or extensive series. Finally, we have also included a chapter on differential diagnosis and a section relating to general aspects in the management of BPPV.
BibTeX: @article{Perez-Vazquez2018, author = {Pérez-Vázquez, Paz and Franco-Gutiérrez, Virginia and Soto-Varela, Andrés and Amor-Dorado, Juan Carlos and Martín-Sanz, Eduardo and Oliva-Domínguez, Manuel and Lopez-Escamez, Jose A}, title = {Practice Guidelines for the Diagnosis and Management of Benign Paroxysmal Positional Vertigo Otoneurology Committee of Spanish Otorhinolaryngology and Head and Neck Surgery Consensus Document.}, journal = {Acta otorrinolaringologica espanola}, year = {2018}, volume = {69}, issue = {6}, pages = {345--366}, doi = {https://doi.org/10.1016/j.otorri.2017.05.001}, keywords = {Benign paroxysmal positional vertigo; Criteria; Criterios; Diagnosis; Diagnóstico; Tratamiento; Treatment; Vértigo posicional paroxístico benigno}, pmid = {28826856} }
Fife, T.D., Iverson, D.J., Lempert, T., Furman, J.M., Baloh, R.W., Tusa, R.J., Hain, T.C., Herdman, S., Morrow, M.J., Gronseth, G.S. and Quality Standards Subcommittee, A.A.o.N.	Practice parameter: therapies for benign paroxysmal positional vertigo (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. [BibTeX]	2008	Neurology Vol. 70(22), pp. 2067-2074	article	DOI
BibTeX: @article{Fife2008, author = {Fife, T D and Iverson, D J and Lempert, T and Furman, J M and Baloh, R W and Tusa, R J and Hain, T C and Herdman, S and Morrow, M J and Gronseth, G S and Quality Standards Subcommittee, American Academy of Neurology}, title = {Practice parameter: therapies for benign paroxysmal positional vertigo (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology.}, journal = {Neurology}, year = {2008}, volume = {70}, issue = {22}, pages = {2067--2074}, doi = {https://doi.org/10.1212/01.wnl.0000313378.77444.ac}, keywords = {Academies and Institutes, standards; Evaluation Studies as Topic; Humans; Neurology, methods, standards; Posture, physiology; Randomized Controlled Trials as Topic, standards; United States; Vertigo, diagnosis, physiopathology, therapy}, pmid = {18505980} }
Oh, H.J., Kim, J.S., Han, B.I. and Lim, J.G.	Predicting a successful treatment in posterior canal benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2007	Neurology Vol. 68(15), pp. 1219-1222	article	DOI
Abstract: To elucidate the characteristics and prognostic value of positioning nystagmus during the second position of the Epley maneuver (90 degrees contralateral head turn from the initial Hallpike maneuver). The Epley maneuver was performed in 126 patients with confirmed posterior canal benign paroxysmal positional vertigo (PC-BPPV). The characteristics of positioning nystagmus were investigated using video Frenzel goggles. During the second position, 99 patients developed torsional upbeating nystagmus, which was in the same direction (orthotropic nystagmus) as during the first position (Hallpike maneuver), whereas 15 patients showed a reversed pattern. In 12 patents, nystagmus was not induced during the second position. All 99 patients with orthotropic nystagmus had resolution of BPPV after the first or second trial of the Epley maneuver. In contrast, 12 of the 15 patients with reversed nystagmus and 8 of the 12 patients without nystagmus failed to resolve. During the second position of the Epley maneuver, an orthotropic pattern of nystagmus predicts a successful repositioning, whereas reversed nystagmus or no nystagmus is suggestive of poor response to repositioning.
BibTeX: @article{Oh2007, author = {Oh, Hui Jong and Kim, Ji Soo and Han, Byung In and Lim, Jeong Geun}, title = {Predicting a successful treatment in posterior canal benign paroxysmal positional vertigo.}, journal = {Neurology}, year = {2007}, volume = {68}, issue = {15}, pages = {1219--1222}, doi = {https://doi.org/10.1212/01.wnl.0000259037.76469.e4}, keywords = {Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, diagnosis, etiology, therapy; Outcome Assessment (Health Care), methods; Physical Therapy Modalities; Posture; Prognosis; Reproducibility of Results; Sensitivity and Specificity; Vertigo, complications, diagnosis, therapy; Vestibular Function Tests, methods}, pmid = {17420406} }
Heinrichs, N., Edler, C., Eskens, S., Mielczarek, M.M. and Moschner, C.	Predicting continued dizziness after an acute peripheral vestibular disorder. [Abstract] [BibTeX]	2007	Psychosomatic medicine Vol. 69(7), pp. 700-707	article	DOI
Abstract: To identify individuals at risk of developing ongoing dizziness 3 months after an acute peripheral vestibular disorder episode, which is usually functionally compensated or even healed within a few weeks. In a prospective longitudinal study, we assessed fear of bodily sensations and cognitions related to anxiety at the time of hospital admission and 3 months later in 43 patients with an episode of vestibular neuritis (VN) or benign paroxysmal positional vertigo (BPPV). All participants were assessed for mental disorders using a structured clinical interview. Only the interaction between fear of bodily sensations within the first 2 weeks after admission and the type of vestibular disorder predicted the extent of dizzy complaints 3 months later; this accounts for 21% of the variance in a multiple regression analysis. Specifically, the prediction was valid only in patients with VN but not in patients with BPPV. Further analysis demonstrated that the interaction was not due to the peripheral vestibular disorder per se but rather determined by the initial severity of dizziness, which was significantly different in BPPV and VN patients. The present study demonstrates that, for the development of persistent psychogenic dizziness after a peripheral vestibular disorder, the fear of bodily sensations is only relevant in interaction with the initial severity of dizziness experienced during the acute organic episode. To prevent development of persistent psychogenic dizziness, we feel that our results indicate the need to screen patients with vestibular disorders for at-risk status and offer them psychological support to deal with their symptoms.
BibTeX: @article{Heinrichs2007, author = {Heinrichs, Nina and Edler, Christiane and Eskens, Sonja and Mielczarek, Mark M and Moschner, Carsten}, title = {Predicting continued dizziness after an acute peripheral vestibular disorder.}, journal = {Psychosomatic medicine}, year = {2007}, volume = {69}, issue = {7}, pages = {700--707}, doi = {https://doi.org/10.1097/PSY.0b013e318151a4dd}, keywords = {Adult; Aged; Cohort Studies; Dizziness, etiology, pathology, psychology; Fear; Female; Humans; Male; Mental Disorders; Middle Aged; Perception; Prognosis; Prospective Studies; Psychiatric Status Rating Scales; Severity of Illness Index; Vestibular Neuronitis, complications}, pmid = {17766688} }
Feil, K., Feuerecker, R., Goldschagg, N., Strobl, R., Brandt, T., von Müller, A., Grill, E. and Strupp, M.	Predictive Capability of an iPad-Based Medical Device (me, javax.xml.bind.JAXBElement@1daed986, x) for the Diagnosis of Vertigo and Dizziness. [Abstract] [BibTeX]	2018	Frontiers in neurology Vol. 9, pp. 29	article	DOI
Abstract: Making the correct diagnosis of patients presenting with vertigo and dizziness in clinical practice is often challenging. In this study we examined the performance of the iPad based program me x in the prediction of different clinical vertigo and dizziness diagnoses and as a diagnostic tool to distinguish between them. The data collection was done in the outpatient clinic of the German Center of Vertigo and Balance Disorders. The "gold standard diagnosis" was defined as the clinical diagnosis of the specialist during the visit of the patient based on standardized history and clinical examination. Another independent and blinded physician finalized each patient's case in the constellatory diagnostic system of me x based on an algorithm using all available clinical information. These diagnoses were compared to the "gold standard" by retrospective review of the charts of the patients. The accuracy provided by me x was defined as the number of correctly classified diagnoses. In addition, the probability of being test positive when a disease was present (sensitivity), of being test negative when a disease was absent (specificity), of having the disease when the test is positive (positive predictive value) and of not having the disease when the test is negative (negative predictive value) for the most common diagnoses were reported. Sixteen possible different vertigo and dizziness diagnoses could be provided by me x. A total of 610 patients (mean age 58.1 ± 16.3 years, 51.2% female) were included. The accuracy for the most common diagnoses was between 82.1 and 96.6% with a sensitivity of 40 to 80.5% and a specificity of more than 80%. When analyzing the quality of me x in a multiclass problem for the six most common clinical diagnoses, the sensitivity, specificity, positive and negative predictive values were as follows: Bilateral vestibulopathy (81.6, 97.1, 71.1, and 97.5%), Menière's disease (77.8, 97.6, 87.0, and 95.3%), benign paroxysmal positional vertigo (61.7, 98.3, 86.6, and 93.4%), downbeat nystagmus syndrome (69.6, 97.7, 71.1, and 97.5%), vestibular migraine (34.7, 97.8, 76.1, and 88.3%), and phobic postural vertigo (80.5, 82.5, 52.5, and 94.6%). This study demonstrates that me x is a new and easy approach to screen for different diagnoses. With the high specificity and negative predictive value, the system helps to rule out differential diagnoses and can therefore also lead to a cost reduction in the health care system. However, the sensitivity was unexpectedly low, especially for vestibular migraine. All in all, this device can only be a complementary tool, in particular for non-experts in the field.
BibTeX: @article{Feil2018, author = {Feil, Katharina and Feuerecker, Regina and Goldschagg, Nicolina and Strobl, Ralf and Brandt, Thomas and von Müller, Albrecht and Grill, Eva and Strupp, Michael}, title = {Predictive Capability of an iPad-Based Medical Device (me, javax.xml.bind.JAXBElement@1daed986, x) for the Diagnosis of Vertigo and Dizziness.}, journal = {Frontiers in neurology}, year = {2018}, volume = {9}, pages = {29}, doi = {https://doi.org/10.3389/fneur.2018.00029}, keywords = {diagnosis; dizziness; iPad; medical devices; vertigo; vestibular}, pmid = {29535671} }
Zhao, J.G., Piccirillo, J.F., Spitznagel, E.L., Kallogjeri, D. and Goebel, J.A.	Predictive capability of historical data for diagnosis of dizziness. [Abstract] [BibTeX]	2011	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 32(2), pp. 284-290	article	DOI
Abstract: The study examines categorical responses to questions on a comprehensive dizziness questionnaire, to find the overall predictive power of the questionnaire, and to identify which question(s) are most predictive of each diagnosis. Retrospective chart review. Specialized dizziness and balance center at a tertiary care hospital. A total of 619 patients (aged 19-89 yr, of whom 60% are women and 40% are men) diagnosed with 1 of 23 types of dizziness or postural instability. All patients were administered a standard 163-item dizziness questionnaire (including 77 review of systems items). Predicted diagnoses from the questionnaire, as determined by binary and multinomial logistic regressions, are compared with an ultimate clinical diagnosis made by an expert neurotologist based on full interview, examination, and clinical tests. Significant question groupings exist for each of the main diagnoses. A subset of 47 questions under multinomial logistic regression gave high predictive accuracies for migraine (92%), benign paroxysmal positional vertigo (90%) and Ménière's disease (86%), and fair predictive power for vestibular neuritis (63%), contributing to an overall predictive accuracy of 84%. A smaller subset of 32 questions gave an overall predictive accuracy of 71%. The capability of historical data to accurately predict the ultimate diagnosis for dizziness emphasizes the importance of a structured questionnaire in the evaluation of such patients. Future developments include the formulation of a computer-based program to generate a differential diagnosis for the practitioner to consider.
BibTeX: @article{Zhao2011, author = {Zhao, Jeff G and Piccirillo, Jay F and Spitznagel, Edward L and Kallogjeri, Dorina and Goebel, Joel A}, title = {Predictive capability of historical data for diagnosis of dizziness.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2011}, volume = {32}, issue = {2}, pages = {284--290}, doi = {https://doi.org/10.1097/MAO.0b013e318204aad3}, keywords = {Adult; Aged; Aged, 80 and over; Analysis of Variance; Diagnosis, Differential; Dizziness, diagnosis; Female; Humans; Logistic Models; Male; Meniere Disease, diagnosis, physiopathology; Middle Aged; Nausea, etiology; Predictive Value of Tests; Prognosis; Retrospective Studies; Surveys and Questionnaires; Vertigo, physiopathology; Vestibular Diseases, diagnosis, physiopathology; Vestibular Neuronitis, diagnosis, physiopathology; Young Adult}, pmid = {21178804} }
Noda, K., Ikusaka, M., Ohira, Y., Takada, T. and Tsukamoto, T.	Predictors for benign paroxysmal positional vertigo with positive Dix-Hallpike test. [Abstract] [BibTeX]	2011	International journal of general medicine Vol. 4, pp. 809-814	article	DOI
Abstract: Patient medical history is important for making a diagnosis of causes of dizziness, but there have been no studies on the diagnostic value of individual items in the history. This study was performed to identify and validate useful questions for suspecting a diagnosis of benign paroxysmal positional vertigo (BPPV). Construction and validation of a disease prediction model was performed at the outpatient clinic in the Department of General Medicine of Chiba University Hospital. Patients with dizziness were enrolled (145 patients for construction of the disease prediction model and 61 patients for its validation). This study targeted BPPV of the posterior semicircular canals only with a positive Dix-Hallpike test (DHT + BPPV) to avoid diagnostic ambiguity. Binomial logistic regression analysis was performed to identify the items that were useful for diagnosis or exclusion of DHT + BPPV. Twelve patients from the derivation set and six patients from the validation set had DHT + BPPV. Binomial logistic regression analysis selected a "duration of dizziness ≤15 seconds" and "onset when turning over in bed" as independent predictors of DHT + BPPV with an odds ratio (95% confidence interval) of 4.36 (1.18-16.19) and 10.17 (2.49-41.63), respectively. Affirmative answers to both questions yielded a likelihood ratio of 6.81 (5.11-9.10) for diagnosis of DHT + BPPV, while negative answers to both had a likelihood ratio of 0.19 (0.08-0.47). A "duration of dizziness ≤15 seconds" and "onset when turning over in bed" were the two most important questions among various historical features of BPPV.
BibTeX: @article{Noda2011, author = {Noda, Kazutaka and Ikusaka, Masatomi and Ohira, Yoshiyuki and Takada, Toshihiko and Tsukamoto, Tomoko}, title = {Predictors for benign paroxysmal positional vertigo with positive Dix-Hallpike test.}, journal = {International journal of general medicine}, year = {2011}, volume = {4}, pages = {809--814}, doi = {https://doi.org/10.2147/IJGM.S27536}, keywords = {benign paroxysmal positional vertigo; diagnosis; likelihood ratio; prediction rules; screening}, pmid = {22162937} }
Sacks, D. and Parham, K.	Preliminary Report on the Investigation of the Association Between BPPV and Osteoporosis Using Biomarkers. [Abstract] [BibTeX]	2015	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 36(9), pp. 1532-1536	article	DOI
Abstract: To test the hypothesis that levels of a BPPV biomarker, otolin-1, correlate with those of osteoporosis markers, aminoterminal propeptide of protocollagen type I (P1NP), and aminoterminal telopeptides of collagen (NTX), thus further supporting a link between the two diseases. Prospective pilot clinical trial (Level of Evidence: 2b). Postmenopausal women with BPPV. Diagnostic. Serum levels of otolin-1, P1NP, NTX, vitamin D, and calcium were examined in relation to each other, age, and DEXA scan T-scores. There was a strong, negative correlation between T-scores and otolin-1 levels. Although P1NP and NTX levels were strongly correlated, neither had statistical correlations with otolin-1. Despite a strong correlation between DEXA scan results and otolin-1 levels, there were no significant correlations between otolin-1 and P1NP or NTX. This suggests that the association between osteoporosis and BPPV is complex, but not likely to be causal. Although more work is needed to elucidate these relationships, this preliminary finding has important practical implications for BPPV in that proactive management of osteoporosis, per se, would not be expected to have benefits in management of BPPV.
BibTeX: @article{Sacks2015, author = {Sacks, Daniel and Parham, Kourosh}, title = {Preliminary Report on the Investigation of the Association Between BPPV and Osteoporosis Using Biomarkers.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2015}, volume = {36}, issue = {9}, pages = {1532--1536}, doi = {https://doi.org/10.1097/MAO.0000000000000853}, keywords = {Absorptiometry, Photon; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, blood; Biomarkers, blood; Bone Density; Bone Diseases, Metabolic, blood, diagnostic imaging; Calcium, blood; Collagen Type I, blood; Extracellular Matrix Proteins, blood; Female; Humans; Middle Aged; Osteoporosis, Postmenopausal, blood, diagnostic imaging; Peptide Fragments, blood; Peptides, blood; Pilot Projects; Procollagen, blood; Prospective Studies; Vitamin D, analogs & derivatives, blood}, pmid = {26375977} }
Magarey, M.E., Rebbeck, T., Coughlan, B., Grimmer, K., Rivett, D.A. and Refshauge, K.	Pre-manipulative testing of the cervical spine review, revision and new clinical guidelines. [Abstract] [BibTeX]	2004	Manual therapy Vol. 9(2), pp. 95-108	article	DOI
Abstract: Members of the Manipulative Physiotherapists Association of Australia (now Musculoskeletal Physiotherapy Australia) were surveyed to determine their use of cervical manipulation, compliance with and attitudes to the Australian Physiotherapy Association's (APA) Protocol for Pre-manipulative Testing of the Cervical Spine, and the incidence of adverse effects from cervical manipulation. The questionnaire was mailed to 740 members and returned by 480 members (65%). Cervical manipulation (84.5%) and passive mobilization (99.8%) were used by a high percentage of respondents. Most were familiar with the protocol with 63% supporting its continued endorsement. Adverse effects were reported at a rate of one per 1000 years of practice (or 0.003/week). The most common effects were symptoms potentially related to VBI (94.4% responses), with no reported major complications. Only 37.1% of respondents always informed the patient about potential dangers of cervical manipulation and consent was sought on every occasion by 33% of respondents. The results suggest that the use and interpretation of the protocol are variable among members of MPA. The risk of adverse effects from manipulative (musculoskeletal) physiotherapy practice, including cervical manipulation, appears to be very low. Recommendations for revision of the protocol were made on the basis of results of the survey and treatment diary, in addition to a review of the literature related to testing for vertebro-basilar insufficiency, adverse incidents related to cervical mobilizing and manipulative technique, differentiating features of VBI related dizziness and vertigo related to benign paroxysmal positional vertigo (BPPV) and current issues surrounding informed consent. Finally, a summary of the content of the new Clinical Guidelines for Pre-Manipulative Testing of the Cervical Spine (APA, 2000) is provided.
BibTeX: @article{Magarey2004, author = {Magarey, Mary E and Rebbeck, Trudy and Coughlan, Brian and Grimmer, Karen and Rivett, Darren A and Refshauge, Kathryn}, title = {Pre-manipulative testing of the cervical spine review, revision and new clinical guidelines.}, journal = {Manual therapy}, year = {2004}, volume = {9}, issue = {2}, pages = {95--108}, doi = {https://doi.org/10.1016/j.math.2003.12.002}, keywords = {Adult; Attitude of Health Personnel; Australia; Cervical Vertebrae; Female; Humans; Male; Manipulation, Spinal, adverse effects, methods, standards; Physician-Patient Relations; Practice Guidelines as Topic; Practice Patterns, Physicians'; Quality Assurance, Health Care; Risk Assessment; Surveys and Questionnaires}, pmid = {15040969} }
Wei, W., Sayyid, Z.N., Ma, X., Wang, T. and Dong, Y.	Presence of Anxiety and Depression Symptoms Affects the First Time Treatment Efficacy and Recurrence of Benign Paroxysmal Positional Vertigo. [Abstract] [BibTeX]	2018	Frontiers in neurology Vol. 9, pp. 178	article	DOI
Abstract: To investigate the possible effects of anxiety and/or depression symptoms on the treatment outcomes and recurrence of benign paroxysmal positional vertigo (BPPV). This is a retrospective study conducted at a single institution. 142 consecutive patients diagnosed with idiopathic BPPV at the Department of Otology in Shengjing Hospital of China Medical University between October 2016 and July 2017 were retrospectively reviewed. 127 patients were finally included in this study. Zung self-rating anxiety scale (SAS) and Zung self-rating depression scale (SDS) were used to evaluate the presence of anxiety and/or depression, respectively, in our BPPV patients. A significant score (at or above 50 for SAS and 53 for SDS) represents the presence of clinically significant symptoms. Two-tailed Student's -test, χ test, and logistic regression analysis were used as appropriate. A value less than 0.05 was considered statistically significant. The prevalence of anxiety and/or depression symptoms in BPPV patients in the present study was 49.61%. The effectiveness of the first time canalith repositioning maneuver (CRM) was 70.08%. With weekly follow-up treatments of CRM, the success rate increased to 97.64% by 1 month. The total recurrence rate at 6-month follow-up post-cure was 14.17%. Holding all other variables constant, patients with psychiatric symptoms (Relative-risk ratio: 3.160; = 0.027) and patients with non-posterior semicircular canal (PSC) involvement (Relative-risk ratio: 7.828, = 0.013) were more likely to experience residual dizziness (RD) even after effective CRM treatment. Psychiatric symptoms (Relative-risk ratio: 6.543; = 0.001) and female gender (Relative-risk ratio: 4.563; = 0.010) are risk factors for the failure of first time CRM. In addition, BPPV patients with psychiatric symptoms (Odds ratio: 9.184, = 0.008) were significantly more likely to experience recurrences within the first 6 months after a successful maneuver. Anxiety-depression status significantly reduced the efficacy of the first time CRM and increased the risk for recurrence. Other factors, such as female gender and non-PSC involvement are also susceptible risk factors for BPPV patients to require multiple treatments and experience delayed recovery. A screening for psychiatric symptoms in BPPV patients and active treatment of these symptoms would benefit both physicians and patients in understanding and improving the prognosis of the disease and treatment options.
BibTeX: @article{Wei2018, author = {Wei, Wei and Sayyid, Zahra N and Ma, Xiulan and Wang, Tian and Dong, Yaodong}, title = {Presence of Anxiety and Depression Symptoms Affects the First Time Treatment Efficacy and Recurrence of Benign Paroxysmal Positional Vertigo.}, journal = {Frontiers in neurology}, year = {2018}, volume = {9}, pages = {178}, doi = {https://doi.org/10.3389/fneur.2018.00178}, keywords = {anxiety; benign paroxysmal positional vertigo; canalith repositioning maneuver; depression; psychiatric symptoms; recurrence; treatment efficacy}, pmid = {29619005} }
Liu, H.	Presentation and outcome of post-traumatic benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2012	Acta oto-laryngologica Vol. 132(8), pp. 803-806	article	DOI
Abstract: The clinical presentation and outcome of post-traumatic benign paroxysmal positional vertigo (t-BPPV) are different from those idiopathic BPPV (i-BPPV). It appears that t-BPPV is more difficult to treat than i-BPPV. To identify the clinical presentation and outcome of t-BPPV. We reviewed the medical records of 40 patients with BPPV after head injury during the period 2004-2011. The outcome was compared with the outcome of 46 patients with i-BPPV who were treated over the same period. In all, 55% of patients with t-BPPV had involvement of two or more semicircular canals (SCCs) in comparison with 6.5% of patients with i-BPPV (p < 0.01). Also, 25% of patients with t-BPPV had involvement of bilateral SCCs in comparison with 2% of patients with i-BPPV (p < 0.01). We found that 35% of patients with t-BPPV were free of the symptoms and signs after a single physical repositioning maneuver, in comparison with 84% of patients with i-BPPV (p < 0.001). During a 1-year follow-up, 67% of patients with t-BPPV and 12% of patients with i-BPPV had a recurrent attack (p < 0.001).
BibTeX: @article{Liu2012a, author = {Liu, Hongjian}, title = {Presentation and outcome of post-traumatic benign paroxysmal positional vertigo.}, journal = {Acta oto-laryngologica}, year = {2012}, volume = {132}, issue = {8}, pages = {803--806}, doi = {https://doi.org/10.3109/00016489.2012.657359}, keywords = {Adolescent; Adult; Aged; Benign Paroxysmal Positional Vertigo; Craniocerebral Trauma, complications, physiopathology; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nystagmus, Physiologic; Patient Positioning; Posture, physiology; Retrospective Studies; Semicircular Canals, physiopathology; Vertigo, etiology, physiopathology; Young Adult}, pmid = {22404210} }
Lüscher, M., Theilgaard, S. and Edholm, B.	Prevalence and characteristics of diagnostic groups amongst 1034 patients seen in ENT practices for dizziness. [Abstract] [BibTeX]	2014	The Journal of laryngology and otology Vol. 128(2), pp. 128-133	article	DOI
Abstract: To determine the prevalence and characteristics of various diagnostic groups amongst patients referred to ENT practices with the primary complaint of dizziness. A prospective, observational, multicentre study. Consecutive patients presenting with dizziness to the participating ENT practices were enrolled. Seven ENT specialists at three clinics participated. Benign paroxysmal positional vertigo was diagnosed in 53.3 per cent of the 1034 study patients. Fifty-nine per cent of these experienced night-time awakening with dizziness, which was a significant proportion in comparison to the other diagnostic groups. Benign paroxysmal positional vertigo was the most frequent diagnosis in all age groups, including those over 70 years. In this study of patients referred to ENT for dizziness, benign paroxysmal positional vertigo was the dominant diagnostic entity, in all age groups and overall. All clinicians in contact with dizzy patients must consider benign paroxysmal positional vertigo, especially in the elderly.
BibTeX: @article{Luescher2014, author = {Lüscher, M and Theilgaard, S and Edholm, B}, title = {Prevalence and characteristics of diagnostic groups amongst 1034 patients seen in ENT practices for dizziness.}, journal = {The Journal of laryngology and otology}, year = {2014}, volume = {128}, issue = {2}, pages = {128--133}, doi = {https://doi.org/10.1017/S0022215114000188}, keywords = {Adolescent; Adult; Age Factors; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, complications, diagnosis, epidemiology; Child; Dizziness, diagnosis, epidemiology, etiology; Female; Humans; Male; Middle Aged; Otolaryngology, statistics & numerical data; Prevalence; Prospective Studies; Vertigo, complications, diagnosis, epidemiology; Young Adult}, pmid = {24521903} }
Martens, C., Goplen, F.K., Nordfalk, K.F., Aasen, T. and Nordahl, S.H.G.	Prevalence and Characteristics of Positional Nystagmus in Normal Subjects. [Abstract] [BibTeX]	2016	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 154(5), pp. 861-867	article	DOI
Abstract: In clinical practice, patients are often referred due to a finding of positional nystagmus that does not always appear to correlate with clinical symptoms of benign paroxysmal positional vertigo. To know when to consider nystagmus to be of clinical relevance, it is necessary to know the prevalence and characteristics of positional nystagmus in a healthy population. Case series of 75 healthy subjects. Two tertiary referral centers in Norway. Seventy-five adult subjects aged 40 ± 13 years (mean ± SD; range, 21-87) without a history of vertigo or balance disorder were included from 2013 to 2015. The subjects underwent 6 different standardized positional tests in a repositioning chair. Videonystagmography was used to record eye movements. Of 1350 recordings, 1329 were included and analyzed. Positional nystagmus was detected in 88% of the subjects. The most common finding was nystagmus in the Dix-Hallpike position, which occurred in 55% of the subjects. The 95th percentile of the maximum slow-phase velocity for each subject was found to be 5.06° per second (n = 54) in the horizontal plane and 6.48° per second (n = 48) in the vertical plane. Positional nystagmus is a common finding in normal subjects and occurred in 88% of the healthy subjects in the present study. Horizontal direction-changing apogeotropic or geotropic nystagmus may occur in asymptomatic subjects. However, nystagmus that is of the paroxysmal type or has a slow-phase velocity greater than approximately 5° per second in the horizontal plane or 6.5° per second in the vertical plane should be considered outside the 95th percentile.
BibTeX: @article{Martens2016, author = {Martens, Camilla and Goplen, Frederik Kragerud and Nordfalk, Karl Fredrik and Aasen, Torbjørn and Nordahl, Stein Helge Glad}, title = {Prevalence and Characteristics of Positional Nystagmus in Normal Subjects.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2016}, volume = {154}, issue = {5}, pages = {861--867}, doi = {https://doi.org/10.1177/0194599816629640}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, diagnosis, epidemiology; Female; Humans; Male; Middle Aged; Norway, epidemiology; Nystagmus, Physiologic, physiology; Prevalence; Vestibular Function Tests; normal population; positional nystagmus; rotational chair; videonystagmography}, pmid = {26908561} }
Gioacchini, F.M., Alicandri-Ciufelli, M., Kaleci, S., Magliulo, G. and Re, M.	Prevalence and diagnosis of vestibular disorders in children: a review. [Abstract] [BibTeX]	2014	International journal of pediatric otorhinolaryngology Vol. 78(5), pp. 718-724	article	DOI
Abstract: To systematically review and discuss the main pathologies associated with vertigo and dizziness in children, paying particular attention to recent advances in diagnosis and therapy. One appropriate string was run on PubMed to retrieve articles dealing with the topics mentioned above. A cross-check was performed on citations and full-text articles found using the selected inclusion and exclusion criteria. A non-comparative meta-analysis concerning the rate of singular vertiginous forms was performed. Ten articles were identified comprising a total of 724 subjects. Overall, the articles we analyzed indicated benign paroxysmal vertigo of childhood (18.7%) and migraine-associated vertigo (17.6%) as the two main entities connected with vertigo and dizziness in children. Head trauma (14%) was the third most common cause of vertigo. The mean (95% CI) rate of every vertiginous form was also calculated in relation to the nine studies analyzed with vestibular migraine (27.82%), benign paroxysmal vertigo (15.68%) and vestibular neuritis (9.81%) being the three most common forms. There appeared to be a paucity of recent literature concerning the development of new diagnostic methods and therapies. On the basis of the literature study, when evaluating a young patient with vertigo and dizziness, the otolaryngologist should be aware that, in children, these symptoms are often connected to different pathologies in comparison to the entities observed in the adult population.
BibTeX: @article{Gioacchini2014, author = {Gioacchini, Federico Maria and Alicandri-Ciufelli, Matteo and Kaleci, Shaniko and Magliulo, Giuseppe and Re, Massimo}, title = {Prevalence and diagnosis of vestibular disorders in children: a review.}, journal = {International journal of pediatric otorhinolaryngology}, year = {2014}, volume = {78}, issue = {5}, pages = {718--724}, doi = {https://doi.org/10.1016/j.ijporl.2014.02.009}, keywords = {Age Distribution; Benign Paroxysmal Positional Vertigo, diagnosis, epidemiology, etiology; Child; Child, Preschool; Craniocerebral Trauma, complications, diagnosis; Dizziness, diagnosis, epidemiology; Humans; Italy, epidemiology; Male; Migraine Disorders, complications, diagnosis; Prevalence; Prognosis; Risk Assessment; Severity of Illness Index; Sex Distribution; Vertigo, diagnosis, epidemiology, etiology; Vestibular Diseases, diagnosis, epidemiology, etiology; Vestibular Function Tests; Vestibular Neuronitis, complications, diagnosis; Children; Dizziness; Head trauma; Migraine; Vertigo; Vestibular neuritis}, pmid = {24612555} }
Vaduva, C., Estéban-Sánchez, J., Sanz-Fernández, R. and Martín-Sanz, E.	Prevalence and management of post-BPPV residual symptoms. [Abstract] [BibTeX]	2018	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 275(6), pp. 1429-1437	article	DOI
Abstract: To evaluate the prevalence and management of residual symptoms in recovered BPPV patients. We performed a retrospective study on BPPV patients of any of the three semicircular canals. Exclusion criteria were multiple-canal BPPV, refractory BPPV, central nervous system pathologies or other vestibular diseases. Patients were treated with repositioning maneuvers until the vertigo disappeared and evaluated for symptoms of instability at 1 month after resolution. A dynamic computerized posturography was then performed on every patient complaining of residual instability. We analyzed demographic data, the affected semicircular canal, number of repositioning maneuvers, presence of anxiety disorders, and we correlated these variables with the presence of residual disequilibrium 1 month after vertigo resolution. We included 361 patients. Residual disequilibrium was found in 107 patients (29.6%) with no significant difference between the rates associated with the three semicircular canals (p = 0.73). The group who needed more than one repositioning maneuver (1 maneuver-229 patients, ≥ 2maneuvers-132 patients) showed a significantly higher prevalence of instability (17.9 vs. 50%; p < 0.0001). 47.2% of the patients with anxiety disorders presented with instability symptoms (p = 0,01). Patients older than 65 showed a significantly higher percentage of residual symptoms (23.3 vs. 34.8%; p = 0.03). Persistence of residual symptoms 1 month after the acute BPPV can be associated with certain risk factors that should be taken into consideration (age, number of repositioning maneuvers needed, anxiety and/or depressive disorders). These patients could benefit of treatment with vestibular rehabilitation.
BibTeX: @article{Vaduva2018, author = {Vaduva, Cristina and Estéban-Sánchez, Jonathan and Sanz-Fernández, Ricardo and Martín-Sanz, Eduardo}, title = {Prevalence and management of post-BPPV residual symptoms.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2018}, volume = {275}, issue = {6}, pages = {1429--1437}, doi = {https://doi.org/10.1007/s00405-018-4980-x}, keywords = {Adult; Aged; Anxiety Disorders, complications; Benign Paroxysmal Positional Vertigo, diagnosis, epidemiology, therapy; Female; Humans; Male; Middle Aged; Patient Positioning; Prevalence; Recurrence; Retrospective Studies; Risk Factors; Semicircular Canals; Balance; Dance; Dynamic posturography; Vertigo}, pmid = {29687182} }
Hancı, D. and Altun, H.	Prevalence of benign paroxysmal positional vertigo among motocross racers: a case-control study. [Abstract] [BibTeX]	2015	Kulak burun bogaz ihtisas dergisi : KBB = Journal of ear, nose, and throat Vol. 25(5), pp. 279-283	article	DOI
Abstract: This study aims to investigate the prevalence of benign paroxysmal positional vertigo (BPPV) among motocross racers after cross-country up and downhill activities. This case-control study included 40 motocross racers (39 males, 1 female; mean age 26 years; range 21 to 43 years) and 40 healthy controls (30 males, 10 females; mean age 28 years; range 22 to 43 years) who had no hearing or balance problems. The Dix-Hallpike maneuver was applied to confirm the diagnosis of BPPV. Patients with BPPV were administered the Epley maneuver every week for one month and followed-up for treatment response assessment. Motocross and control groups were similar in terms of demographic and laboratory parameters. While BPPV was detected in four motocross racers (10%) according to Dix-Hallpike maneuver outcome and clinical findings, there was no BPPV in the control group. Of the motocross racers with BPPV, three had unilateral, one had bilateral disease. Of these patients, Epley maneuver was applied two times in two patients and three times in the other two patients. There was no vertigo or nystagmus in any of the patients with BPPV in one month. Intensive motocross activity is a cause of post-traumatic BPPV developing without head trauma. Large-scale, randomized controlled studies are needed to establish the post-traumatic etiology of BPPV in motocross racers.
BibTeX: @article{Hanci2015a, author = {Hancı, Deniz and Altun, Hüseyin}, title = {Prevalence of benign paroxysmal positional vertigo among motocross racers: a case-control study.}, journal = {Kulak burun bogaz ihtisas dergisi : KBB = Journal of ear, nose, and throat}, year = {2015}, volume = {25}, issue = {5}, pages = {279--283}, doi = {https://doi.org/10.5606/kbbihtisas.2015.90922}, keywords = {Adult; Benign Paroxysmal Positional Vertigo, diagnosis, therapy; Case-Control Studies; Exercise Therapy; Female; Follow-Up Studies; Hearing Tests; Humans; Male; Motorcycles; Nystagmus, Pathologic, diagnosis; Off-Road Motor Vehicles; Physical Examination; Prevalence; Young Adult}, pmid = {26476516} }
Kerrigan, M.A., Costigan, M.F., Blatt, K.J., Mathiason, M.A. and Domroese, M.E.	Prevalence of benign paroxysmal positional vertigo in the young adult population. [Abstract] [BibTeX]	2013	PM & R : the journal of injury, function, and rehabilitation Vol. 5(9), pp. 778-785	article	DOI
Abstract: To evaluate the prevalence of benign paroxysmal positional vertigo (BPPV), defined as positionally induced nystagmus (PIN) with associated symptoms on provocative testing, in the young healthy adult population. A prospective, cohort, screening study. A community-based hospital located in a small midwestern city with a greater metropolitan population of approximately 125,000. One hundred ninety-eight young adults (99 men and 99 women), ages 18-34 years and not being treated for dizziness or balance problems, were recruited from November 2009 to April 2010. The participants completed questionnaires that detailed demographics, medical and surgical history, sports and/or activity participation history, and baseline symptoms commonly associated with BPPV. The participants were screened for inclusion with an ocular motor assessment in room light, followed by a vestibular positional assessment for BPPV with infrared camera-equipped goggles recorded on digital video disk. The prevalence of BPPV, defined as PIN, along with symptoms in study participants. The prevalence of BPPV was 9% in this young adult population. Symptoms during testing were reported in 14% of all subjects (22% of women, 5% of men). Of 22 women who reported symptoms, 12 had PIN (P = .519), whereas the 5 men who reported symptoms all had PIN (P = .001). PIN, characteristic of that seen in BPPV (with or without associated symptoms), was identified in 53% of subjects, with 43% of subjects having posterior canal involvement, 10% having anterior canal involvement, and 8% having horizontal canal involvement. Eleven percent of subjects had bilateral semicircular canal involvement. Nine percent of our young adult subjects were diagnosed with previously unrecognized BPPV, with provoked symptoms of dizziness, headache, nausea, or imbalance, symptoms that may cause significant physical and psychosocial limitations if left untreated. This is an important finding because BPPV is an often-overlooked diagnosis that has a known, very effective treatment.
BibTeX: @article{Kerrigan2013, author = {Kerrigan, Mary A and Costigan, Marguerite F and Blatt, Kathryn J and Mathiason, Michelle A and Domroese, Mark E}, title = {Prevalence of benign paroxysmal positional vertigo in the young adult population.}, journal = {PM & R : the journal of injury, function, and rehabilitation}, year = {2013}, volume = {5}, issue = {9}, pages = {778--785}, doi = {https://doi.org/10.1016/j.pmrj.2013.05.010}, keywords = {Adolescent; Adult; Benign Paroxysmal Positional Vertigo; Eye Movements, physiology; Female; Follow-Up Studies; Humans; Male; Mass Screening, methods; Population Surveillance; Prevalence; Prospective Studies; Surveys and Questionnaires; Vertigo, epidemiology, physiopathology; Wisconsin, epidemiology; Young Adult}, pmid = {23707569} }
van der Zaag-Loonen, H.J., van Leeuwen, R.B., Bruintjes, T.D. and van Munster, B.C.	Prevalence of unrecognized benign paroxysmal positional vertigo in older patients. [Abstract] [BibTeX]	2015	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 272(6), pp. 1521-1524	article	DOI
Abstract: Dizziness is a relatively common complaint which occurs more often with increasing age. Benign paroxysmal positional vertigo (BPPV) is an important cause which can easily be treated but is frequently not recognized by professionals. The aim of this study was to assess the prevalence of unrecognized BPPV in older patients. Patients ≥70 years of age (n = 989) indicated whether they experienced dizziness, and if so whether the symptoms were typical for BPPV. If affirmed, a diagnostic maneuver was performed. Positive patients were treated at once. All suspected patients completed quality of life questionnaires and were followed for 3 and 6 months. Positive BPPV patients were compared with negative (but suspected) patients. Almost one quarter of the patients (226 patients, 23 %) suffered from dizziness, among whom 101 were suspected of BPPV. Less than half (n = 45) underwent the diagnostic maneuver, of whom 13 (29 %) were positive for BPPV. At follow-up, one patient developed BPPV, leading to a total of 14 positive patients (overall prevalence 1.4 %). BPPV positive patients did not differ from BPPV negative patients. Among a large group of older patients, one quarter experiences dizziness, and 1.4 % has definite BPPV.
BibTeX: @article{Zaag-Loonen2015, author = {van der Zaag-Loonen, H J and van Leeuwen, R B and Bruintjes, Tj D and van Munster, B C}, title = {Prevalence of unrecognized benign paroxysmal positional vertigo in older patients.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2015}, volume = {272}, issue = {6}, pages = {1521--1524}, doi = {https://doi.org/10.1007/s00405-014-3409-4}, keywords = {Aged; Benign Paroxysmal Positional Vertigo, complications, diagnosis, epidemiology, physiopathology, psychology, therapy; Diagnostic Errors, prevention & control, statistics & numerical data; Dizziness, etiology, physiopathology, therapy; Female; Humans; Male; Musculoskeletal Manipulations, methods; Netherlands; Patient Positioning, methods; Prevalence; Quality of Life; Surveys and Questionnaires; Symptom Assessment, methods; Treatment Outcome; Vertigo, etiology; Vestibule, Labyrinth, physiopathology}, pmid = {25488279} }
Lee, J.D., Kim, C.-H., Hong, S.M., Kim, S.H., Suh, M.-W., Kim, M.-B., Shim, D.B., Chu, H., Lee, N.H., Kim, M., Hong, S.K. and Seo, J.-H.	Prevalence of vestibular and balance disorders in children and adolescents according to age: A multi-center study. [Abstract] [BibTeX]	2017	International journal of pediatric otorhinolaryngology Vol. 94, pp. 36-39	article	DOI
Abstract: Children differ from adults in the expression of dizziness symptoms and the causes of dizziness. In several studies, benign paroxysmal vertigo of childhood (BPVC) and vestibular migraine (VM) were seen exclusively in children with vertigo, but the age threshold used to define 'children' varies, and there are few reported studies about adolescents with dizziness. In this study, we investigated the prevalence of vestibular and balance disorders according to age category in a multi-center study (otolaryngology departments of 11 hospitals) of children and adolescents. Children and adolescents aged under 18 who visited the otolaryngology departments of 11 hospitals for dizziness were included. We classified the patients into three categories: preschool (up to and including 6-year-olds), school age (7- to 12-year-olds), and adolescents (13- to 18-year-olds). These patients were reviewed retrospectively based on their clinical charts. In the preschool age group, BPVC was most common, followed by VM. In the school-age group, BPVC and VMs were most common, followed by psychogenic vertigo and benign paroxysmal positional vertigo (BPPV). In adolescents, VM was the most common, and Ménière's disease, cardiogenic vertigo, and BPVC, which are seen primarily in adults, were also seen in some adolescents. In children and adolescents with dizziness, VM and BPVC were the most common diseases, and prevalence of disease by age showed differing distributions. These findings will help in diagnosing and managing children and adolescents with vertigo.
BibTeX: @article{Lee2017a, author = {Lee, Jong Dae and Kim, Chang-Hee and Hong, Seok Min and Kim, Sung Huhn and Suh, Myung-Whan and Kim, Min-Beom and Shim, Dae Bo and Chu, Hosuk and Lee, No Hee and Kim, Minbum and Hong, Sung Kwang and Seo, Jae-Hyun}, title = {Prevalence of vestibular and balance disorders in children and adolescents according to age: A multi-center study.}, journal = {International journal of pediatric otorhinolaryngology}, year = {2017}, volume = {94}, pages = {36--39}, doi = {https://doi.org/10.1016/j.ijporl.2017.01.012}, keywords = {Adolescent; Age Factors; Benign Paroxysmal Positional Vertigo, complications, epidemiology; Child; Child, Preschool; Dizziness, etiology; Female; Humans; Male; Meniere Disease, complications, epidemiology; Migraine Disorders, complications, epidemiology; Postural Balance; Prevalence; Republic of Korea, epidemiology; Retrospective Studies; Vertigo, complications, epidemiology; Adolescents; Children; Vertigo}, pmid = {28167008} }
Chau, A.T., Menant, J.C., Hübner, P.P., Lord, S.R. and Migliaccio, A.A.	Prevalence of Vestibular Disorder in Older People Who Experience Dizziness. [Abstract] [BibTeX]	2015	Frontiers in neurology Vol. 6, pp. 268	article	DOI
Abstract: Dizziness and imbalance are clinically poorly defined terms, which affect 30% of people over 65 years of age. In these people, it is often difficult to define the primary cause of dizziness, as it can stem from cardiovascular, vestibular, psychological, and neuromuscular causes. However, identification of the primary cause is vital in determining the most effective treatment strategy for a patient. Our aim is to accurately identify the prevalence of benign paroxysmal positional vertigo (BPPV), peripheral, and central vestibular hypofunction in people aged over 50 years who had experienced dizziness within the past year. Seventy-six participants aged 51-92 (mean ± SD = 69 ± 9.5 years) were tested using the head thrust dynamic visual acuity (htDVA) test, dizziness handicap inventory (DHI), as well as sinusoidal and unidirectional rotational chair testing, in order to obtain data for htDVA score, DHI score, sinusoidal (whole-body, 0.1-2 Hz with peak velocity at 30°/s) vestibulo-ocular reflex (VOR) gain and phase, transient (whole-body, acceleration at 150°/s(2) to a constant velocity rotation of 50°/s) VOR gain and time constant (TC), optokinetic nystagmus (OKN) gain, and TC (whole-body, constant velocity rotation at 50°/s). We found that BPPV, peripheral and central vestibular hypofunction were present in 38 and 1% of participants, respectively, suggesting a likely vestibular cause of dizziness in these people. Of those with a likely vestibular cause, 63% had BPPV; a figure higher than previously reported in dizziness clinics of 25%. Our results indicate that htDVA, sinusoidal (particularly 0.5-1 Hz), and transient VOR testing were the most effective at detecting people with BPPV or vestibular hypofunction, whereas DHI and OKN were effective at only detecting non-BPPV vestibular hypofunction.
BibTeX: @article{Chau2015, author = {Chau, Allan T and Menant, Jasmine C and Hübner, Patrick P and Lord, Stephen R and Migliaccio, Americo A}, title = {Prevalence of Vestibular Disorder in Older People Who Experience Dizziness.}, journal = {Frontiers in neurology}, year = {2015}, volume = {6}, pages = {268}, doi = {https://doi.org/10.3389/fneur.2015.00268}, keywords = {aged; benign paroxysmal positional vertigo; peripheral and central vestibular function; postural balance; vestibular function tests}, pmid = {26733940} }
Roberts, R.A., Gans, R.E., Kastner, A.H. and Listert, J.J.	Prevalence of vestibulopathy in benign paroxysmal positional vertigo patients with and without prior otologic history. [Abstract] [BibTeX]	2005	International journal of audiology Vol. 44(4), pp. 191-196	article
Abstract: The purpose of this study was to determine the prevalence of reduced or absent labyrinthine reactivity (vestibulopathy) in two groups of participants with posterior canal BPPV. One group had prior diagnosis of otologic disease (positive history group). No one in the second group had ever been diagnosed with otologic disease (negative history group). Caloric responses were retrospectively analyzed for the two groups. Patients with a positive history exhibited a greater prevalence of vestibulopathy than patients with a negative history. The positive history group, on average, also exhibited a larger unilateral weakness than those patients in the negative history group. We conclude that patients with BPPV and a history of otologic disease are more likely to present with vestibulopathy, than patients with BPPV and no history of otologic disease. This finding supports the benefit of complete vestibular evaluation in patients with BPPV to ensure comprehensive and successful treatment outcome.
BibTeX: @article{Roberts2005a, author = {Roberts, Richard A and Gans, Richard E and Kastner, Allison H and Listert, Jennifer J}, title = {Prevalence of vestibulopathy in benign paroxysmal positional vertigo patients with and without prior otologic history.}, journal = {International journal of audiology}, year = {2005}, volume = {44}, issue = {4}, pages = {191--196}, keywords = {Adult; Aged; Aged, 80 and over; Caloric Tests; Case-Control Studies; Ear Diseases, complications; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic; Prevalence; Retrospective Studies; Vertigo, complications, etiology, physiopathology; Vestibular Neuronitis, epidemiology, etiology, physiopathology; Vestibule, Labyrinth, physiopathology}, pmid = {16011047} }
Leong, A.C., Barker, F. and Bleach, N.R.	Primary assessment of the vertiginous patient at a pre-ENT balance clinic. [Abstract] [BibTeX]	2008	The Journal of laryngology and otology Vol. 122(2), pp. 132-138	article	DOI
Abstract: Due to problems with long waiting times for assessment of vertiginous patients (more than 24 weeks), we changed practice and instituted a pre-ENT balance clinic assessment; we then audited the results. In particular, we looked at the subgroup with benign positional paroxysmal vertigo. One hundred and fifteen patients were seen at the pre-ENT balance clinic from October 2003 to September 2004. Those diagnosed with benign positional paroxysmal vertigo received particle repositioning therapy at the same clinic and did not subsequently need ENT assessment. By the end of the audit period, waiting times were reduced to three weeks, and more than one-quarter of vertiginous patients (i.e. those diagnosed with benign positional paroxysmal vertigo) did not need to be reviewed at an ENT clinic. We believe this to be the first study to present prospective data showing that patients with benign positional paroxysmal vertigo may be safely diagnosed and effectively managed at a pre-ENT balance clinic.
BibTeX: @article{Leong2008a, author = {Leong, A C and Barker, F and Bleach, N R}, title = {Primary assessment of the vertiginous patient at a pre-ENT balance clinic.}, journal = {The Journal of laryngology and otology}, year = {2008}, volume = {122}, issue = {2}, pages = {132--138}, doi = {https://doi.org/10.1017/S0022215107007797}, keywords = {Diagnostic Techniques, Otological, economics, standards; Female; Humans; Male; National Health Programs, economics, standards; Outcome Assessment (Health Care); Referral and Consultation, economics, statistics & numerical data; Vertigo, diagnosis, economics, therapy; Waiting Lists}, pmid = {17470305} }
Walther, L.E., Blödow, A., Buder, J. and Kniep, R.	Principles of calcite dissolution in human and artificial otoconia. [Abstract] [BibTeX]	2014	PloS one Vol. 9(7), pp. e102516	article	DOI
Abstract: Human otoconia provide mechanical stimuli to deflect hair cells of the vestibular sensory epithelium for purposes of detecting linear acceleration and head tilts. During lifetime, the volume and number of otoconia are gradually reduced. In a process of degeneration morphological changes occur. Structural changes in human otoconia are assumed to cause vertigo and balance disorders such as benign paroxysmal positional vertigo (BPPV). The aim of this study was to investigate the main principles of morphological changes in human otoconia in dissolution experiments by exposure to hydrochloric acid, EDTA, demineralized water and completely purified water respectively. For comparison reasons artificial (biomimetic) otoconia (calcite gelatin nanocomposits) and natural calcite were used. Morphological changes were detected in time steps by the use of environmental scanning electron microscopy (ESEM). Under in vitro conditions three main dissolution mechanisms were identified as causing characteristic morphological changes of the specimen under consideration: pH drops in the acidic range, complex formation with calcium ions and changes of ion concentrations in the vicinity of otoconia. Shifts in pH cause a more uniform reduction of otoconia size (isotropic dissolution) whereas complexation reactions and changes of the ionic concentrations within the surrounding medium bring about preferred attacks at specific areas (anisotropic dissolution) of human and artificial otoconia. Owing to successive reduction of material, all the dissolution mechanisms finally produce fragments and remnants of otoconia. It can be assumed that the organic component of otoconia is not significantly attacked under the given conditions. Artificial otoconia serve as a suitable model system mimicking chemical attacks on biogenic specimens. The underlying principles of calcite dissolution under in vitro conditions may play a role in otoconia degeneration processes such as BPPV.
BibTeX: @article{Walther2014, author = {Walther, Leif Erik and Blödow, Alexander and Buder, Jana and Kniep, Rüdiger}, title = {Principles of calcite dissolution in human and artificial otoconia.}, journal = {PloS one}, year = {2014}, volume = {9}, issue = {7}, pages = {e102516}, doi = {https://doi.org/10.1371/journal.pone.0102516}, keywords = {Calcification, Physiologic; Calcium Carbonate, chemistry, metabolism; Humans; Microscopy, Electron, Scanning; Otolithic Membrane, chemistry, physiology, ultrastructure; Solubility}, pmid = {25048115} }
Zaag-Loonen, H.v.d., Bruintjes, T. and Leeuwen, R.v.	Probable Benign Paroxysmal Positional Vertigo Converts into Definite BPPV in One in Six Patients. [Abstract] [BibTeX]	2018	The journal of international advanced otology Vol. 14(3), pp. 456-458	article	DOI
Abstract: Patients with positional vertigo who have a positive Dix-Hallpike (DH) test are diagnosed as having definite benign paroxysmal positional vertigo (BPPV), and those who have a negative DH test as having probable BPPV. Little is known about the course of the disease in the latter group. The aim of the present study was to assess how many patients with probable BPPV convert into having a positive DH test during follow-up. We included new patients who had experienced typical positional vertigo within the past 4 weeks and had a negative DH test. Patients were followed up over a period of 8 weeks. If the symptoms re-occurred, they were invited to return to the clinic for diagnostic DH test and, if positive, treated with a canalith repositioning maneuver. During the inclusion period of 18 months, 167 patients had probable BPPV, in which 43 fulfilled the inclusion criteria. The mean age of the patients was 57 (SD 14.5) years. Of the patients, 27 (63%) were females. During follow-up, 25 (58%) patients suffered from recurring positional vertigo, in which 13 underwent the DH test. Of the 13 patients, 8 were positive in 7 (16%) patients; 1 patient had a positive DH test twice. Among patients with a history of BPPV but a negative DH test at the first consultation, more than half (58%) experienced positional vertigo within 8 weeks. In 1 of 6 patients, the diagnosis was changed from probable to definite BPPV. Our advice to professionals who are confronted with a patient with symptoms of BPPV, but with a negative DH test, is to adopt a policy of low-threshold access for patients with recurring symptoms.
BibTeX: @article{Zaag-Loonen2018, author = {Zaag-Loonen, Hester van der and Bruintjes, Tjasse and Leeuwen, Roeland van}, title = {Probable Benign Paroxysmal Positional Vertigo Converts into Definite BPPV in One in Six Patients.}, journal = {The journal of international advanced otology}, year = {2018}, volume = {14}, issue = {3}, pages = {456--458}, doi = {https://doi.org/10.5152/iao.2018.4862}, pmid = {30644375} }
Singh, A.K. and Chaturvedi, V.N.	Prochlorperazine versus cinnarizine in cases of vertigo. [Abstract] [BibTeX]	1998	Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India Vol. 50(4), pp. 392-397	article	DOI
Abstract: Cases of vertigo comprised 1.82% of Ear, Nose & Throat out patient cases. Peripheral lesion as a cause of vertigo was seen in 51.12%. Meniere's disease and Benign Paroxysmal Positional Vertigo (BPPV) were found to be the common causes comprising 21.80% and 15.78% of total cases of vertigo. Central lesion as a cause of vertigo was seen in 48.87% of cases. Vertebre Basilar Insufficiency (VBI) was the commonest cause of central lesion seen in 20.30% of cases. An equal number of cases, selected randomly, underwent treatment with prochlorperazine ± Head Balance exercises and Cinnarizine ± Head Balance exercises. At the end of 5 weeks of treatment there was 100% subjective improvement with prochlorperazine group and 97.14% in the group with cinnarizine. Side effects were noted in 34.00% of cases; of these 23.00% were seen in cinnarizine group and 11.00% in prochlorperazine. Drowsiness was the commonest side effect and was statistically more significant with cinnarzine group. Response to the treatment was significantly more in cases with vertigo of peripheral origin as compared with vertigo of central origin.
BibTeX: @article{Singh1998, author = {Singh, A K and Chaturvedi, V N}, title = {Prochlorperazine versus cinnarizine in cases of vertigo.}, journal = {Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India}, year = {1998}, volume = {50}, issue = {4}, pages = {392--397}, doi = {https://doi.org/10.1007/BF03000698}, pmid = {23119469} }
Kentala, E., Viikki, K., Pyykkö, I. and Juhola, M.	Production of diagnostic rules from a neurotologic database with decision trees. [Abstract] [BibTeX]	2000	The Annals of otology, rhinology, and laryngology Vol. 109(2), pp. 170-176	article	DOI
Abstract: A decision tree is an artificial intelligence program that is adaptive and is closely related to a neural network, but can handle missing or nondecisive data in decision-making. Data on patients with Meniere's disease, vestibular schwannoma, traumatic vertigo, sudden deafness, benign paroxysmal positional vertigo, and vestibular neuritis were retrieved from the database of the otoneurologic expert system ONE for the development and testing of the accuracy of decision trees in the diagnostic workup. Decision trees were constructed separately for each disease. The accuracies of the best decision trees were 94%, 95%, 99%, 99%, 100%, and 100% for the respective diseases. The most important questions concerned the presence of vertigo, hearing loss, and tinnitus; duration of vertigo; frequency of vertigo attacks; severity of rotational vertigo; onset and type of hearing loss; and occurrence of head injury in relation to the timing of onset of vertigo. Meniere's disease was the most difficult to classify correctly. The validity and structure of the decision trees are easily comprehended and can be used outside the expert system.
BibTeX: @article{Kentala2000a, author = {Kentala, E and Viikki, K and Pyykkö, I and Juhola, M}, title = {Production of diagnostic rules from a neurotologic database with decision trees.}, journal = {The Annals of otology, rhinology, and laryngology}, year = {2000}, volume = {109}, issue = {2}, pages = {170--176}, doi = {https://doi.org/10.1177/000348940010900211}, keywords = {Databases, Factual; Decision Trees; Ear Diseases, diagnosis; Expert Systems; Hearing Loss, Sudden, diagnosis; Humans; Meniere Disease, diagnosis; Neurilemmoma, diagnosis; Vertigo, diagnosis; Vestibular Neuronitis, diagnosis}, pmid = {10685569} }
Korres, S., Balatsouras, D.G. and Ferekidis, E.	Prognosis of patients with benign paroxysmal positional vertigo treated with repositioning manoeuvres. [Abstract] [BibTeX]	2006	The Journal of laryngology and otology Vol. 120(7), pp. 528-533	article	DOI
Abstract: To evaluate the prognostic factors in benign paroxysmal positional vertigo (BPPV) treated with canalith repositioning procedures (CRPs). Retrospective study of consecutive BPPV cases diagnosed over three years. All patients underwent a complete otolaryngologic, audiologic and neurotologic evaluation. The appropriate CRP was performed, depending on the type of BPPV. Prognostic factors studied included age, sex, aetiology, duration of disease, abnormal electronystagmographic findings, canal involvement, improper performance of manoeuvres, response on first or repeat treatment, and presence of recurrences. One hundred and fifty-five patients were studied, 66 men and 89 women, with mean ages of 58.7 and 60.4 years, respectively. Age and the involvement of two canals or bilateral disease had an effect on initial treatment outcome and were correlated to increased recurrences but not to repeat treatment outcome. Secondary BPPV, abnormal electronystagmographic findings and improper performance of manoeuvres had a significant effect both on initial and repeat treatment, but not on recurrences. Sex and duration of symptoms had no effect. Canalith repositioning procedures provide fast and long-lasting treatment of BPPV in most patients. However, in a small subgroup of patients, failures may be noticed that may be attributed to various prognostic factors.
BibTeX: @article{Korres2006, author = {Korres, S and Balatsouras, D G and Ferekidis, E}, title = {Prognosis of patients with benign paroxysmal positional vertigo treated with repositioning manoeuvres.}, journal = {The Journal of laryngology and otology}, year = {2006}, volume = {120}, issue = {7}, pages = {528--533}, doi = {https://doi.org/10.1017/S0022215106000958}, keywords = {Adult; Age Factors; Aged; Aged, 80 and over; Electronystagmography, methods; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, complications, physiopathology; Prognosis; Recurrence; Retrospective Studies; Semicircular Canals, pathology, physiopathology; Sex Factors; Time Factors; Treatment Failure; Treatment Outcome; Vertigo, complications, physiopathology, therapy}, pmid = {16556351} }
Boleas-Aguirre, M.S., Vazquez, F. and Perez, N.	Progressive cochleo-vestibular labyrinthitis. [Abstract] [BibTeX]	2007	Revue de laryngologie - otologie - rhinologie Vol. 128(1-2), pp. 63-64	article
Abstract: We report a rare case of sudden deafness and benign paroxysmal positional vertigo (BPPV) corresponding to a canalithiasis of the ipsilateral left posterior semicircular canal (PSC). The initial examination showed intact lateral semicircular canal (LSC) function. Cerebral MRI results were normal. However evoked otoacoustics emissions were absent in the left ear. The patient developed, in the course of one week, symptoms and signs of an acute unilateral vestibulopathy in the same ear. However there were no change in hearing loss after it. The association of BPPV acute vestibulopathy and sudden deafness is uncommon but usually the former develops well after the second and third. This case is best explained by a vestibulocochlear labyrinthitis.
BibTeX: @article{Boleas-Aguirre2007a, author = {Boleas-Aguirre, M S and Vazquez, F and Perez, N}, title = {Progressive cochleo-vestibular labyrinthitis.}, journal = {Revue de laryngologie - otologie - rhinologie}, year = {2007}, volume = {128}, issue = {1-2}, pages = {63--64}, keywords = {Adult; Cochlea, pathology; Disease Progression; Female; Humans; Labyrinthitis, complications, pathology; Magnetic Resonance Imaging; Otoacoustic Emissions, Spontaneous, physiology; Vertigo, etiology, therapy; Vestibule, Labyrinth, pathology}, pmid = {17633668} }
Kraeling, M.	Proposed treatment for geriatric vestibular disease in dogs. [Abstract] [BibTeX]	2014	Topics in companion animal medicine Vol. 29(1), pp. 6-9	article	DOI
Abstract: Sudden-onset vestibular dysfunction in the canine is a commonly seen condition in veterinary practice, with some veterinarians reporting several cases each month. However, traditional veterinary medicine has little to offer these patients other than symptomatic relief for the severe nausea that accompanies the vertigo and supportive advice for the owners. Owners of affected dogs are informed that these symptoms usually resolve within a few days. As physical therapists, we often see cases of benign paroxysmal positional vertigo in our human practice clinics, and effective protocols for diagnosis and treatment of the condition have been developed for this condition. A modified testing and repositioning postural maneuver used successfully on 12 canine patients in our canine rehabilitation clinic (The Canine Fitness Centre, Calgary, Alberta, Canada) is hereby described.
BibTeX: @article{Kraeling2014, author = {Kraeling, Margaret}, title = {Proposed treatment for geriatric vestibular disease in dogs.}, journal = {Topics in companion animal medicine}, year = {2014}, volume = {29}, issue = {1}, pages = {6--9}, doi = {https://doi.org/10.1053/j.tcam.2014.04.004}, keywords = {Animals; Dog Diseases, physiopathology, therapy; Dogs; Musculoskeletal Manipulations, methods, veterinary; Vestibular Diseases, physiopathology, therapy, veterinary; BPPV; ear; equilibrium; idiopathic vestibular disease; vestibular dysfunction}, pmid = {25103883} }
Parham, K., Leonard, G., Feinn, R.S., Lafreniere, D. and Kenny, A.M.	Prospective clinical investigation of the relationship between idiopathic benign paroxysmal positional vertigo and bone turnover: a pilot study. [Abstract] [BibTeX]	2013	The Laryngoscope Vol. 123(11), pp. 2834-2839	article	DOI
Abstract: Idiopathic benign paroxysmal positional vertigo (BPPV) is a strong indicator of decreased bone density (osteopenia/osteoporosis) in postmenopausal women, and there is a correlation between BPPV and serum levels of biochemical markers of bone turnover. Prospective pilot clinical trial. Two groups of postmenopausal women were recruited. The BPPV group consisted of 16 women with a diagnosis of BPPV. The OSTEO group consisted of 13 women with history of osteopenia/osteoporosis. Dual-energy x-ray absorptiometry scan results were compared, along with serum levels of ionized calcium (iCa), vitamin D, aminoterminal propeptide of protocollagen type I (P1NP), and aminoterminal telopeptides of collagen (sNTX). Prevalence of decreased bone mass density among BPPV subjects was 81%, and prevalence of BPPV among OSTEO subjects was 31%. BPPV subjects had higher P1NP levels. Multiple regression analysis showed that among BPPV subjects, there was positive correlation between P1NP and sNTX and a negative correlation between P1NP and vitamin D level. Age was positively correlated with serum levels of both biomarkers among the BPPV subjects. T score, serum iCa, and serum vitamin D levels did not appear to correlate with presence of BPPV. Idiopathic BPPV subjects have a high prevalence of osteopenia/osteoporosis. Levels of biochemical markers of bone turnover correlate with presence of BPPV. Our results, based on a sample of U.S. subjects, support an association between idiopathic BPPV and disorders of bone turnover.
BibTeX: @article{Parham2013, author = {Parham, Kourosh and Leonard, Gerald and Feinn, Richard S and Lafreniere, Denis and Kenny, Anne M}, title = {Prospective clinical investigation of the relationship between idiopathic benign paroxysmal positional vertigo and bone turnover: a pilot study.}, journal = {The Laryngoscope}, year = {2013}, volume = {123}, issue = {11}, pages = {2834--2839}, doi = {https://doi.org/10.1002/lary.24162}, keywords = {Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Bone and Bones, metabolism; Female; Humans; Middle Aged; Osteoporosis, complications, metabolism; Prospective Studies; Vertigo, etiology, metabolism; Benign paroxysmal positional vertigo; geriatric; osteopenia; osteoporosis; postmenopause}, pmid = {23674177} }
Bertholon, P., Tringali, S., Faye, M.B., Antoine, J.C. and Martin, C.	Prospective study of positional nystagmus in 100 consecutive patients. [Abstract] [BibTeX]	2006	The Annals of otology, rhinology, and laryngology Vol. 115(8), pp. 587-594	article	DOI
Abstract: The purpose of this study was to investigate the various diagnoses of patients who present with positional nystagmus. Positional maneuvers were systematically performed in the plane of the posterior canal (PC; Dix-Hallpike maneuver) and the horizontal canal (HC; patients were rolled to either side in a supine position) on 490 consecutive patients essentially referred for vertigo and/or gait unsteadiness. One hundred patients (20%) presented positional nystagmus. This nystagmus had a peripheral origin in 83 patients, including 80 patients with benign paroxysmal positional vertigo (BPPV). In BPPV, the PC was involved in 61 patients, the HC in 18 patients (geotropic horizontal nystagmus in 11 and ageotropic in 7; changing from geotropic to ageotropic or the reverse in 4 patients), and both the PC and HC in 1 patient. There was evidence of central positional nystagmus in 12 patients, including positional downbeat nystagmus during the Dix-Hallpike maneuver in 7 patients with various neurologic disorders, and ageotropic horizontal nystagmus during the HC maneuver in 2 patients with, respectively, cerebellar ischemia and definite migrainous vertigo. The peripheral or central origin of the positional nystagmus could not be ascertained in 5 patients, including 1 patient with probable migrainous vertigo and another with possible anterior canal BPPV. A rotatory-upbeat nystagmus in the context of PC BPPV, a horizontal nystagmus, whether geotropic or ageotropic, due to HC BPPV, and a positional downbeat nystagmus related to various central disorders are the 3 most common types of positional nystagmus. Geotropic horizontal positional nystagmus and, most certainly, horizontal positional nystagmus changing from geotropic to ageotropic or the reverse point to HC BPPV. In contrast, an ageotropic horizontal positional nystagmus that is not changing (from ageotropic to geotropic) may indicate a central lesion.
BibTeX: @article{Bertholon2006, author = {Bertholon, Pierre and Tringali, Stephane and Faye, Mamadou B and Antoine, Jean Christophe and Martin, Christian}, title = {Prospective study of positional nystagmus in 100 consecutive patients.}, journal = {The Annals of otology, rhinology, and laryngology}, year = {2006}, volume = {115}, issue = {8}, pages = {587--594}, doi = {https://doi.org/10.1177/000348940611500804}, keywords = {Adult; Aged; Aged, 80 and over; Cerebellar Diseases, complications, diagnosis; Electronystagmography; Female; Humans; Labyrinth Diseases, complications, diagnosis; Magnetic Resonance Imaging; Male; Middle Aged; Migraine Disorders, complications, diagnosis; Nystagmus, Physiologic; Prospective Studies; Stroke, complications, diagnosis}, pmid = {16944657} }
Thalmann, I.	Proteomics and the inner ear. [Abstract] [BibTeX]	2001	Disease markers Vol. 17(4), pp. 259-270	article
Abstract: The inner ear, one of the most complex organs, contains within its bony shell three sensory systems, the evolutionary oldest gravity receptor system, the three semicircular canals for the detection of angular acceleration, and the auditory system--unrivaled in sensitivity and frequency discrimination. All three systems are susceptible to a host of afflictions affecting the quality of life for all of us. In the first part of this review we present an introduction to the milestones of inner ear research to pave the way for understanding the complexities of a proteomics approach to the ear. Minute sensory structures, surrounded by large fluid spaces and a hard bony shell, pose extreme challenges to the ear researcher. In spite of these obstacles, a powerful preparatory technique was developed, whereby precisely defined microscopic tissue elements can be isolated and analyzed, while maintaining the biochemical state representative of the in vivo conditions. The second part consists of a discussion of proteomics as a tool in the elucidation of basic and pathologic mechanisms, diagnosis of disease, as well as treatment. Examples are the organ of Corti proteins OCP1 and OCP2, oncomodulin, a highly specific calcium-binding protein, and several disease entities, Meniere's disease, benign paroxysmal positional vertigo, and perilymphatic fistula.
BibTeX: @article{Thalmann2001, author = {Thalmann, I}, title = {Proteomics and the inner ear.}, journal = {Disease markers}, year = {2001}, volume = {17}, issue = {4}, pages = {259--270}, keywords = {Animals; Ear Diseases, diagnosis; Ear, Inner, metabolism; Humans; Meniere Disease, metabolism; Methods; Proteome, metabolism; Vertigo, metabolism}, pmid = {11790893} }
Su, G.N.-C., Tai, P.-W., Su, P.-T. and Chien, H.-H.	Protracted benign paroxysmal positional vertigo following osteotome sinus floor elevation: a case report. [Abstract] [BibTeX]	2008	The International journal of oral & maxillofacial implants Vol. 23(5), pp. 955-959	article
Abstract: Benign paroxysmal positional vertigo (BPPV) is a relatively rare condition characterized by onset of rotation dizziness triggered by head movements or change in posture. BPPV etiology includes head injury, infection, vascular disorders, surgical trauma, and idiopathic events. This report presents a case of protracted BPPV following osteotome sinus floor elevation and simultaneous implant placement. A 49-year-old female suffered intense vertigo and nausea immediately after implant placement using an osteotome sinus floor elevation procedure, especially when changing head position while sitting upright. Despite antivertigo medications, the condition did not improve. Following referral to a neurotologist, BPPV contralateral to the operation site was diagnosed 14 days after the osteotome sinus floor elevation procedure. The Epley's maneuver was then applied and, gradually, symptoms of BPPV disappeared 3 months after the implant surgery. No recurrence of BPPV was observed during further 3-month follow-up. Prevention and management of osteotome sinus floor elevation-related BPPV are reviewed in this report.
BibTeX: @article{Su2008, author = {Su, George Nan-Chang and Tai, Pei-Wei and Su, Po-Tsang and Chien, Hua-Hong}, title = {Protracted benign paroxysmal positional vertigo following osteotome sinus floor elevation: a case report.}, journal = {The International journal of oral & maxillofacial implants}, year = {2008}, volume = {23}, issue = {5}, pages = {955--959}, keywords = {Dental Implantation, Endosseous, adverse effects; Female; Head Movements; Humans; Maxillary Sinus, surgery; Middle Aged; Oral Surgical Procedures, Preprosthetic, adverse effects; Osteotomy, adverse effects; Physical Therapy Modalities; Vertigo, etiology, therapy}, pmid = {19014169} }
Lee, S.-U., Kim, H.-J. and Kim, J.-S.	Pseudo-spontaneous and head-shaking nystagmus in horizontal canal benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2014	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 35(3), pp. 495-500	article	DOI
Abstract: To determine the characteristics and diagnostic value of pseudo-spontaneous and head-shaking nystagmus (HSN) in benign paroxysmal positional vertigo involving the horizontal semicircular canal (HC-BPPV). Retrospective case series review. After excluding 19 patients with canal paresis, abnormal head impulse test, recent history of peripheral or central vestibular disorders, or poor cooperation, we retrospectively recruited 127 patients with HC-BPPV from January 2009 to July 2012. The patients included 69 geotropic and 58 apogeotropic types. We analyzed the pattern of pseudo-spontaneous nystagmus and HSN according to the lesion side. Pseudo-spontaneous nystagmus was observed in 87 (87/127, 68.5%) patients, both in geotropic (46/69, 66.7%) and apogeotropic (41/58, 70.7%) types without difference in the prevalence between the types (p = 0.627). Pseudo-spontaneous nystagmus beat more to the lesion side in apogeotropic type (28/41, 68.3%, p = 0.028) but in either direction without directional preponderance in geotropic type (p = 0.659). Of the 90 patients who underwent horizontal head-shaking, 27 (30.0%) showed HSN that was more common in apogeotropic than in geotropic type (22/44 [50.0%] versus 5/46 [10.9%], p < 0.001). Patients with apogeotropic HC-BPPV showed predominantly contralesional HSN (19/22 [86.4%], p = 0.001), whereas patients with geotropic type did not show any directional preponderance of HSN (contralesional in 2 and ipsilesional in 3). HSN is more common and mostly contralesional in apogeotropic HC-BPPV. HSN may be a lateralizing sign in apogeotropic HC-BPPV. Different prevalence and patterns of HSN in apogeotropic and geotropic HC-BPPV suggest dissimilar cupular dynamics in those disorders.
BibTeX: @article{Lee2014a, author = {Lee, Sun-Uk and Kim, Hyo-Jung and Kim, Ji-Soo}, title = {Pseudo-spontaneous and head-shaking nystagmus in horizontal canal benign paroxysmal positional vertigo.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2014}, volume = {35}, issue = {3}, pages = {495--500}, doi = {https://doi.org/10.1097/MAO.0000000000000250}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Female; Head Movements, physiology; Humans; Male; Middle Aged; Nystagmus, Pathologic, physiopathology; Retrospective Studies; Semicircular Canals, physiopathology; Vertigo, physiopathology}, pmid = {24492134} }
Im, D.H., Yang, Y.S., Choi, H., Choi, S., Shin, J.E. and Kim, C.-H.	Pseudo-spontaneous nystagmus in horizontal semicircular canal canalolithiasis. [Abstract] [BibTeX]	2017	Medicine Vol. 96(34), pp. e7849	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) involving horizontal semicircular canal (HSCC) is characterized by direction-changing positional nystagmus (DCPN) in a supine roll test, and the occurrence of spontaneous nystagmus in HSCC BPPV has been reported recently. The aim of this study is to investigate the characteristics of pseudo-spontaneous nystagmus (PSN) in patients with HSCC canalolithiasis, and evaluate the effect of the presence of PSN on treatment outcome.Between April 2014 and January 2016, 75 and 59 patients with HSCC canalolithiasis and cupulolithiasis, respectively, were enrolled. Spontaneous and positional nystagmus were examined.PSN was observed in 31 of 75 patients (41%) with HSCC canalolithiasis, and 55 of 59 patients (93%) with HSCC cupulolithiasis. PSN persisted during the period of observation, which was at least 1 minute in all patients with PSN. In HSCC canalolithiasis, direction-reversing nystagmus was observed in 58 patients (25 bilateral and 33 unilateral). Nine of 25 patients with bilateral direction-reversing nystagmus, and 22 of 33 patients with unilateral direction-reversing nystagmus showed PSN. None of 17 patients without direction-reversing nystagmus showed PSN. The direction of PSN corresponded to that of direction-reversing nystagmus in all 22 patients with unilateral direction-reversing nystagmus. The proportion of patients who recovered after 1 session of repositioning maneuver was not significantly different between patients with and without PSN (P = .867).PSN was observed more commonly in HSCC cupulolithiasis than canalolithiasis. The pathophysiologic mechanism underlying PSN can be explained by natural inclination of HSCC and medial to lateral orientation of the HSCC cupular axis in cupulolithiasis, and by spontaneous reversal of initial positional nystagmus (direction-reversing nystagmus) generated by short-term adaptation of vestibulo-ocular reflex in canalolithiasis. The presence of PSN in HSCC canalolithiasis may not affect the treatment outcome.
BibTeX: @article{Im2017, author = {Im, Dong Hyuk and Yang, Young Soo and Choi, Hyerang and Choi, Seongjun and Shin, Jung Eun and Kim, Chang-Hee}, title = {Pseudo-spontaneous nystagmus in horizontal semicircular canal canalolithiasis.}, journal = {Medicine}, year = {2017}, volume = {96}, issue = {34}, pages = {e7849}, doi = {https://doi.org/10.1097/MD.0000000000007849}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo, epidemiology; Female; Humans; Labyrinth Diseases, epidemiology; Lithiasis, epidemiology; Male; Middle Aged; Nystagmus, Pathologic, epidemiology; Patient Positioning; Semicircular Canals, pathology; Vestibular Function Tests; Young Adult}, pmid = {28834895} }
Lee, H.-J., Kim, Y.H., Hong, S.K. and Kim, H.-J.	Pseudo-spontaneous nystagmus in lateral semicircular canal benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2012	Clinical and experimental otorhinolaryngology Vol. 5(4), pp. 201-206	article	DOI
Abstract: Spontaneous nystagmus, which has been considered a typical sign of acute vestibulopathy, has recently been reported in benign paroxysmal positional vertigo involving the lateral semicircular canals (LC-BPPV) without unilateral vestibulopathy (pseudo-spontaneous nystagmus, PSN), but research about its clinical application is still limited. Here we investigate the frequency and characteristics of PSN in LC-BPPV patients, and estimate its prognostic value. For 95 patients with LC-BPPV, we examined nystagmus in the sitting position in the clinic with video goggles. Patients were categorized as PSN or non-PSN, according to presence of horizontal nystagmus in the sitting position at diagnosis. The duration of vertiginous symptoms before diagnosis and the duration of treatment were compared between the two groups. The results of video-nystagmography test were reviewed when available. PSN was examined in 16 (16.8%) patients, all of whose symptoms disappeared immediately after successful repositioning therapy. While the duration of symptoms did not differ statistically between groups (P=0.481), the duration of treatment in the PSN group was significantly longer than in the non-PSN group (P<0.001). We conclude that the presence of spontaneous nystagmus in the sitting position does not preclude a diagnosis of LC-BPPV without unilateral vestibulopathy. PSN was related to a poor outcome of LC-BPPV in this study.
BibTeX: @article{Lee2012, author = {Lee, Hyo-Jeong and Kim, Yong Hyun and Hong, Sung Kwang and Kim, Hyung-Jong}, title = {Pseudo-spontaneous nystagmus in lateral semicircular canal benign paroxysmal positional vertigo.}, journal = {Clinical and experimental otorhinolaryngology}, year = {2012}, volume = {5}, issue = {4}, pages = {201--206}, doi = {https://doi.org/10.3342/ceo.2012.5.4.201}, keywords = {Benign paroxysmal positional vertigo; Pathologic nystagmus; Semicircular canals}, pmid = {23205224} }
Asprella-Libonati, G.	Pseudo-spontaneous nystagmus: a new sign to diagnose the affected side in lateral semicircular canal benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2008	Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale Vol. 28(2), pp. 73-78	article
Abstract: Early diagnosis of the affected side in Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo is important in effectively applying treatment manoeuvres. This study was performed to examine the frequency of a new clinical sign, pseudo-spontaneous nystagmus, in a large cohort of patients with Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo, comparing its efficacy in the identification of the involved side with that of other diagnostic signs, seated supine positioning nystagmus, and the intensity of the nystagmus evoked by the head yaw test in the supine position. Overall, 293 patients affected by Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo (197 geotropic and 96 apogeotropic forms) were examined. Pseudo-spontaneous nystagmus was observed in 222 patients (76%). After a very slow, repeated horizontal rotation of the head, in the seated position, this percentage increased to 96% (281 patients). The pseudo-spontaneous nystagmus and the seated supine positioning nystagmus always beat in the same direction and both were in accordance in identifying the affected side with the nystagmus evoked by the head yaw test. The differential diagnosis between spontaneous nystagmus and pseudo-spontaneous nystagmus is easily achieved with the head pitch test in the sitting position: the pseudo-spontaneous nystagmus disappears with the head bent forward 30 degrees (neutral position), it reverses its direction with the head bent 60 degrees forward, it returns visible bringing the head in axis with the body and increases its intensity extending the head about 30 degrees backwards. Pseudo-spontaneous nystagmus is an important sign for determining the affected ear in Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo. Early identification of the affected side improves efficacy of treatment and compliance of patients.
BibTeX: @article{Asprella-Libonati2008, author = {Asprella-Libonati, G}, title = {Pseudo-spontaneous nystagmus: a new sign to diagnose the affected side in lateral semicircular canal benign paroxysmal positional vertigo.}, journal = {Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale}, year = {2008}, volume = {28}, issue = {2}, pages = {73--78}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Child; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, diagnosis, physiopathology; Nystagmus, Physiologic, physiology; Semicircular Canals, physiopathology; Vertigo, diagnosis, physiopathology}, pmid = {18669071} }
Eckhardt-Henn, A., Best, C., Bense, S., Breuer, P., Diener, G., Tschan, R. and Dieterich, M.	Psychiatric comorbidity in different organic vertigo syndromes. [Abstract] [BibTeX]	2008	Journal of neurology Vol. 255(3), pp. 420-428	article	DOI
Abstract: A high degree of psychiatric disorders has repeatedly been described among patients with organic vertigo syndromes and attributed to vestibular dysfunction. Yet almost no investigations exist which differentiate between various organic vertigo syndromes with regard to psychiatric comorbidity. The following prospective, interdisciplinary study was carried out to explore whether patients with different organic vertigo syndromes exhibit different psychological comorbidities. 68 patients with organic vertigo syndromes (benign paroxysmal positioning vertigo (BPPV) n = 20, vestibular neuritis (VN) n = 18, Menière's disease (MD) n = 7, vestibular migraine (VM) n = 23) were compared with 30 healthy volunteers. All patients and control persons underwent structured neurological and neuro-otological testing. A structured diagnostic interview (-I) (SCID-I) and a battery of psychometric tests were used to evaluate comorbid psychiatric disorders. Patients with VM and MD showed significantly higher prevalence of psychiatric comorbidity (MD = 57%, VM = 65%) especially with anxiety and depressive disorders, than patients with VN (22%) and BPPV (15 %) compared to normal subjects (20 %). These elevated rates of comorbidities resulted in significantly elevated odds-ratios (OR) for the development of comorbid psychiatric disorders in general (for VM OR = 7.5, for MD OR = 5.3) and especially for anxiety disorders (for VM OR = 26.6, for MD OR = 38.7). As a consequence, a structured psychological and psychometric testing and an interdisciplinary therapy should be proceeded in cases with complex and prolonged vertigo courses, especially in patients with VM and MD. Possible reasons of these unexpected results in VM and MD are discussed.
BibTeX: @article{Eckhardt-Henn2008, author = {Eckhardt-Henn, Annegret and Best, Christoph and Bense, Sandra and Breuer, Peter and Diener, Gudrun and Tschan, Regine and Dieterich, Marianne}, title = {Psychiatric comorbidity in different organic vertigo syndromes.}, journal = {Journal of neurology}, year = {2008}, volume = {255}, issue = {3}, pages = {420--428}, doi = {https://doi.org/10.1007/s00415-008-0697-x}, keywords = {Adult; Aged; Anxiety Disorders, complications; Comorbidity; Depressive Disorder, complications; Female; Humans; Interview, Psychological; Male; Mental Disorders, complications, epidemiology, psychology; Middle Aged; Prospective Studies; Psychiatric Status Rating Scales; Psychometrics; Somatoform Disorders, etiology; Vertigo, complications, epidemiology, psychology; Vestibular Diseases, complications}, pmid = {18338198} }
Best, C., Eckhardt-Henn, A., Tschan, R. and Dieterich, M.	Psychiatric morbidity and comorbidity in different vestibular vertigo syndromes. Results of a prospective longitudinal study over one year. [Abstract] [BibTeX]	2009	Journal of neurology Vol. 256(1), pp. 58-65	article	DOI
Abstract: High rates of coexisting vestibular deficits and psychiatric disorders have been reported in patients with vertigo. Hence, a causal linkage between the vestibular system and emotion processing systems has been postulated. The aim of this study was to evaluate the impact of vestibular function and vestibular deficits as well as preexisting psychiatric pathologies on the course of vestibular vertigo syndromes over 1 year. This interdisciplinary prospective longitudinal study included a total of 68 patients with vestibular vertigo syndromes. Four subgroups were compared: benign paroxysmal positioning vertigo (BPPV, n=19), vestibular neuritis (VN, n=14), vestibular migraine (VM, n=27), and Menière's disease (MD, n=8). All patients underwent neurological and detailed neurootological examinations as well as two standardized interviews and a psychometric examination battery at five different times (T0-T4) over 1 year. The prevalence of psychiatric disorders at baseline (T0) did not differ between the four subgroups. Only patients with VM showed significantly higher rates of psychiatric disorders (p=0.044) in the follow-up over 1 year. Patients with a positive history of psychiatric disorders before the onset of the vestibular disorder had significantly increased rates of psychiatric disorders compared to patients with a negative history of psychiatric disorders (T1: p=0.004, T3: p=0.015, T4: p=0.012). The extent of vestibular deficit or dysfunction did not have any influence on the further course of the vestibular disease with respect to the development of psychiatric disorders. A positive history of psychiatric disorders is a strong predictor for the development of reactive psychiatric disorders following a vestibular vertigo syndrome. Especially patients with vestibular migraine are at risk of developing somatoform dizziness. The degree of vestibular dysfunction does not correlate with the development of psychiatric disorders.
BibTeX: @article{Best2009a, author = {Best, Christoph and Eckhardt-Henn, Annegret and Tschan, Regine and Dieterich, Marianne}, title = {Psychiatric morbidity and comorbidity in different vestibular vertigo syndromes. Results of a prospective longitudinal study over one year.}, journal = {Journal of neurology}, year = {2009}, volume = {256}, issue = {1}, pages = {58--65}, doi = {https://doi.org/10.1007/s00415-009-0038-8}, keywords = {Adult; Aged; Comorbidity; Female; Follow-Up Studies; Humans; Male; Meniere Disease, diagnosis, epidemiology, physiopathology, psychology; Mental Disorders, diagnosis, epidemiology, physiopathology; Middle Aged; Migraine Disorders, diagnosis, epidemiology, physiopathology, psychology; Physical Examination, methods; Prevalence; Prospective Studies; Psychiatric Status Rating Scales; Risk Factors; Syndrome; Vertigo, diagnosis, epidemiology, physiopathology; Vestibular Function Tests, methods; Vestibular Neuronitis, diagnosis, epidemiology, physiopathology, psychology; Young Adult}, pmid = {19221849} }
Reale, L., Guarnera, M., Grillo, C., Maiolino, L., Ruta, L. and Mazzone, L.	Psychological assessment in children and adolescents with Benign Paroxysmal Vertigo. [Abstract] [BibTeX]	2011	Brain & development Vol. 33(2), pp. 125-130	article	DOI
Abstract: Migraine in childhood and adolescence has been associated with the presence of behavioural and emotional difficulties, but only few data are available with respect to unusual types of headache syndromes such as Benign Paroxysmal Vertigo of Childhood (BPVC). Aim of the present study was to evaluate the behavioural and emotional profiles of clinically referred children and adolescents suffering from BPVC and migraine, as compared to normal controls. According to the revised International Classification of Headache Disorders (ICHD-2) the BPVC belongs to the category of "primary headache", as a migraine equivalent, in a subset that is called "periodic syndromes of childhood". A total of 60 clinically referred children and adolescents (4-15 years) 21 suffering from BPVC and 20 from migraine, according to the diagnostic criteria of the ICHD-2, and 19 normal control (NC) were recruited in this study. Psychological assessment were performed using the Child Behaviour Checklist (CBCL), the Children's Depression Inventory (CDI) and the Multidimensional Anxiety Scale for Children (MASC). Although most of the patients suffering from headache had scores within the normative non-pathological range, both BPVC and migraine patients had significantly higher CBCL total, internalizing, and externalizing scores, as compared to NC. Furthermore, both BPVC and migraine groups displayed significantly higher CDI and MASC scores than NC group. No differences were found between the two types of headache. In conclusion, clinically referred children and adolescents with BPVC and migraine showed higher indices of behavioural and emotional symptoms, both internalizing and externalizing, as compared to normal peers.
BibTeX: @article{Reale2011, author = {Reale, Laura and Guarnera, Manuela and Grillo, Caterina and Maiolino, Luigi and Ruta, Liliana and Mazzone, Luigi}, title = {Psychological assessment in children and adolescents with Benign Paroxysmal Vertigo.}, journal = {Brain & development}, year = {2011}, volume = {33}, issue = {2}, pages = {125--130}, doi = {https://doi.org/10.1016/j.braindev.2010.03.006}, keywords = {Adolescent; Analysis of Variance; Behavioral Symptoms, diagnosis, etiology; Benign Paroxysmal Positional Vertigo; Chi-Square Distribution; Child; Child, Preschool; Diagnostic Techniques, Ophthalmological; Electroencephalography; Female; Humans; Male; Mood Disorders, diagnosis, etiology; Neurologic Examination, methods; Physical Examination, methods; Psychological Tests; Vertigo, complications, diagnosis, psychology}, pmid = {20395088} }
Piker, E.G., Jacobson, G.P., McCaslin, D.L. and Grantham, S.L.	Psychological comorbidities and their relationship to self-reported handicap in samples of dizzy patients. [Abstract] [BibTeX]	2008	Journal of the American Academy of Audiology Vol. 19(4), pp. 337-347	article
Abstract: Factors such as anxiety, depression, somatic awareness, autonomic symptoms, and differences in coping strategies are known to affect dizziness handicap. We studied these factors in 63 consecutive "dizzy" patients. This sample was subgrouped into normals and patients with benign paroxysmal positional vertigo, compensated and uncompensated unilateral peripheral vestibular system impairment, or abnormal vestibular evoked myogenic potential as a single significant diagnostic finding. Results showed that (1) anxiety and depression occur with greater frequency in dizzy patients than in the normal population; (2) the magnitude of anxiety, depression, somatization, and autonomic symptoms does not differ significantly in subgroups of patients; (3) women tended to report greater handicap and somatic/autonomic symptoms; and (4) Dizziness Handicap Inventory total scores were correlated with patients' complaints of somatic/autonomic symptoms, anxiety, depression, and coping strategies. These findings suggest that self-reported measures represent unique pieces of information important for the management of dizzy patients.
BibTeX: @article{Piker2008, author = {Piker, Erin G and Jacobson, Gary P and McCaslin, Devin L and Grantham, Sarah L}, title = {Psychological comorbidities and their relationship to self-reported handicap in samples of dizzy patients.}, journal = {Journal of the American Academy of Audiology}, year = {2008}, volume = {19}, issue = {4}, pages = {337--347}, keywords = {Adaptation, Psychological; Adult; Age Distribution; Aged; Anxiety, epidemiology; Autonomic Nervous System Diseases, epidemiology; Comorbidity; Depression, epidemiology; Dizziness, epidemiology, psychology; Female; Humans; Male; Middle Aged; Predictive Value of Tests; Sex Distribution; Surveys and Questionnaires; Vertigo, epidemiology, psychology}, pmid = {18795472} }
Nagarkar, A.N., Gupta, A.K. and Mann, S.B.	Psychological findings in benign paroxysmal positional vertigo and psychogenic vertigo. [Abstract] [BibTeX]	2000	The Journal of otolaryngology Vol. 29(3), pp. 154-158	article
Abstract: A prospective study conducted at the Post Graduate Institute of Medical Education and Research, Chandigarh, India, to study the psychological factors in cases of benign paroxysmal positional vertigo (BPPV) and to compare them with patients with psychogenic vertigo. In the present study, 75 subjects each (25-45 years) with BPPV and psychogenic vertigo were compared with an equal number of age- and sex-matched normal controls using the psychological and audiovestibular test batteries. The psychological variables tested, namely, loneliness, depression, anxiety components, introversion, and social desirability, were found to be statistically significant (p < .01) for the three groups (i.e., BPPV, psychogenic, and control). There was no significant difference among the three groups on the audiovestibular measures. Psychological factors play an important role in patients with BPPV. The provoking activities result in precipitation of an acute attack and the patients experience heightened emotionality because of the incapacitating feeling of severe vertigo.
BibTeX: @article{Nagarkar2000, author = {Nagarkar, A N and Gupta, A K and Mann, S B}, title = {Psychological findings in benign paroxysmal positional vertigo and psychogenic vertigo.}, journal = {The Journal of otolaryngology}, year = {2000}, volume = {29}, issue = {3}, pages = {154--158}, keywords = {Acute Disease; Adult; Anxiety, diagnosis, etiology; Depression, diagnosis, etiology; Female; Humans; Male; Middle Aged; Personality Disorders, diagnosis; Personality Inventory; Posture; Prospective Studies; Severity of Illness Index; Vertigo, diagnosis, psychology}, pmid = {10883828} }
Beyea, J.A. and Parnes, L.S.	Purely vertical upbeat nystagmus in bilateral posterior canal benign paroxysmal positional vertigo: a case report. [Abstract] [BibTeX]	2010	The Laryngoscope Vol. 120(1), pp. 208-209	article	DOI
Abstract: Vertical nystagmus occurs in patients with central vestibular system pathology. Lesions of the pons, medulla, and cerebellum lead to vertical nystagmus. Given this association, vertical nystagmus is considered pathognomonic in nature. We present a case of benign paroxysmal positional vertigo (BPPV) with positive Dix-Hallpike bilaterally, but also with upbeat purely vertical nystagmus in the straight back head hanging position. Computed tomography imaging of the typically pathologic structures in vertical nystagmus (brainstem/posterior fossa) revealed normal anatomy. We propose this case as an instance of peripheral-associated purely vertical nystagmus without central pathology, while building on our previous understanding of BPPV physiology.
BibTeX: @article{Beyea2010, author = {Beyea, Jason A and Parnes, Lorne S}, title = {Purely vertical upbeat nystagmus in bilateral posterior canal benign paroxysmal positional vertigo: a case report.}, journal = {The Laryngoscope}, year = {2010}, volume = {120}, issue = {1}, pages = {208--209}, doi = {https://doi.org/10.1002/lary.20730}, keywords = {Aged; Humans; Male; Nystagmus, Pathologic, complications, diagnostic imaging; Tomography, X-Ray Computed; Vertigo, complications}, pmid = {19798767} }
Traboulsi, H. and Teixido, M.	Qualitative analysis of the Dix-Hallpike maneuver in multi-canal BPPV using a biomechanical model: Introduction of an expanded Dix-Hallpike maneuver for enhanced diagnosis of multi-canal BPPV. [Abstract] [BibTeX]	2017	World journal of otorhinolaryngology - head and neck surgery Vol. 3(3), pp. 163-168	article	DOI
Abstract: Multiple canal BPPV can be a diagnostic challenge to the clinician. This is due in part to the complex anatomy of the labyrinth but also to complex and often simultaneous ocular responses that result from stimulation of multiple canals during traditional diagnostic testing. Our objective was to analyze the Dix-Hallpike maneuver used in the diagnosis of BPPV to look for patterns of simultaneous canal response and to develop a diagnostic maneuver that will allow separation of canal responses in multiple canal BPPV. A previously created and published 3D biomechanical model of the human labyrinths for the study of BPPV was used to analyze and compare the position and movement of otoliths in the Dix-Hallpike maneuver as well as in a proposed expanded version of the traditional Dix-Hallpike maneuver. The traditional Dix-Hallpike maneuver with the head hanging may promote movement of otoliths in 5 of the six semicircular canals. The Dix-Hallpike maneuver with the head lowered only to the horizontal position allows for otoconia in only the lowermost posterior canal to fall to the most gravity dependent position. This position allows for minimal or no movement of otoconia in the contralateral posterior canal, or in either superior canal. Turning the head ninety degrees to the opposite side while still in the horizontal position will provoke otolith movement in only the contralateral posterior canal. The superior canals can then be examined for free otolith debris by extending the neck to a head-hanging position. These positions may be assumed directly from one to the next in the lying position. There seems to be no advantage to sitting up between positions. The Dix-Hallpike maneuver may cause simultaneous movement of otoliths present in multiple canals and create an obstacle to accurate diagnosis in multi-canal BPPV. An expanded Dix-Hallpike maneuver is described which adds intermediate steps with the head positioned to the right and left in the horizontal position before head-hanging. This expanded maneuver has helped to isolate affected semi-circular canals for individual assessment in multiple canal BPPV.
BibTeX: @article{Traboulsi2017, author = {Traboulsi, Henri and Teixido, Michael}, title = {Qualitative analysis of the Dix-Hallpike maneuver in multi-canal BPPV using a biomechanical model: Introduction of an expanded Dix-Hallpike maneuver for enhanced diagnosis of multi-canal BPPV.}, journal = {World journal of otorhinolaryngology - head and neck surgery}, year = {2017}, volume = {3}, issue = {3}, pages = {163--168}, doi = {https://doi.org/10.1016/j.wjorl.2017.01.005}, keywords = {Benign paroxysmal positional vertigo; Biomechanical model; Canalithiasis; Dix-Hallpike; Dizziness; Multiple canal}, pmid = {29516062} }
Rizk, H., Agrawal, Y., Barthel, S., Bennett, M.L., Doherty, J.K., Gerend, P., Gold, D.R., Morrill, D., Oas, J.G., Roberts, J.K., Woodson, E., Zapala, D.A., Bennett, A. and Shenoy, A.M.	Quality Improvement in Neurology: Neurotology Quality Measurement Set. [BibTeX]	2018	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 159(4), pp. 603-607	article	DOI
BibTeX: @article{Rizk2018, author = {Rizk, Habib and Agrawal, Yuri and Barthel, Susan and Bennett, Marc L and Doherty, Joni K and Gerend, Patricia and Gold, Daniel R and Morrill, David and Oas, John G and Roberts, J Kirk and Woodson, Erika and Zapala, David A and Bennett, Amy and Shenoy, Anant M}, title = {Quality Improvement in Neurology: Neurotology Quality Measurement Set.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2018}, volume = {159}, issue = {4}, pages = {603--607}, doi = {https://doi.org/10.1177/0194599818790947}, keywords = {Ménière’s disease; benign paroxysmal positional vertigo (BPPV); neurotology; quality improvement; quality measures; unilateral vestibular hypofunction; vertigo; vestibular migraine}, pmid = {30168353} }
Handa, P.R., Kuhn, A.M.B., Cunha, F., Schaffleln, R. and Ganança, F.F.	Quality of life in patients with benign paroxysmal positional vertigo and/or Ménière's disease. [Abstract] [BibTeX]	2005	Brazilian journal of otorhinolaryngology Vol. 71(6), pp. 776-782	article
Abstract: Patients with benign paroxysmal positional vertigo and/or Ménière's disease relate damages in quality of life. To compare the impact of dizziness on quality of life, in patients with benign paroxysmal positional vertigo and/or Ménière's disease, in crisis and out of crisis, and to evaluate the influence of gender, age and impaired semicircular canal. clinical with transversal cohort. The prospective study was realized in 2003/04 at Federal University of São Paulo. The Dizziness Handicap Inventory was applied in seventy patients with positional vertigo, seventy with Ménière's disease and fifteen with both. Two-proportion equality test and the Analysis of variance were employed in this study. When comparing the groups, Dizziness Handicap Inventory results evidenced higher averages in crisis and out of crisis for Ménière's disease group than for positional vertigo group. The same occurred only during the crisis period in the group when comparing with both disorders (p<0,05). No significant statistical differences were observed, when comparing the results considering age, gender and, in the group with positional vertigo, affection of posterior semicircular canal as variables. Ménière's disease patients presented worse quality of life when compared to BPPV patients, in and out of crisis, and during the crisis when regarding the patients with association of both disorders. The damage on quality of life was independent of gender, age and in the BPPV cases it was independent of posterior canal affection.
BibTeX: @article{Handa2005, author = {Handa, Patrícia Rumi and Kuhn, Ana Maria Baccari and Cunha, Fabiana and Schaffleln, Ricardo and Ganança, Fernando Freitas}, title = {Quality of life in patients with benign paroxysmal positional vertigo and/or Ménière's disease.}, journal = {Brazilian journal of otorhinolaryngology}, year = {2005}, volume = {71}, issue = {6}, pages = {776--782}, keywords = {Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Cohort Studies; Female; Humans; Male; Meniere Disease, complications, physiopathology; Middle Aged; Prospective Studies; Quality of Life; Semicircular Canals, physiopathology; Sex Factors; Surveys and Questionnaires; Vertigo, complications, physiopathology}, pmid = {16878248} }
Boselli, F., Kleiser, L., Bockisch, C.J., Hegemann, S.C.A. and Obrist, D.	Quantitative analysis of benign paroxysmal positional vertigo fatigue under canalithiasis conditions. [Abstract] [BibTeX]	2014	Journal of biomechanics Vol. 47(8), pp. 1853-1860	article	DOI
Abstract: In our daily life, small flows in the semicircular canals (SCCs) of the inner ear displace a sensory structure called the cupula which mediates the transduction of head angular velocities to afferent signals. We consider a dysfunction of the SCCs known as canalithiasis. Under this condition, small debris particles disturb the flow in the SCCs and can cause benign paroxysmal positional vertigo (BPPV), arguably the most common form of vertigo in humans. The diagnosis of BPPV is mainly based on the analysis of typical eye movements (positional nystagmus) following provocative head maneuvers that are known to lead to vertigo in BPPV patients. These eye movements are triggered by the vestibulo-ocular reflex, and their velocity provides an indirect measurement of the cupula displacement. An attenuation of the vertigo and the nystagmus is often observed when the provocative maneuver is repeated. This attenuation is known as BPPV fatigue. It was not quantitatively described so far, and the mechanisms causing it remain unknown. We quantify fatigue by eye velocity measurements and propose a fluid dynamic interpretation of our results based on a computational model for the fluid-particle dynamics of a SCC with canalithiasis. Our model suggests that the particles may not go back to their initial position after a first head maneuver such that a second head maneuver leads to different particle trajectories causing smaller cupula displacements.
BibTeX: @article{Boselli2014, author = {Boselli, F and Kleiser, L and Bockisch, C J and Hegemann, S C A and Obrist, D}, title = {Quantitative analysis of benign paroxysmal positional vertigo fatigue under canalithiasis conditions.}, journal = {Journal of biomechanics}, year = {2014}, volume = {47}, issue = {8}, pages = {1853--1860}, doi = {https://doi.org/10.1016/j.jbiomech.2014.03.019}, keywords = {Benign Paroxysmal Positional Vertigo; Computer Simulation; Eye Movements; Fatigue, physiopathology; Humans; Models, Anatomic; Nystagmus, Pathologic, physiopathology; Semicircular Canals, physiopathology; Time Factors; Vertigo, physiopathology; BPPV; Canalithiasis; Endolymph flow; Force Coupling Method; Method of Fundamental Solutions; Nystagmus; Semicircular canals (SCCs)}, pmid = {24720888} }
Mizukoshi, K., Kobayashi, H., Ohashi, N. and Watanabe, Y.	Quantitative analysis of the visual vestibulo-ocular reflex using sinusoidal rotation in patients with peripheral vestibular disorders. [Abstract] [BibTeX]	1984	Acta oto-laryngologica. Supplementum Vol. 406, pp. 178-181	article
Abstract: In order to investigate interaction of the vestibular and optokinetic systems in patients with peripheral vestibular disorders, the visual vestibulo-ocular reflex (V-VOR) gain in 49 patients with peripheral vestibular disorders was quantitatively measured by using pendular harmonic sinusoidal rotation with optokinetic stationary stimuli. The patients were rotated sinusoidally both with eyes closed and open at an amplitude of 240 degrees and at a frequency of 0.1 Hz (peak velocity 75.4%s). Comparing the vestibulo-ocular reflex (VOR) and V-VOR gains in the patients with definite Meniere's disease (23 cases), benign paroxysmal positional vertigo (BPPV, 13 cases) and sudden deafness with vertigo or dizziness (13 cases), the VOR-DP and normal V-VOR gain were more frequently observed in patients with Meniere's disease (13 cases) and sudden deafness (7 cases) than in those with the BPPV (3 cases). In the four patients with bilateral Meniere's disease and sudden deafness, abnormally decreased VOR-gain (under 0.55) in the bilateral directions with slightly decreased V-VOR gain was measured when tested independently. However, abnormal V-VOR gain was observed in only one case of sudden deafness due to retrocochlear lesions. From our VOR and V-VOR gain observations comparing the caloric responses, we have concluded that the comparison of VOR with V-VOR gains provides additional information for evaluation of peripheral vestibular disorders as well as central nervous system disorders.
BibTeX: @article{Mizukoshi1984, author = {Mizukoshi, K and Kobayashi, H and Ohashi, N and Watanabe, Y}, title = {Quantitative analysis of the visual vestibulo-ocular reflex using sinusoidal rotation in patients with peripheral vestibular disorders.}, journal = {Acta oto-laryngologica. Supplementum}, year = {1984}, volume = {406}, pages = {178--181}, keywords = {Computers; Dizziness, physiopathology; Female; Hearing Loss, Sudden, physiopathology; Humans; Male; Meniere Disease, physiopathology; Nystagmus, Physiologic; Oculomotor Nerve, physiopathology; Reflex; Vertigo, physiopathology; Vestibular Function Tests; Vestibular Nerve, physiopathology; Vestibule, Labyrinth, physiopathology}, pmid = {6332455} }
Li, J., Guo, P., Tian, S., Li, K. and Zhang, H.	Quick repositioning maneuver for horizontal semicircular canal benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2015	Journal of otology Vol. 10(3), pp. 115-117	article	DOI
Abstract: To investigate the efficacy of quick repositioning maneuver for horizontal semicircular canal benign paroxysmal positional vertigo (H-BPPV). Clinical data of 67 patients with H-BPPV who underwent quick repositioning maneuver in our hospital from July 2009 to November 2014 were retrospectively analyzed. The maneuver involved rotating the patient in the axial plane for 180° from the involved side towards contralateral side as quickly as possible. Complete symptom resolution was achieved in 61 patients (91.0%) at one week and in 64 patients (95.5%) at 3 months post-treatment. During the repositioning maneuver process, there were no obvious untoward responses except transient nausea with or without vomiting in a few patients. The results indicate that the quick repositioning maneuver is an easy and effective alternative treatment in the management of H-BPPV.
BibTeX: @article{Li2015, author = {Li, Jinrang and Guo, Pengfei and Tian, Shiyu and Li, Keliang and Zhang, Hao}, title = {Quick repositioning maneuver for horizontal semicircular canal benign paroxysmal positional vertigo.}, journal = {Journal of otology}, year = {2015}, volume = {10}, issue = {3}, pages = {115--117}, doi = {https://doi.org/10.1016/j.joto.2015.11.005}, keywords = {Horizontal semicircular canal; Repositioning maneuver; Vertigo; Vestibular diseases}, pmid = {29937793} }
Kim, J.-S., Oh, S.-Y., Lee, S.-H., Kang, J.-H., Kim, D.U., Jeong, S.-H., Choi, K.-D., Moon, I.-S., Kim, B.-K., Oh, H.J. and Kim, H.J.	Randomized clinical trial for apogeotropic horizontal canal benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2012	Neurology Vol. 78(3), pp. 159-166	article	DOI
Abstract: To determine the immediate and long-term therapeutic efficacies of Gufoni and head-shaking maneuvers in apogeotropic type of benign paroxysmal positional vertigo involving the horizontal semicircular canal (HC-BPPV), a randomized, prospective, sham-controlled study was conducted. In 10 nationwide dizziness clinics in Korea, 157 consecutive patients (95 women, age range: 18-89 years, mean age ± SD = 59.9 ± 13.6) with apogeotropic HC-BPPV were randomized to Gufoni (n = 52), head-shaking (n = 54), or sham maneuver (n = 51). For Gufoni maneuver, patients underwent ipsilesional side-lying and upward head-turn for migration of the debris toward the vestibule. Immediate responses were determined within 1 hour after a maximum of 2 trials of each maneuver and in the following day. The patients also had weekly follow-ups for 1 month after the initial maneuver. After a maximum of 2 maneuvers on the initial visit day, Gufoni (38/52, 73.1%) and head-shaking (33/53, 62.3%) maneuvers showed better responses than the sham maneuver (17/49, 34.7%). The cumulative therapeutic effects were also better with Gufoni (p < 0.001) and head-shaking (p = 0.026) maneuvers compared with the sham maneuver. However, therapeutic efficacies did not differ between the Gufoni and head-shaking groups in terms of both immediate (p = 0.129) and long-term (p = 0.239) outcomes. Using a prospective randomized trial, we demonstrated that the Gufoni and head-shaking maneuvers are effective in treating apogeotropic HC-BPPV. This study provides Class II evidence that Gufoni and head-shaking maneuvers are effective in treating apogeotropic horizontal BPPV up to 1 month after initial treatment. NCT00810641.
BibTeX: @article{Kim2012d, author = {Kim, J-S and Oh, S-Y and Lee, S-H and Kang, J-H and Kim, D U and Jeong, S-H and Choi, K-D and Moon, I-S and Kim, B-K and Oh, H J and Kim, H J}, title = {Randomized clinical trial for apogeotropic horizontal canal benign paroxysmal positional vertigo.}, journal = {Neurology}, year = {2012}, volume = {78}, issue = {3}, pages = {159--166}, doi = {https://doi.org/10.1212/WNL.0b013e31823fcd26}, keywords = {Adolescent; Adult; Exercise Therapy, methods, statistics & numerical data; Female; Head Movements; Humans; Male; Middle Aged; Prevalence; Republic of Korea, epidemiology; Treatment Outcome; Vertigo, epidemiology, rehabilitation}, pmid = {22170885} }
Kim, J.S., Oh, S.-Y., Lee, S.-H., Kang, J.H., Kim, D.U., Jeong, S.-H., Choi, K.-D., Moon, I.S., Kim, B.K. and Kim, H.J.	Randomized clinical trial for geotropic horizontal canal benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2012	Neurology Vol. 79(7), pp. 700-707	article	DOI
Abstract: To determine the immediate and long-term therapeutic efficacies of barbecue rotation and Gufoni maneuvers, a randomized, prospective, and sham-controlled study was conducted in patients with the geotropic type of benign paroxysmal positional vertigo involving the horizontal semicircular canal (HC-BPPV). In 10 nationwide dizziness clinics in Korea, 170 consecutive patients (107 women, age range 11-97 years, mean age ± SD 61 ± 15 years, median = 61 years) with geotropic HC-BPPV were randomly assigned to barbecue rotation (n = 56), Gufoni (n = 64), or sham maneuver (n = 50). An immediate response was determined within 1 hour after a maximum of 2 trials of each maneuver on the visit day. We also assessed the cumulative results of each maneuver by following up the patients for 1 month. After a maximum of 2 maneuvers on the initial visit day, barbecue rotation (38 of 55 [69.1%]) and Gufoni (39 of 64 [60.9%]) maneuvers showed better responses than the sham maneuver (17 of 48 [35.4%]). The cumulative therapeutic effects were also better with barbecue rotation (p = 0.006) and Gufoni (p = 0.031) maneuvers than with the sham maneuver. However, therapeutic efficacies did not differ between the barbecue rotation and Gufoni groups in terms of both immediate (p = 0.46) and long-term (p = 0.10) outcomes. Using a prospective randomized trial, we demonstrated that barbecue rotation and Gufoni maneuvers are effective in treating geotropic HC-BPPV. This study provides Class I evidence that barbecue rotation and Gufoni maneuvers are effective in the treatment of geotropic HC-BPPV.
BibTeX: @article{Kim2012a, author = {Kim, Ji Soo and Oh, Sun-Young and Lee, Seung-Han and Kang, Ji Hoon and Kim, Dong Uk and Jeong, Seong-Hae and Choi, Kwang-Dong and Moon, In Soo and Kim, Byung Kun and Kim, Hyo Jung}, title = {Randomized clinical trial for geotropic horizontal canal benign paroxysmal positional vertigo.}, journal = {Neurology}, year = {2012}, volume = {79}, issue = {7}, pages = {700--707}, doi = {https://doi.org/10.1212/WNL.0b013e3182648b8b}, keywords = {Aged; Benign Paroxysmal Positional Vertigo; Female; Head Movements, physiology; Humans; Male; Middle Aged; Patient Positioning, methods; Posture, physiology; Rotation; Treatment Outcome; Vertigo, physiopathology, therapy}, pmid = {22855868} }
Dorresteijn, P.M., Ipenburg, N.A., Murphy, K.J., Smit, M., van Vulpen, J.K., Wegner, I., Stegeman, I. and Grolman, W.	Rapid Systematic Review of Normal Audiometry Results as a Predictor for Benign Paroxysmal Positional Vertigo. [Abstract] [BibTeX]	2014	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 150(6), pp. 919-924	article	DOI
Abstract: To evaluate whether absence of hearing loss on pure-tone audiometry (PTA) is reliable as a diagnostic test for predicting benign paroxysmal positional vertigo (BPPV) in adult patients with vertigo. PubMed, Embase, and the Cochrane Library. A systematic literature search was conducted on December 10, 2013. Relevant publications were selected based on title, abstract, and full text. Selected articles were assessed for relevance and risk of bias using predetermined criteria. Prevalence and the positive and negative predictive value (PPV and NPV) were extracted. Of 603 retrieved publications, 1 article with high relevance and moderate risk of bias was included. In this study, the prevalence of BPPV was 28%. The PPV of hearing loss assessed by PTA was 31% (95% CI, 17-49) and the NPV was 73% (95% CI, 61-83). The absence of hearing loss on PTA decreased the risk of BPPV by 1%. There is insufficient high-quality evidence regarding the diagnostic value of the absence of hearing loss, assessed by PTA, for predicting BPPV in adult patients with vertigo.
BibTeX: @article{Dorresteijn2014, author = {Dorresteijn, Paul M and Ipenburg, Norbertus A and Murphy, Kathryn J and Smit, Michelle and van Vulpen, Jonna K and Wegner, Inge and Stegeman, Inge and Grolman, Wilko}, title = {Rapid Systematic Review of Normal Audiometry Results as a Predictor for Benign Paroxysmal Positional Vertigo.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2014}, volume = {150}, issue = {6}, pages = {919--924}, doi = {https://doi.org/10.1177/0194599814527233}, keywords = {Audiometry, Pure-Tone; Benign Paroxysmal Positional Vertigo, diagnosis, etiology; Hearing Loss, complications, diagnosis; Humans; Predictive Value of Tests; Reproducibility of Results; BPPV; benign paroxysmal positional vertigo; hearing loss; pure-tone audiometry; systematic review; vertigo}, pmid = {24642523} }
Reinink, H., Wegner, I., Stegeman, I. and Grolman, W.	Rapid systematic review of repeated application of the epley maneuver for treating posterior BPPV. [Abstract] [BibTeX]	2014	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 151(3), pp. 399-406	article	DOI
Abstract: To evaluate the effect of repeated application of the Epley maneuver on patient-reported symptom relief and resolution of nystagmus in patients with posterior benign paroxysmal positional vertigo (p-BPPV). PubMed, Embase, and the Cochrane Library. A systematic search was conducted. Studies reporting original study data were included. Relevance and risk of bias (RoB) of the selected articles were assessed. Studies with low relevance, high RoB, or both were excluded. Success percentages and mean values were extracted. A total of 955 unique studies were retrieved. Fourteen of these satisfied the eligibility criteria. All of the included studies carried a high relevance and a moderate RoB. The majority of studies were 1-armed trials, in which the Epley was repeated only in case previous attempt(s) had failed. The maneuver was not repeated if it was successful. In 32% to 90% of patients, the first treatment session was successful. Reported cumulative success percentages ranged from 40% to 100% after the second session, 67% to 98% after the third session, 87% to 100% after the fourth session, and 100% in the studies in which patients received 5 sessions. One study evaluating the effect of multiple maneuvers in a single session showed a rise in success percentages from 84% for 1 maneuver to 90% after 2 maneuvers and 92% after 3 maneuvers. Multiple studies with moderate RoB show a beneficial effect of multiple sessions of the Epley maneuver in p-BPPV patients who are not fully cleared of symptoms after the first session.
BibTeX: @article{Reinink2014, author = {Reinink, Hendrik and Wegner, Inge and Stegeman, Inge and Grolman, Wilko}, title = {Rapid systematic review of repeated application of the epley maneuver for treating posterior BPPV.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2014}, volume = {151}, issue = {3}, pages = {399--406}, doi = {https://doi.org/10.1177/0194599814536530}, keywords = {Adult; Benign Paroxysmal Positional Vertigo; Exercise Therapy, methods; Female; Humans; Male; Middle Aged; Patient Positioning, methods; Physical Therapy Modalities; Posture, physiology; Semicircular Canals, physiopathology; Time Factors; Treatment Outcome; Vertigo, diagnosis, rehabilitation; Young Adult; BPPV; CRP; Epley; canalith repositioning maneuver; systematic review; vertigo}, pmid = {24876167} }
van Duijn, J.G., Isfordink, L.M., Nij Bijvank, J.A., Stapper, C.W., van Vuren, A.J., Wegner, I., Kortekaas, M.F. and Grolman, W.	Rapid Systematic Review of the Epley Maneuver for Treating Posterior Canal Benign Paroxysmal Positional Vertigo. [Abstract] [BibTeX]	2014	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 150(6), pp. 925-932	article	DOI
Abstract: The aim of this study was to compare watchful waiting to the Epley maneuver as a management option for patients with posterior canal benign paroxysmal positional vertigo (p-BPPV) regarding symptom relief. PubMed, Embase, and The Cochrane Library. A systematic search was conducted. Studies reporting original study data were included. Relevance and risk of bias (RoB) of the selected articles were assessed. Studies with low relevance, high RoB, or both were excluded. Absolute risk differences and their 95% confidence intervals (CIs) were extracted for the included studies. A total of 1448 unique studies were retrieved. Eight of these satisfied the eligibility criteria. At 1-week follow-up, all included studies reported a clinically relevant effect in favor of the Epley maneuver regarding symptom relief (absolute risk differences ranging from 20% [95% CI, 5%-37%] to 59% [95% CI, 32%-76%]) or conversion to a negative Dix-Hallpike (absolute risk differences ranging from 17% [95% CI, -5%-37%] to 64% [95% CI, 29%-79%]). At 1-month follow-up, the results of the included studies diverged further. Absolute risk differences ranged from 6% (95% CI, -24%-35%) more symptom relief in favor of watchful waiting to 79% (95% CI, 56%-88%) in favor of the Epley maneuver. All data of the selected studies show a benefit in favor of the Epley maneuver at 1-week follow-up in the management of p-BPPV. The Epley maneuver should be considered in all patients with p-BPPV.
BibTeX: @article{Duijn2014, author = {van Duijn, Jeroen G and Isfordink, Liz M and Nij Bijvank, Jenny A and Stapper, Carlijne W and van Vuren, Annelies J and Wegner, Inge and Kortekaas, Marlous F and Grolman, Wilko}, title = {Rapid Systematic Review of the Epley Maneuver for Treating Posterior Canal Benign Paroxysmal Positional Vertigo.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2014}, volume = {150}, issue = {6}, pages = {925--932}, doi = {https://doi.org/10.1177/0194599814527732}, keywords = {Benign Paroxysmal Positional Vertigo, therapy; Humans; Musculoskeletal Manipulations; Watchful Waiting; BPPV; Epley; systematic review; vertigo}, pmid = {24687942} }
Wegner, I., Niesten, M.E.F., van Werkhoven, C.H. and Grolman, W.	Rapid Systematic Review of the Epley Maneuver versus Vestibular Rehabilitation for Benign Paroxysmal Positional Vertigo. [Abstract] [BibTeX]	2014	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 151(2), pp. 201-207	article	DOI
Abstract: To evaluate the effectiveness of the Epley maneuver compared with vestibular rehabilitation on patient-reported symptom relief and conversion of the Dix-Hallpike from positive to negative in patients with posterior benign paroxysmal positional vertigo (p-BPPV). PubMed, Embase, and the Cochrane Library. A systematic search was conducted. Studies reporting original study data were included. Relevance and risk of bias (RoB) of the selected articles were assessed. Studies with low relevance, high RoB, or both were excluded. For outcomes of interest, absolute risk differences and their 95% confidence intervals (CIs) were extracted. A total of 373 unique studies were retrieved. Five of these satisfied the eligibility criteria. One study with low RoB and 3 studies with moderate RoB showed that the Epley maneuver is more effective than vestibular rehabilitation at 1-week follow-up with regard to patient-reported symptom relief and conversion of the Dix-Hallpike maneuver from positive to negative (risk differences range from 10% [95% CI, 30-47] to 55% [95% CI, 35-71]). There is inconsistent evidence for the effectiveness of the Epley maneuver compared with vestibular rehabilitation at 1-month follow-up. Most studies suggest that the Epley maneuver and vestibular rehabilitation are equally effective at 1-month follow-up. The Epley maneuver is more effective in treating p-BPPV than vestibular rehabilitation at 1-week follow-up. There is inconsistent evidence for the effectiveness of the Epley maneuver compared with vestibular rehabilitation at 1-month follow-up.
BibTeX: @article{Wegner2014, author = {Wegner, Inge and Niesten, Marlien E F and van Werkhoven, Cornelis H and Grolman, Wilko}, title = {Rapid Systematic Review of the Epley Maneuver versus Vestibular Rehabilitation for Benign Paroxysmal Positional Vertigo.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2014}, volume = {151}, issue = {2}, pages = {201--207}, doi = {https://doi.org/10.1177/0194599814534940}, keywords = {Benign Paroxysmal Positional Vertigo, rehabilitation; Exercise Movement Techniques; Humans; Patient Positioning, methods; Physical Therapy Modalities; BPPV; CRP; Epley; rehabilitation therapy; systematic review; vertigo; vestibular therapy}, pmid = {24847048} }
Kahraman, S.S. and Arli, C.	Re: "Symptom Resolution Rates of Posttraumatic versus Nontraumatic Benign Paroxysmal Positional Vertigo: A Systematic Review". [BibTeX]	2015	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 153(5), pp. 896	article	DOI
BibTeX: @article{Kahraman2015, author = {Kahraman, Serif Samil and Arli, Cengiz}, title = {Re: "Symptom Resolution Rates of Posttraumatic versus Nontraumatic Benign Paroxysmal Positional Vertigo: A Systematic Review".}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2015}, volume = {153}, issue = {5}, pages = {896}, doi = {https://doi.org/10.1177/0194599815601991}, keywords = {Benign Paroxysmal Positional Vertigo; Craniocerebral Trauma, complications; Humans; Posture, physiology; Recovery of Function; Semicircular Canals, physiopathology}, pmid = {26527753} }
Volkenstein, S. and Dazert, S.	Recent surgical options for vestibular vertigo. [Abstract] [BibTeX]	2017	GMS current topics in otorhinolaryngology, head and neck surgery Vol. 16, pp. Doc01	article	DOI
Abstract: Vertigo is not a well-defined disease but a symptom that can occur in heterogeneous entities diagnosed and treated mainly by otolaryngologists, neurologists, internal medicine, and primary care physicians. Most vertigo syndromes have a good prognosis and management is predominantly conservative, whereas the need for surgical therapy is rare, but for a subset of patients often the only remaining option. In this paper, we describe and discuss different surgical therapy options for hydropic inner ear diseases, Menière's disease, dehiscence syndromes, perilymph fistulas, and benign paroxysmal positional vertigo. At the end, we shortly introduce the most recent developments in regard to vestibular implants. Surgical therapy is still indicated for vestibular disease in selected patients nowadays when conservative options did not reduce symptoms and patients are still suffering. Success depends on the correct diagnosis and choosing among different procedures the ones going along with an adequate patient selection. With regard to the invasiveness and the possible risks due to surgery, in depth individual counseling is absolutely necessary. Ablative and destructive surgical procedures usually achieve a successful vertigo control, but are associated with a high risk for hearing loss. Therefore, residual hearing has to be included in the decision making process for surgical therapy.
BibTeX: @article{Volkenstein2017, author = {Volkenstein, Stefan and Dazert, Stefan}, title = {Recent surgical options for vestibular vertigo.}, journal = {GMS current topics in otorhinolaryngology, head and neck surgery}, year = {2017}, volume = {16}, pages = {Doc01}, doi = {https://doi.org/10.3205/cto000140}, keywords = {Menière’s disease; dehiscence syndrome; endolymphatic sac surgery; peripheral vestibular vertigo; surgical treatment; vestibular implants}, pmid = {29279721} }
Massey, B.J., Osborne, R., Beneciuk, J.M. and Rowe, R.H.	Recognition and management of BPPV for an elderly female patient referred for low back pain: a resident's case study. [Abstract] [BibTeX]	2014	Physiotherapy theory and practice Vol. 30(6), pp. 444-451	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is common among older adults and frequently misdiagnosed or unidentified. Undiagnosed BPPV has been associated with depression, falls and ADL limitations. This case study describes the diagnostic process and management of BPPV for a 65-year-old patient with a primary complaint of chronic low back pain (LBP) in an outpatient orthopedic physical therapy setting. Following routine screening performed on initial evaluation, the patient was educated about examination findings that indicated the potential for BPPV and given the option to proceed with further assessment or defer until LBP was under control. The patient attended 16 visits over the course of care and the complaint of vertigo, described as a true spinning sensation, was assessed further on the visit 5. Continued assessment confirmed BPPV and the canalith repositioning procedure was administered. Following positive response to this intervention, the maneuver was re-administered on visit 6. Complete resolution of symptoms was reported on visit 7 and for the remainder of physical therapy services over the following month. Physical therapists may play a vital role in reducing healthcare expenses associated with cost to arrive at the diagnosis of BPPV, as well as improving the quality of life and safety of the older adult population affected by BPPV.
BibTeX: @article{Massey2014, author = {Massey, B James and Osborne, Raine and Beneciuk, Jason M and Rowe, Robert H}, title = {Recognition and management of BPPV for an elderly female patient referred for low back pain: a resident's case study.}, journal = {Physiotherapy theory and practice}, year = {2014}, volume = {30}, issue = {6}, pages = {444--451}, doi = {https://doi.org/10.3109/09593985.2014.893597}, keywords = {Aged; Benign Paroxysmal Positional Vertigo, diagnosis, rehabilitation; Chronic Pain, diagnosis, rehabilitation, surgery; Diagnosis, Differential; Disability Evaluation; Female; Humans; Laminectomy, methods; Low Back Pain, diagnosis, rehabilitation, surgery; Pain Measurement; Physical Examination, methods; Physical Therapy Modalities; Risk Assessment; Severity of Illness Index; Treatment Outcome; Benign paroxysmal positional vertigo; modified epley maneuver; physical therapy; vertigo}, pmid = {24597728} }
Fife, T.D.	Recognition and management of horizontal canal benign positional vertigo. [Abstract] [BibTeX]	1998	The American journal of otology Vol. 19(3), pp. 345-351	article
Abstract: We reviewed the features of nystagmus in 24 patients with horizontal canal benign positional vertigo (BPV). Patients were treated with canalith repositioning maneuvers. Our goal was to develop a framework for distinguishing horizontal from posterior canal BPV and to further develop a mechanistic model explaining the horizontal canal variant of BPV. The study design was a retrospective case review with prospective treatment outcome and follow-up. The study was performed at a secondary and tertiary referral center for vertigo and dizziness. The diagnosis of horizontal canal BPV was based on: 1) recurrent brief episodes of positional vertigo; 2) paroxysmal bursts of horizontal positional nystagmus; and 3) lack of any other identifiable central nervous system disorder to explain the nystagmus. Patient average age was 62 years, and average duration of symptoms was 12 weeks. We documented patients' symptoms and the characteristics of nystagmus. We reviewed the effectiveness of several similar canalith repositioning treatments. We observed and recorded factors that distinguish horizontal from posterior canal BPV. We monitored the direction of nystagmus, the type of maneuver that evoked the nystagmus, and the response to canalith repositioning. Symptom description alone was not sufficient to distinguish among canal types of BPV. Horizontal geotropic direction-changing positional nystagmus was observed in 19 of 24 patients. The other patients had ageotropic nystagmus. Both types were distinct from the nystagmus of posterior canal BPV. Response to canalith repositioning was 75% at 1 week of follow-up. Conversion of BPV from one canal to another occurred in some patients, but each canal could be treated individually. Patients with positional vertigo should undergo Dix-Hallpike positioning and supine lateral head turns to each side. Paroxysmal positional horizontal nystagmus that changes direction with changes in head position strongly suggests the diagnosis. Canalith repositioning for posterior canal BPV may fail in horizontal BPV. A 360 degrees barbecue rotation toward the presumably healthy ear done two to four times or until nystagmus disappears may result in more rapid resolution of symptoms.
BibTeX: @article{Fife1998, author = {Fife, T D}, title = {Recognition and management of horizontal canal benign positional vertigo.}, journal = {The American journal of otology}, year = {1998}, volume = {19}, issue = {3}, pages = {345--351}, keywords = {Adult; Aged; Aged, 80 and over; Electronystagmography, methods; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nystagmus, Pathologic, diagnosis; Posture; Prospective Studies; Retrospective Studies; Vertigo, diagnosis, therapy; Vestibular Function Tests}, pmid = {9596187} }
Sugita-Kitajima, A. and Koizuka, I.	Recovery of otolith function in patients with benign paroxysmal positional vertigo evaluated by sinusoidal off-vertical axis rotation. [Abstract] [BibTeX]	2008	Neuroscience letters Vol. 436(2), pp. 124-127	article	DOI
Abstract: The vestibulo-ocular reflex (VOR) was studied via sinusoidal off-vertical axis rotation (OVAR) to evaluate otolith function in patients with benign paroxysmal positional vertigo (BPPV). Subjects were sinusoidally rotated with eyes open in complete darkness at frequencies of 0.4 and 0.8 Hz with a maximum angular velocity of 60 degrees /s in earth vertical axis rotation (EVAR) and OVAR. Ten patients with BPPV patients were investigated. We performed OVAR tests for all patients for the following different points and compared otolith function: (1) The point at which patients had typical nystagmus; we call this state 'Before', that is, before recovery. (2) The point when their nystagmus disappeared; we call this state 'After' that is, after nystagmus disappear. Results showed that VOR gain during OVAR at 0.8 Hz in a 30 degrees nose-up position in BPPV patients was significantly less than the gain during EVAR at the point Before. On the other hand, gain was not significantly different between EVAR and OVAR at the point After. VOR gain itself at 0.8 Hz nose-up OVAR showed a significant increase at the point After compared to Before. This increase of VOR gain might be caused by the recovery of the otolith function in patients with BPPV.
BibTeX: @article{Sugita-Kitajima2008, author = {Sugita-Kitajima, Akemi and Koizuka, Izumi}, title = {Recovery of otolith function in patients with benign paroxysmal positional vertigo evaluated by sinusoidal off-vertical axis rotation.}, journal = {Neuroscience letters}, year = {2008}, volume = {436}, issue = {2}, pages = {124--127}, doi = {https://doi.org/10.1016/j.neulet.2008.03.004}, keywords = {Adult; Female; Humans; Male; Middle Aged; Otolithic Membrane, physiopathology; Recovery of Function, physiology; Reflex, Vestibulo-Ocular, physiology; Rotation; Vertigo, pathology, physiopathology}, pmid = {18372111} }
Imai, T., Okumura, T., Nishiike, S., Takeda, N., Ohta, Y., Osaki, Y., Sato, T. and Inohara, H.	Recovery of positional nystagmus after benign paroxysmal positional vertigo fatigue. [Abstract] [BibTeX]	2018	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 275(12), pp. 2967-2973	article	DOI
Abstract: In benign paroxysmal positional vertigo (BPPV), positional nystagmus is generally weaker when the Dix-Hallpike test is repeated. This phenomenon is known as BPPV fatigue. The positional nystagmus induced by the Dix-Hallpike test can be observed again when time has passed. There has been no study regarding the length of time required to recover the positional nystagmus. The purpose of this study was to examine whether positional nystagmus recovers within 30 min after the disappearance of the nystagmus by BPPV fatigue. This was a prospective observational study. Twenty patients with posterior canal type of BPPV (canalolithiasis of the posterior canal) were included. Dix-Hallpike tests were performed three times for each patient. A second Dix-Hallpike test was performed immediately after the first Dix-Hallpike test. A third Dix-Hallpike test was performed 30 min after the second Dix-Hallpike test. We recorded positional nystagmus induced by the Dix-Hallpike tests and analyzed maximum slow-phase eye velocity (SPEV) of the positional nystagmus. The average maximum SPEV of positional nystagmus induced by the second Dix-Hallpike test (4.8°/s) was statistically lower than that induced by the first Dix-Hallpike test (48.0°/s); this decrease was caused by BPPV fatigue. There was no statistical difference between average maximum SPEV of positional nystagmus induced by the first Dix-Hallpike test and that induced by the third Dix-Hallpike test (41.6°/s); this indicates that the effect of BPPV fatigue disappeared. The effect of BPPV fatigue disappears within 30 min. A second Dix-Hallpike test should be performed at least 30 min after the first.
BibTeX: @article{Imai2018, author = {Imai, Takao and Okumura, Tomoko and Nishiike, Suetaka and Takeda, Noriaki and Ohta, Yumi and Osaki, Yasuhiro and Sato, Takashi and Inohara, Hidenori}, title = {Recovery of positional nystagmus after benign paroxysmal positional vertigo fatigue.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2018}, volume = {275}, issue = {12}, pages = {2967--2973}, doi = {https://doi.org/10.1007/s00405-018-5165-3}, keywords = {Adult; Benign Paroxysmal Positional Vertigo, physiopathology; Female; Humans; Male; Middle Aged; Nystagmus, Physiologic, physiology; Prospective Studies; Recovery of Function, physiology; Vestibular Function Tests; BPPV fatigue; Canalolithiasis; Dix–Hallpike test; Positional nystagmus; Three-dimensional}, pmid = {30324405} }
Luryi, A.L., Lawrence, J., Bojrab, D.I., LaRouere, M., Babu, S., Zappia, J., Sargent, E.W., Chan, E., Naumann, I., Hong, R.S. and Schutt, C.A.	Recurrence in Benign Paroxysmal Positional Vertigo: A Large, Single-Institution Study. [Abstract] [BibTeX]	2018	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 39(5), pp. 622-627	article	DOI
Abstract: To report rates of recurrence in benign paroxysmal positional vertigo (BPPV) and associated patient and disease factors. Retrospective chart review. Single high-volume otology practice. Patients diagnosed with BPPV from 2007 to 2016 with documented resolution of symptoms. Diagnostic and particle repositioning maneuvers for BPPV. BPPV recurrence, time to recurrence, and ear(s) affected at recurrence. A total of 1,105 patients meeting criteria were identified. Of this population, 37% had recurrence of BPPV in either ear or both ears. Overall same-ear recurrence rate was 28%; 76% of recurrences involved the same ear(s) as initial presentation. Recurrences that occurred after longer disease-free intervals were more likely to involve the opposite ear than early recurrences (p = 0.02). Female sex (40.4% versus 32.7%, p = 0.01) and history of previous BPPV (57.5% versus 32.4%, p < 0.0005) were associated with increased risk of recurrence, while history of Menière's disease, diabetes mellitus, and traumatic etiology were not. Approximately, half (56%) of recurrences occurred within 1 year of resolution. A large single-institution study of recurrence in BPPV is presented along with Kaplan-Meier disease-free survival curves. Female sex and history of previous BPPV were associated with increased recurrence, while previously suspected risk factors for recurrence including history of Menière's disease, diabetes, and trauma were not. Remote recurrence is more likely to involve the contralateral ear than early recurrence. These data solidify the expected course of treated BPPV allowing for improved clinical care and patient counseling.
BibTeX: @article{Luryi2018d, author = {Luryi, Alexander L and Lawrence, Juliana and Bojrab, Dennis I and LaRouere, Michael and Babu, Seilesh and Zappia, John and Sargent, Eric W and Chan, Eleanor and Naumann, Ilka and Hong, Robert S and Schutt, Christopher A}, title = {Recurrence in Benign Paroxysmal Positional Vertigo: A Large, Single-Institution Study.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2018}, volume = {39}, issue = {5}, pages = {622--627}, doi = {https://doi.org/10.1097/MAO.0000000000001800}, pmid = {29649052} }
Pérez, P., Franco, V., Cuesta, P., Aldama, P., Alvarez, M.J. and Méndez, J.C.	Recurrence of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2012	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 33(3), pp. 437-443	article	DOI
Abstract: To determine the recurrence rate of benign positional paroxysmal vertigo (BPPV) and the factors associated to such recurrences. Prospective study. Sixty-nine consecutive patients treated for first episode of BPPV. 63 months. Mean follow-up: 47 months. The recurrence rate was 27%. Fifty percent of recurrences occurred in the first 6 months. Nineteen patients had 1 or more recurrence of BPPV; 10 had 1 recurrence, 7 patients had 2, and 2 patients had 3 recurrences. There was no significant difference in the recurrence rate according to sex, age, side, cause of BPPV, or instability after successful treatment. Multi-canal BPPV (log-rank, p = 0.024) and anterior canal BPPV (log-rank, p = 0.029) showed a significantly greater tendency to recur and to do so earlier. There was a significant difference in time to recurrence related to the number of maneuvers used to resolve the initial BPPV episode (log-rank, p = 0.023). Except for cases of BPPV secondary to labyrinthitis or neurolabyrinthitis, at least 70% of the recurrences affected a different side and/or different canal than the primary BPPV. The recurrence rate of BPPV is 27%, and relapse largely occurs in the first 6 months. When BPPV recurrence is suspected, every canal on both sides must be investigated because it is the BPPV syndrome that recurs, rather than BPPV affecting a particular side or canal. Complex cases of BPPV have a greater risk of recurrence.
BibTeX: @article{Perez2012, author = {Pérez, Paz and Franco, Virginia and Cuesta, Paz and Aldama, Patricia and Alvarez, María Jesús and Méndez, Juan Carlos}, title = {Recurrence of benign paroxysmal positional vertigo.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2012}, volume = {33}, issue = {3}, pages = {437--443}, doi = {https://doi.org/10.1097/MAO.0b013e3182487f78}, keywords = {Adult; Age Factors; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Ear Canal, physiopathology; Female; Follow-Up Studies; Functional Laterality, physiology; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Nystagmus, Pathologic, physiopathology; Prospective Studies; Recurrence; Sex Factors; Survival Analysis; Time Factors; Treatment Outcome; Vertigo, epidemiology, physiopathology}, pmid = {22388730} }
Beynon, G.J., Baguley, D.M. and da Cruz, M.J.	Recurrence of symptoms following treatment of posterior semicircular canal benign positional paroxysmal vertigo with a particle repositioning manoeuvre. [Abstract] [BibTeX]	2000	The Journal of otolaryngology Vol. 29(1), pp. 2-6	article
Abstract: A consecutive series of 51 patients (34 females and 17 males) with posterior semicircular canal benign positional paroxysmal vertigo (BPPV) were treated with the modified Epley particle positioning manoeuvre (PRM). Follow-up data were available on all 51 patients. After one manoeuvre, 42 patients had a negative Dix-Hallpike test, and after a second manoeuvre, 8 of the remaining 9 patients had a negative Dix-Hallpike test (testing was conducted 1 to 2 weeks after the PRM was performed). Therefore, the overall short-term success rate after two manoeuvres was 50 of 51 patients (98%), which is similar to other series. A follow-up questionnaire to determine the incidence of recurrence of symptoms was administered after a minimum period of 30 weeks. Twenty-three patients reported a recurrence (or, in the case of the one treatment failure, persistence) of their symptoms (45%). Therefore, although virtually all patients can be treated successfully with the PRM, almost half of these patients can be expected to experience a further recurrence of symptoms. This long-term recurrence rate is higher than has previously been reported and is a significant factor clinicians must be aware of in their treatment of this condition. In particular, this finding emphasizes the need for patient counselling with regard to the likelihood of recurrence and access to follow-up treatment if recurrence occurs.
BibTeX: @article{Beynon2000a, author = {Beynon, G J and Baguley, D M and da Cruz, M J}, title = {Recurrence of symptoms following treatment of posterior semicircular canal benign positional paroxysmal vertigo with a particle repositioning manoeuvre.}, journal = {The Journal of otolaryngology}, year = {2000}, volume = {29}, issue = {1}, pages = {2--6}, keywords = {Counseling; Female; Follow-Up Studies; Humans; Incidence; Logistic Models; Longitudinal Studies; Male; Middle Aged; Posture; Recurrence; Remission Induction; Retreatment; Semicircular Canals, physiopathology; Surveys and Questionnaires; Treatment Outcome; Vertigo, physiopathology, therapy}, pmid = {10709164} }
Kim, Y.H., Kim, K.-S., Kim, K.J., Choi, H., Choi, J.-S. and Hwang, I.K.	Recurrence of vertigo in patients with vestibular neuritis. [Abstract] [BibTeX]	2011	Acta oto-laryngologica Vol. 131(11), pp. 1172-1177	article	DOI
Abstract: CONCLUSION. The recurrence rate of vertigo due to any cause in patients with vestibular neuritis (VN) was about 26.0% in our study. No clinical characteristics were significantly associated with recurrences. We aimed to: 1) determine the prevalence of recurrent VN; 2) compare the clinical characteristics and epidemiologic factors of patients with non-recurrent and recurrent VN; and 3) determine the prevalence of benign paroxysmal positional vertigo (BPPV) in patients with VN. In 131 patients diagnosed as having VN (68 males, aged 49.8 ± 14.9 years and 63 females, aged 57.5 ± 12.5 years), a retrospective chart review and telephone survey about the recurrent vertigo were performed. Vestibular function testing, inner ear magnetic resonance imaging (MRI), and pure tone audiograms were performed on every patient. Vestibular function testing was repeated in patients with recurrences. Fourteen of 131 patients (10.7%) had recurrent VN. The subjective intensity of recurrent VN was less than the first attack. There were no significant differences in clinical characteristics such as accompanying headache or preceding respiratory infection and in epidemiologic risk factors between patients with recurrent and non-recurrent VN. Twenty of 131 patients (15.3%) experienced BPPV during the follow-up period.
BibTeX: @article{Kim2011, author = {Kim, Young Hyo and Kim, Kyu-Sung and Kim, Kyu Jin and Choi, Hoseok and Choi, Jeong-Seok and Hwang, In Kug}, title = {Recurrence of vertigo in patients with vestibular neuritis.}, journal = {Acta oto-laryngologica}, year = {2011}, volume = {131}, issue = {11}, pages = {1172--1177}, doi = {https://doi.org/10.3109/00016489.2011.593551}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo; Female; Humans; Male; Middle Aged; Prevalence; Recurrence; Republic of Korea, epidemiology; Retrospective Studies; Vertigo, epidemiology, etiology; Vestibular Neuronitis, complications, epidemiology}, pmid = {21728751} }
Giacomini, P.G., Napolitano, B., Alessandrini, M., Di Girolamo, S. and Magrini, A.	Recurrent paroxysmal positional vertigo related to oral contraceptive treatment. [Abstract] [BibTeX]	2006	Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology Vol. 22(1), pp. 5-8	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is a high-prevalence vestibular end-organ disorder caused by the detachment of utricular otoconia which float in the posterior or lateral semicircular canal. In the majority of cases the etiology of BPPV is unknown and it may follow viral infection, vascular disorders or head trauma. BPPV may be recurrent, with some authors demonstrating a correlation between recurrence and female gender. We report herein on ten cases (out of 289 diagnoses of BPPV) of recurrent idiopathic BPPV, occurring in healthy women receiving oral contraceptive treatment, which ceased after treatment suspension. It has been hypothesized that the impaired water and electrolyte balance, the variations of endolymphatic pH and the impairment of glucose or lipid metabolism induced by oral contraceptive treatment may cause otoconial degeneration and subsequent otoconia detachment and BPPV. The rarity of the finding (10/289) could account for the poor attention paid to the hormonal pathogenesis of BPPV.
BibTeX: @article{Giacomini2006, author = {Giacomini, Pier Giorgio and Napolitano, Bianca and Alessandrini, Marco and Di Girolamo, Stefano and Magrini, Antonio}, title = {Recurrent paroxysmal positional vertigo related to oral contraceptive treatment.}, journal = {Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology}, year = {2006}, volume = {22}, issue = {1}, pages = {5--8}, doi = {https://doi.org/10.1080/09513590500441614}, keywords = {Adult; Contraceptives, Oral, Hormonal, adverse effects; Female; Humans; Otolithic Membrane, drug effects; Saccule and Utricle, drug effects; Vertigo, chemically induced}, pmid = {16522527} }
	Reducing vertigo symptoms. [BibTeX]	2013	Harvard health letter Vol. 38(9), pp. 5	article
BibTeX: @article{2013,, title = {Reducing vertigo symptoms.}, journal = {Harvard health letter}, year = {2013}, volume = {38}, issue = {9}, pages = {5}, keywords = {Benign Paroxysmal Positional Vertigo; Health Behavior; Humans; Supine Position; Vertigo, prevention & control; Vestibule, Labyrinth}, pmid = {24409541} }
Guerra Jiménez, G. and Pérez Fernández, N.	Reduction in posterior semicircular canal gain by age in video head impulse testing. Observational study. [Abstract] [BibTeX]	2016	Acta otorrinolaringologica espanola Vol. 67(1), pp. 15-22	article	DOI
Abstract: and objectives: In-depth assessment of the vestibulo-ocular reflex with the new video systems available provides information on various previously-unidentified characteristics in patients with peripheral vestibular disorder. The aim of this work is to quantify how often pathological gain (uni- or bilateral) in the posterior semicircular canal (PSC) gain appears in video head-impulse testing (vHIT) with preservation of the gain in the rest of the semicircular canals, and to analyse the relation of this frequency with patient age and/or diagnosis. This was a prospective observational study on adults referred to our unit between June 2012 and February 2014. Age, sex, pathological antecedents, prior history of vestibular pathology, diagnosis and time of evolution of the clinical picture and its characteristics were recorded. Each patient underwent a complete otoneurological examination, including vHIT (Otometrics®). Depending on suspected diagnosis, patients also received cervical vestibular evoked myogenic potential (VEMP) testing, tonal audiometry and speech test, as well as assessment by Neurology and/or nuclear magnetic resonance or computed axial tomography scan imaging study. In all, 363 patients were assessed; 57 (16%) patients (33 males and 24 females; mean age, 57 ± 15 years) showed pathological PSC gains, 46 (81%) unilateral and 11 (19%) bilateral. Ménière's Disease was the most frequent diagnosis, followed by benign paroxysmal positional vertigo (27%). Patients with unilateral involvement were younger than those with bilateral (55 vs. 68 years; p=0.03). In the patients with bilateral involvement, PSC gain and age were related (-0.7; 0.04) and the gain value was symmetrical in both ears (0.7; p=0.05). The gain in the anterior and horizontal canals tended to decrease with age, but without statistical significance in our sample. Of the patients referred for an otoneurological consultation, 16% showed pathological PSC gain (unilateral in 81% and bilateral in 19% of the cases). This gain involvement was attributable to age when the gain was bilateral and symmetrical.
BibTeX: @article{GuerraJimenez2016, author = {Guerra Jiménez, Gloria and Pérez Fernández, Nicolás}, title = {Reduction in posterior semicircular canal gain by age in video head impulse testing. Observational study.}, journal = {Acta otorrinolaringologica espanola}, year = {2016}, volume = {67}, issue = {1}, pages = {15--22}, doi = {https://doi.org/10.1016/j.otorri.2014.12.002}, keywords = {Aged; Female; Head Impulse Test; Humans; Male; Middle Aged; Prospective Studies; Reflex, Vestibulo-Ocular; Semicircular Canals; Vestibular Diseases, diagnosis; Age; Canal semicircular posterior; Edad; Posterior semicircular canal; Test del impulso cefálico; Video head impulse test}, pmid = {25702190} }
Wu, Y., Gu, C., Han, W., Lu, X., Chen, C. and Fan, Z.	Reduction of bone mineral density in native Chinese female idiopathic benign paroxysmal positional vertigo patients. [Abstract] [BibTeX]	2018	American journal of otolaryngology Vol. 39(1), pp. 31-33	article	DOI
Abstract: This study aimed to investigate the clinical association between idiopathic benign paroxysmal positional vertigo (BPPV) and reduction of bone mineral density (BMD). BMD was measured in 78 native Chinese female de novo idiopathic BPPV patients and 126 healthy controls using dual-energy X-ray absorptiometry. We compared the mean T-scores and abnormal BMD prevalence between the two groups. The mean T-scores were significantly lower in idiopathic BPPV patients than in healthy controls. The prevalence of osteopenia and osteoporosis were significantly higher in idiopathic BPPV patients than in healthy controls (65.4% vs 48.4%, p=0.013). BMD reduction may be associated with idiopathic BPPV occurrence.
BibTeX: @article{Wu2018d, author = {Wu, Yunqin and Gu, Chengyao and Han, Weiwei and Lu, Xiaoxiong and Chen, Caijing and Fan, Zhenyi}, title = {Reduction of bone mineral density in native Chinese female idiopathic benign paroxysmal positional vertigo patients.}, journal = {American journal of otolaryngology}, year = {2018}, volume = {39}, issue = {1}, pages = {31--33}, doi = {https://doi.org/10.1016/j.amjoto.2017.09.004}, keywords = {Absorptiometry, Photon, methods; Age Factors; Aged; Asian Continental Ancestry Group, statistics & numerical data; Benign Paroxysmal Positional Vertigo, diagnosis, epidemiology; Bone Density, physiology; Bone Diseases, Metabolic, diagnosis, epidemiology; Case-Control Studies; Comorbidity; Humans; Male; Middle Aged; Osteoporosis, diagnostic imaging, epidemiology; Prevalence; Reference Values; Severity of Illness Index; Benign paroxysmal positional vertigo; Bone mineral density; Occurrence; Osteopenia; Osteoporosis; Otoconia}, pmid = {29042068} }
Talaat, H.S., Kabel, A.-M.H., Khaliel, L.H., Abuhadied, G., El-Naga, H.A.E.-R.A. and Talaat, A.S.	Reduction of recurrence rate of benign paroxysmal positional vertigo by treatment of severe vitamin D deficiency. [Abstract] [BibTeX]	2016	Auris, nasus, larynx Vol. 43(3), pp. 237-241	article	DOI
Abstract: Several studies correlated between vitamin D deficiency and the development, and the recurrence of benign positional paroxysmal vertigo (BPPV), but none of them proved that treatment of vitamin D deficiency would reduce the recurrence rate of BPPV. This study aims to detect the effect of treatment of severe vitamin D deficiency on the recurrence rate of BPPV. The inclusion criteria of the study group were: (1) Unilateral, idiopathic, posterior canal BPPV with no history suggestive of secondary BPPV and (2) 25-hydroxyvitamin D3 level ≤10 ng/ml. All subjects enrolled in the current study underwent detailed clinical history, audiovestibular evaluation consisting of pure-tone audiometry, Immittancemetry, Videonystugmography, serum 25-hydroxyvitamin D3 assessment, and Dual-energy X-ray absorptiometry (DXA). Vitamin D therapy was prescribed for the study group. Serum 25-hydroxyvitamin D3 level was evaluated twice, on recruitment into the study group and 3 months after commencing vitamin D therapy. According to the results of the second evaluation of serum 25-hydroxyvitamin D3, the study group was subdivided into two subgroups: Subgroup (I): including 28 subjects who disclosed elevation of serum 25-hydroxyvitamin D3 level; improvement ≥10 ng/ml. Subgroup (II): including 65 patients who disclosed elevation of serum 25-hydroxyvitamin D3 levels <10 ng/ml. The study group was followed up for 18 months in order to observe the recurrence of BPPV. The differences between both study subgroups (I) & (II) regarding age, sex distribution, and bone mineral density were insignificant. The number of subjects who had recurrence of BPPV in subgroup (I) was 4 (14%) versus 28 subjects (43%) in subgroup (II). The mean values for recurrent attacks/subject in subgroups (I) & (II) were 0.18, and 0.66 attack/subject respectively; these differences between both subgroups were of high statistical significance (p<0.01). The Odds Ratio for development of recurrence of BPPV in subjects with severe vitamin D deficiency was 4.54 (95% CI: 1.41-14.58, p<0.01). The relapse attacks of BPPV affected both ears irrespective of the ear showing the original BPPV attack. The present study indicates that improvement of serum 25-hydroxyvitamin D3 levels is associated with substantial decrease in recurrence of BPPV.
BibTeX: @article{Talaat2016, author = {Talaat, Hossam Sanyelbhaa and Kabel, Abdel-Magied Hasan and Khaliel, Lobna Hamed and Abuhadied, Ghada and El-Naga, Heba Abd El-Rehem Abo and Talaat, Ahmed Sanyelbhaa}, title = {Reduction of recurrence rate of benign paroxysmal positional vertigo by treatment of severe vitamin D deficiency.}, journal = {Auris, nasus, larynx}, year = {2016}, volume = {43}, issue = {3}, pages = {237--241}, doi = {https://doi.org/10.1016/j.anl.2015.08.009}, keywords = {Absorptiometry, Photon; Adult; Benign Paroxysmal Positional Vertigo, epidemiology, prevention & control; Bone Density; Calcifediol, blood; Cholecalciferol, therapeutic use; Comorbidity; Female; Humans; Male; Middle Aged; Recurrence; Severity of Illness Index; Vitamin D Deficiency, blood, drug therapy, epidemiology; Vitamins, therapeutic use; BPPV recurrence; Dizziness; Vertigo; Vitamin D deficiency}, pmid = {26386496} }
Geser, R. and Straumann, D.	Referral and final diagnoses of patients assessed in an academic vertigo center. [Abstract] [BibTeX]	2012	Frontiers in neurology Vol. 3, pp. 169	article	DOI
Abstract: To identify under-diagnosed neuro-otological disorders and to evaluate whether under-diagnosing depends on the age of the patient. Retrospective analysis of medical charts from 951 consecutive patients (685 under and 266 above the age of 65 years) who entered diagnostic procedures at the Interdisciplinary Center for Vertigo and Balance Disorders, University Hospital Zurich, Switzerland. Final diagnoses were compared to referral diagnoses. Relative to referral diagnoses, the proportion of patients finally diagnosed with benign paroxysmal positional vertigo (BPPV) almost doubled both in younger (<65 year from 12.7 to 25.1%) and older patients (from 20.7 to 37.6%). Striking relative increases were found for the diagnoses multisensory dizziness in older patients (from 20.7 to 37.6%) and vestibular migraine in younger patients (1.8 to 20.2%). In both age groups, the proportion of patients with undetermined diagnoses was reduced by about 60% (younger: 69.8 to 9.8%; older: 69.2 to 12.4%) by the diagnostic procedures in the vertigo center. These changes were all significant (p < 0.05) in McNemar tests with continuity correction (2 × 2 tables: focused diagnosis vs. other diagnoses, referral vs. final). Significant changes of diagnoses can be expected by a specialized neuro-otological work-up. In particular, BPPV, multisensory dizziness, and vestibular migraine are under-diagnosed by referring physicians. This finding calls for better education of primary care takers in the field of neuro-otology.
BibTeX: @article{Geser2012, author = {Geser, Rebekka and Straumann, Dominik}, title = {Referral and final diagnoses of patients assessed in an academic vertigo center.}, journal = {Frontiers in neurology}, year = {2012}, volume = {3}, pages = {169}, doi = {https://doi.org/10.3389/fneur.2012.00169}, keywords = {benign paroxysmal positional vertigo; diagnostic impact; dizziness; multisensory dizziness; neuro-otology; vertigo; vestibular migraine}, pmid = {23226141} }
Feazadeh, A. and Carmeli, E.	Rehabilitation exercise for treatment of vestibular disorder: a case study. [Abstract] [BibTeX]	2006	TheScientificWorldJournal Vol. 6, pp. 291-294	article	DOI
Abstract: Vertigo and dizziness are common symptoms in the general population. While the clinical picture is well known and widely described, there are different interpretations of Benign Paroxysmal Positional Vertigo. The purpose of this case report was to describe the treatment of a 56 year old woman with complains of positional vertigo for 35 consecutive years. She suffered from a sudden onset of rotatory, unilateral horizontal canal type benign paroxysmal positional vertigo (BPPV). The symptoms started a day after falling from a bus, where she injured her head. Otherwise her medical history was unremarkable. She was treated with an individualized home exercise program of eye movement exercises, Brandt/Daroff exercises, and general conditioning exercises (i.e., laying on the left side from sitting on the bed, while the head rotated 45 degrees to the right, waiting for about one minute; twice a day on gradual basis, not laying on the side all the way, but to use enough pillows to lay about at 60 degrees). Four weeks from the start of physical therapy, the patient was free of symptoms, even when her neck was in the extended position.
BibTeX: @article{Feazadeh2006, author = {Feazadeh, Avraham and Carmeli, Eli}, title = {Rehabilitation exercise for treatment of vestibular disorder: a case study.}, journal = {TheScientificWorldJournal}, year = {2006}, volume = {6}, pages = {291--294}, doi = {https://doi.org/10.1100/tsw.2006.19}, keywords = {Dizziness, complications, rehabilitation; Exercise Therapy, methods; Female; Humans; Middle Aged; Self Care, methods; Treatment Outcome; Vertigo, complications, rehabilitation; Vestibular Diseases, complications, rehabilitation}, pmid = {16518517} }
Jang, Y.S. and Kang, M.-K.	Relationship between bone mineral density and clinical features in women with idiopathic benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2009	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 30(1), pp. 95-100	article	DOI
Abstract: To evaluate the relationship between bone mineral density (BMD) and clinical features in women with idiopathic benign paroxysmal positional vertigo (IBPPV). Prospective study. Tertiary referral center. Patients with BMD measurements made after a diagnosis of IBPPV were included. The IBPPV (n = 78) and control groups (n = 177) were divided into ordinal age categories of similar size. Group A (n = 20) patients were aged 20 to 39 years, Group B (n = 21) patients were aged 40 to 49 years, Group C (n = 18) patients were aged 50 to 59 years, and Group D (n = 19) patients were aged 60 to 69 years. In each age range, the BMD values were compared according to the number of canalith repositioning maneuvers (CRMs) or the presence of recurrence. We divided all patients into 2 groups with the normal and abnormal BMD values and compared both groups based on the number of CRMs or the frequency of recurrence. The BMD value, the number of CRMs, and the presence of recurrence. In Groups A, B, and C, there was a significant difference in the BMD values between the control, 1-visit, and 2-or-more-visits subgroups. In Group D, the 2-or-more-visits subgroup had a lower BMD value than other subgroups. The difference in the number of CRMs between the normal and abnormal BMD groups was significant. In Groups A and B, there was a significant difference in the BMD values between the control, first-attack, and recurrent-attacks subgroups. In Groups C and D, the recurrent-attacks subgroup had lower BMD values than other subgroups. The difference in the frequency of recurrence between the normal and abnormal BMD groups was significant. Patients with IBPPV had lower BMD values compared with control subjects, and patients with low BMD values showed a significant increase in the number of CRMs required and the recurrence rate.
BibTeX: @article{Jang2009, author = {Jang, Yoon Seok and Kang, Myung-Koo}, title = {Relationship between bone mineral density and clinical features in women with idiopathic benign paroxysmal positional vertigo.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2009}, volume = {30}, issue = {1}, pages = {95--100}, doi = {https://doi.org/10.1097/MAO.0b013e31818f5777}, keywords = {Adult; Age Distribution; Aged; Bone Density; Ear Canal, physiology, physiopathology; Female; Humans; Middle Aged; Posture, physiology; Prospective Studies; Vertigo, physiopathology; Young Adult}, pmid = {19008769} }
Otsuka, K., Ogawa, Y., Inagaki, T., Shimizu, S., Konomi, U., Kondo, T. and Suzuki, M.	Relationship between clinical features and therapeutic approach for benign paroxysmal positional vertigo outcomes. [Abstract] [BibTeX]	2013	The Journal of laryngology and otology Vol. 127(10), pp. 962-967	article	DOI
Abstract: To examine the clinical features, age and gender distribution of patients, treatment methods, and outcomes of benign paroxysmal positional vertigo. This paper reports a review of 357 patients treated for this condition at a single institution over a duration of 5 years. Patients with posterior canal benign paroxysmal positional vertigo were divided into two groups: one group underwent the Epley manoeuvre and the other received medication. The lateral canal canalolithiasis patients were also divided into two groups: one underwent the Lempert manoeuvre and the other received medication. Lastly, the lateral canal cupulolithiasis patients were treated with medication and non-specific physical techniques. For patients with posterior canal benign paroxysmal positional vertigo, resolution time was significantly shorter in the Epley manoeuvre group than in the medication group. For the lateral canal canalolithiasis patients, resolution time was significantly shorter in the Lempert manoeuvre group than in the medication group. Resolution time was significantly longer in the lateral canal cupulolithiasis patients than in the other patients. The average age of patients increased with the number of recurrences, as did predominance in females. Average age and rate of sensorineural hearing loss were significantly higher in patients with intractable benign paroxysmal positional vertigo compared with those in the curable benign paroxysmal positional vertigo group.
BibTeX: @article{Otsuka2013, author = {Otsuka, K and Ogawa, Y and Inagaki, T and Shimizu, S and Konomi, U and Kondo, T and Suzuki, M}, title = {Relationship between clinical features and therapeutic approach for benign paroxysmal positional vertigo outcomes.}, journal = {The Journal of laryngology and otology}, year = {2013}, volume = {127}, issue = {10}, pages = {962--967}, doi = {https://doi.org/10.1017/S0022215113001990}, keywords = {Adult; Age Factors; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, classification, diagnosis, therapy; Female; Humans; Longitudinal Studies; Male; Middle Aged; Patient Positioning, methods; Posture, physiology; Prognosis; Recurrence; Sex Factors; Treatment Outcome; Young Adult}, pmid = {24047965} }
Maiolo, V., Savastio, G., Modugno, G.C. and Barozzi, L.	Relationship between multidetector CT imaging of the vestibular aqueduct and inner ear pathologies. [Abstract] [BibTeX]	2013	The neuroradiology journal Vol. 26(6), pp. 683-692	article	DOI
Abstract: This study investigated the relationships between morphological changes in the vestibular aqueduct (VA) in different inner ear pathologies. Eighty-eight patients (34 males and 54 females, ranging from seven to 88 years of age; average age 49.2 years) with cochleovestibular disorders underwent temporal bone CT (with a 64-channel helical CT system according to temporal bone protocol parameters; 0.6 mm slice thickness, 0.6 mm collimation, bone reconstruction algorithm). All patients with cochleovestibular disorders who underwent temporal bone CT had been previously divided into six different suspected clinical classes: A) suspected pathology of the third window; B) suspected retrocochlear hearing loss; C) defined Ménière's disease; D) labyrinth lithiasis; E) recurrent vertigo. On CT images we analyzed the length, width and morphology of the VA, contact between the VA and the jugular bulb (JB), the thickness of the osseous capsule covering the semicircular canals, the pneumatization rate of the temporal bone and the diameter of the internal auditory canal. At the end of the diagnostic work-up all patients were grouped into six pathological classes, represented as follow: 1) benign paroxysmal positional vertigo (BPPV), 2) recurrent vertigo (RV), 3) enlarged vestibular aqueduct syndrome (EVAS), 4) sudden or progressive unilateral sensorineural hearing loss (SNHL), 5) superior semicircular canal dehiscence syndrome (SSCD), 6) recurrent vestibulocochlear symptoms in Ménière's disease. We evaluated 176 temporal bones in 88 patients. The VA was clearly visualized in 166/176 temporal bones; in ten ears the VA was not visualized. In 14 ears (11 patients, in three of whom bilaterally) we found an enlarged VA while in 31 ears the VA was significantly narrower. In 16 ears a dehiscence of the JB with the vestibular or cochlear aqueduct was noted. In all six patients with suspected EVAS we found a AV wider than 1.5 mm on CT scans; moreover CT identified four patients with large VA and ill-defined clinical symptoms. Most patients with BPPV (11 patients, Class 1) we did not find any VA abnormalities on CT scans, confirming the clinical diagnosis in ten patients; in the remaining patients we found an enlarged VA, not clinically suspected. In the RV class (eight patients, Class 2) we found three patients with negative CT scans, two patients with narrow aqueduct and subsequently reclassified as Ménière's disease patients, and three patients with ectasic JB dehiscence with the VA. In patients suffering from SNHL we found no statistically significant correlation with the morphological abnormalities. The clinical suspicion of SSCD was confirmed by CT in 11/13 patients (84.6 %); in addition another seven patients showed a thinning or dehiscence of the superior semicircular canals as the prevailing alteration on CT scans, and were reclassified in this group. Ménière's disease symptoms were correlated with a VA alteration in more than half of the cases; the most striking finding in this class was that the VA was significantly narrower (21 patients). Our study demonstrates that alterations of the VA morphology are not only related to EVAS but are also found in other inner ear pathologies such as Ménière's disease. Furthermore, MDCT may confirm the presence of correlations between the morphology of inner ear structures such as VA, semicircular canals or JB dehiscence, and alterations of vestibulocochlear function.
BibTeX: @article{Maiolo2013, author = {Maiolo, Vincenzo and Savastio, Gabriella and Modugno, Giovanni Carlo and Barozzi, Libero}, title = {Relationship between multidetector CT imaging of the vestibular aqueduct and inner ear pathologies.}, journal = {The neuroradiology journal}, year = {2013}, volume = {26}, issue = {6}, pages = {683--692}, doi = {https://doi.org/10.1177/197140091302600612}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Child; Female; Humans; Labyrinth Diseases, diagnostic imaging, pathology; Male; Middle Aged; Tomography, X-Ray Computed; Vestibular Aqueduct, diagnostic imaging, pathology; Young Adult; bony labyrinth; cochleovestibular diseases; multidetector computed tomography; temporal bone; vestibular aqueduct}, pmid = {24355188} }
Seo, T., Tominaga, S. and Sakagami, M.	Relationship between neurological asymptomatic vertigo and the vertebrobasilar system as revealed by magnetic resonance angiography. [Abstract] [BibTeX]	2000	ORL; journal for oto-rhino-laryngology and its related specialties Vol. 62(2), pp. 63-67	article	DOI
Abstract: Many patients suffering from vertigo have no neurological symptoms except for a positional nystagmus. Vertigo without any neurological findings has not been thought to be a vertebrobasilar (VB) attack. The purpose of this study is to clarify the relationship between vertigo without any neurological symptoms and the VB system using magnetic resonance angiography (MRA). MRAs of the VB system were examined in 31 patients with positional nystagmus of unknown origin (PNU) and in 14 patients with benign paroxysmal positional vertigo (BPPV) as control. MRA was performed with a 1.5-tesla system using the two-dimensional time-of-flight technique. Abnormalities such as elongation, bending, narrowing or obstruction of the artery were detected in 27 patients of the PNU group and 8 patients of the BPPV group. A significant difference in the abnormalities was noticed between the two groups (p < 0.05; chi(2) test). This result is almost similar to those of previous studies using conventional vertebral angiography and digital subtraction angiography. Thus, MRA is useful in examination of the VB system. Moreover, our study suggested that the positional nystagmus might result from VB ischemia, even if there were no other neurological signs.
BibTeX: @article{Seo2000, author = {Seo, T and Tominaga, S and Sakagami, M}, title = {Relationship between neurological asymptomatic vertigo and the vertebrobasilar system as revealed by magnetic resonance angiography.}, journal = {ORL; journal for oto-rhino-laryngology and its related specialties}, year = {2000}, volume = {62}, issue = {2}, pages = {63--67}, doi = {https://doi.org/10.1159/000027719}, keywords = {Adult; Aged; Aged, 80 and over; Basilar Artery, pathology; Blood Flow Velocity; Female; Humans; Magnetic Resonance Angiography, methods; Male; Middle Aged; Nystagmus, Physiologic; Vertebral Artery, pathology; Vertebrobasilar Insufficiency, complications, diagnosis; Vertigo, etiology}, pmid = {10729794} }
Kim, S.K., Kim, J.H., Jeon, S.S. and Hong, S.M.	Relationship between sleep quality and dizziness. [Abstract] [BibTeX]	2018	PloS one Vol. 13(3), pp. e0192705	article	DOI
Abstract: Poor sleep quality has a number of significant negative effects on daytime function. However, few studies have examined sleep quality in patients with dizziness. Here, we investigated the potential association between sleep quality and various types of dizziness. We examined dizziness and sleep disturbance in 237 patients experiencing dizziness using Korean versions of the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), and Dizziness Handicap Inventory (DHI). All participants were classified as having benign paroxysmal positional vertigo (BPPV), Ménière's disease (MD), vestibular neuritis (VN), vestibular migraine (VM), psychogenic dizziness (PD), or Other. The mean PSQI and ISI scores were highest in the PD group. The rate of sleep disturbance was highest in the Other group when the cut-off score for each questionnaire was set differently, except ISI ≥ 15. The correlation between DHI and sleep disturbance indices was highest in the VM group. Multivariate regression showed that PSQI score and DHI-E score were significantly related to the PD and Other groups, while the Other group was significantly related to the ISI score. The findings of this study strongly suggest that there are associations between sleep quality and some disease subtypes associated with dizziness. Therefore, it is important to consider sleep disturbance in patients with psychogenic dizziness, such as phobic postural vertigo and chronic subjective dizziness, or nonspecific dizziness.
BibTeX: @article{Kim2018d, author = {Kim, Sung Kyun and Kim, Ji Hoon and Jeon, Seung Sik and Hong, Seok Min}, title = {Relationship between sleep quality and dizziness.}, journal = {PloS one}, year = {2018}, volume = {13}, issue = {3}, pages = {e0192705}, doi = {https://doi.org/10.1371/journal.pone.0192705}, keywords = {Adolescent; Adult; Aged; Benign Paroxysmal Positional Vertigo, physiopathology; Child; Cross-Sectional Studies; Dizziness, physiopathology; Female; Humans; Male; Meniere Disease, physiopathology; Middle Aged; Quality of Life; Sleep, physiology; Sleep Wake Disorders, physiopathology; Surveys and Questionnaires; Vestibular Neuronitis, physiopathology; Young Adult}, pmid = {29513688} }
Cakir, B.O., Ercan, I., Cakir, Z.A., Civelek, S. and Turgut, S.	Relationship between the affected ear in benign paroxysmal positional vertigo and habitual head-lying side during bedrest. [Abstract] [BibTeX]	2006	The Journal of laryngology and otology Vol. 120(7), pp. 534-536	article	DOI
Abstract: To assess the association between the habitual head position during bedrest and the affected ear in benign paroxysmal positional vertigo (BPPV). Prospective trial of patients with active BPPV of the posterior semicircular canal, confirmed on physical examination. Seventy-five patients were asked to explain the head position and lying side they were accustomed to before falling asleep in bed. Fifty patients (67 per cent) habitually adopted a lateral head position during bedrest. The ear affected by BPPV was found to be consistent with the head-lying side during bedrest in 43 cases (86 per cent) (29 cases for the right ear and 14 cases for the left ear). Habitual lateral head-positioning during bedrest can be a major factor leading to the development of BPPV in the ipsilateral ear.
BibTeX: @article{Cakir2006, author = {Cakir, B O and Ercan, I and Cakir, Z A and Civelek, S and Turgut, S}, title = {Relationship between the affected ear in benign paroxysmal positional vertigo and habitual head-lying side during bedrest.}, journal = {The Journal of laryngology and otology}, year = {2006}, volume = {120}, issue = {7}, pages = {534--536}, doi = {https://doi.org/10.1017/S002221510600082X}, keywords = {Adult; Aged; Bed Rest; Ear, pathology; Female; Head; Humans; Male; Middle Aged; Posture; Prospective Studies; Semicircular Canals, pathology; Vertigo, etiology, pathology}, pmid = {16834802} }
Norré, M.E.	Relevance of function tests in the diagnosis of vestibular disorders. [Abstract] [BibTeX]	1994	Clinical otolaryngology and allied sciences Vol. 19(5), pp. 433-440	article
Abstract: The diagnostic value or relevance of a vestibular function test is dependent on the whole clinical and functional context of each particular case. It is not the ability to show 'abnormality' in a high number of patients complaining of whatever kind of vertigo, that indicates the relevance of a function test. Neither is relevance of a test based upon the possibility that this test can re-categorize some patients in the same way as has been done by other tests. Each test evaluates some particular functional aspect and this is very different from one test to another. A test is more relevant, i.e. indicates more abnormality when the type of vertigo caused by the dysfunction is also considered. These statements are confirmed by experience in peripheral vestibular disorders, especially benign paroxysmal positional vertigo (BPPV). A paroxysmal positional nystagmus (ppn) (nystagmus and vertigo elicited by movements and manoeuvres) is linked to the problem of provoked vertigo and gives a confirmation of this vertigo by reproducing it in some manoeuvres. Some inconstancy in the reproduction of this ppn may cause difficulties in diagnosis. Caloric tests are the clue for diagnosis of sudden unilateral loss (so-called neuronitis), whereas they give only complementary information for patients with BPPV. Posturography adds information in all categories concerning the standing position and can be interesting in the scope of rehabilitation treatment. The findings of a retrospective study in patients with BPPV (n = 95), compared with patients with Ménière's disease (n = 89) and others with sudden unilateral loss syndrome (n = 48), illustrate these concepts.
BibTeX: @article{Norre1994a, author = {Norré, M E}, title = {Relevance of function tests in the diagnosis of vestibular disorders.}, journal = {Clinical otolaryngology and allied sciences}, year = {1994}, volume = {19}, issue = {5}, pages = {433--440}, keywords = {Audiometry; Caloric Tests; Electroencephalography; Humans; Nystagmus, Pathologic; Posture; Retrospective Studies; Saccades; Vertigo, diagnosis, physiopathology; Vestibule, Labyrinth, physiopathology}, pmid = {7834887} }
Blau, P. and Shoup, A.	Reliability of a rating scale used to distinguish direction of eye movement using infrared/video ENG recordings during repositioning maneuvers. [Abstract] [BibTeX]	2007	International journal of audiology Vol. 46(8), pp. 427-432	article	DOI
Abstract: The purpose of this study was to determine the validity of the nystagmus rating scale (NRS) and to assess inter- and intra-rater reliability of audiologists and experts using the scale. Face and content validity was established by eliciting feedback from two neurotologists and one neurologist. A training tape was developed to describe the rating scale and provide practice with patterns of nystagmus in benign paroxysmal positional vertigo (BPPV). Eye movements of 34 patients, ages 33 to 82 years, were videotaped using infrared/video ENG during repositioning maneuvers. Six randomly paired audiologists and six experts viewed the videotape recordings and completed the NRS for each pattern. Cohen's kappa coefficients were calculated to determine inter-rater reliability. The kappa values were 0.31 with 41% agreement for audiologists, and 0.48 with 59% agreement for experts. Intra-rater reliability for a subgroup of audiologists was 0.55 with 64% agreement, and for experts was 0.75 with 81% agreement. In summary, even in this experienced population, additional training in viewing nystagmus patterns is needed to improve reliability among clinicians during diagnosis and treatment.
BibTeX: @article{Blau2007, author = {Blau, Patricia and Shoup, Angela}, title = {Reliability of a rating scale used to distinguish direction of eye movement using infrared/video ENG recordings during repositioning maneuvers.}, journal = {International journal of audiology}, year = {2007}, volume = {46}, issue = {8}, pages = {427--432}, doi = {https://doi.org/10.1080/14992020701355082}, keywords = {Adult; Aged; Aged, 80 and over; Electronystagmography, methods; Eye Movements, physiology; Female; Humans; Male; Middle Aged; Observer Variation; Posture; Reproducibility of Results; Severity of Illness Index; Vertigo, diagnosis, epidemiology; Visual Perception, physiology}, pmid = {17654084} }
Lapenna, R., Faralli, M., Del Zompo, M.R., Cipriani, L., Mobaraki, P.D. and Ricci, G.	Reliability of an anamnestic questionnaire for the diagnosis of benign paroxysmal positional vertigo in the elderly. [Abstract] [BibTeX]	2016	Aging clinical and experimental research Vol. 28(5), pp. 881-888	article	DOI
Abstract: There is common agreement in the literature that it can result in an underestimation of benign paroxysmal positional vertigo (BPPV) in the elderly. The aim of this work was to analyze the role of anamnesis in the diagnosis of BPPV in patients of different ages through the development and validation of a scored questionnaire. The questionnaire is based on the presence/absence of six typical anamnestic features of BPPV. The Mini-Mental State Exam (MMS) was also administered to patients over 65 years of age. Bedsides, examination for BPPV was then carried out, assigning the outcome of the questionnaire and eventual MMS to the final diagnosis for each patient. The sensitivity and specificity of the questionnaire for high scores (>8) were found to be, respectively, 86 % and 80 % in all patients, 94 and 71 % in those under 65 years of age, 78 and 90 % in patients over 65, and, in particular, 63 and 83 % in those with MMS >24 and 100 and 100 % in those with MMS ≤24. The reliability and average score of the questionnaire were statistically significantly lower in the group of elderly patients without cognitive deficits. The lower reliability of the questionnaire in the geriatric population, rather than the presence of cognitive deterioration, seems to correlate with other comorbidities or simply to a lower mobility of the head triggering positional symptoms. The use of the questionnaire could however reduce the risk of a missed diagnosis of BPPV given its good reliability across all ages.
BibTeX: @article{Lapenna2016, author = {Lapenna, Ruggero and Faralli, Mario and Del Zompo, Maria Rita and Cipriani, Laura and Mobaraki, Puya Dehgani and Ricci, Giampietro}, title = {Reliability of an anamnestic questionnaire for the diagnosis of benign paroxysmal positional vertigo in the elderly.}, journal = {Aging clinical and experimental research}, year = {2016}, volume = {28}, issue = {5}, pages = {881--888}, doi = {https://doi.org/10.1007/s40520-015-0487-0}, keywords = {Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, diagnosis, physiopathology, psychology; Cognition; Comorbidity; Diagnostic Errors, prevention & control; Female; Geriatric Assessment, methods; Humans; Intelligence Tests; Male; Medical History Taking, methods; Middle Aged; Postural Balance; Reproducibility of Results; Sensitivity and Specificity; Statistics as Topic; Surveys and Questionnaires, standards; Anamnesis; Balance; Benign paroxysmal positional vertigo; Dizziness; Elderly; Questionnaire}, pmid = {26537236} }
Norré, M.E.	Reliability of examination data in the diagnosis of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	1995	The American journal of otology Vol. 16(6), pp. 806-810	article
Abstract: A practical clinical view of the reliability of the data obtained in the several steps of the examination procedure is discussed to obtain an objective basis for the selection of patients with provoked vertigo (benign paroxysmal positioning vertigo [BPPV]) in view of treatment of this type of vertigo by rehabilitation therapy. Clinical experience supports the concept that the diagnosis has to be based not only upon a typical history, but also upon the presence of a reproducible vertigo and paroxysmal positional nystagmus (ppn). Such a ppn can be reproduced not only as a "classic" nystagmus by the Dix-Hallpike maneuver, but also as a positional nystagmus and vertigo during electronystagmographic recording in the position tests and in the vestibular habituation training (VHT)-test battery (a battery of 19 maneuvers applied for defining the adequate exercises in the rehabilitation treatment of BPPV). The ppn is not a constant reproductible sign in every patient, and in some, only one of these tests confirms the BPPV. This experience is confirmed by the analysis of the reviewed data in 95 patients, which showed that one third of the patients described their vertigo in a rather atypical way, whereas further testing revealed a BPPV. In this way any absolute reliability of history has to be denied. In fact, only the finding of a ppn is conclusive for confirming BPPV. However, as in former experiences, here too, the presence of such a ppn appeared not to be a constant datum, so that in some patients more than one examination was necessary to come to a reliable diagnosis. Patients in whom only vertigo could be reproduced, never confirmed by nystagmus, were excluded as an atypical ppv group.
BibTeX: @article{Norre1995, author = {Norré, M E}, title = {Reliability of examination data in the diagnosis of benign paroxysmal positional vertigo.}, journal = {The American journal of otology}, year = {1995}, volume = {16}, issue = {6}, pages = {806--810}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Audiometry; Caloric Tests; Electronystagmography; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, diagnosis; Posture; Reproducibility of Results; Retrospective Studies; Vertigo, diagnosis}, pmid = {8572147} }
Tirelli, G., Nicastro, L., Gatto, A. and Tofanelli, M.	Repeated canalith repositioning procedure in BPPV: Effects on recurrence and dizziness prevention. [Abstract] [BibTeX]	2017	American journal of otolaryngology Vol. 38(1), pp. 38-43	article	DOI
Abstract: To evaluate whether a repeated canalith repositioning procedure (CRP) influences the residual symptoms and the rate of recurrence of benign paroxysmal positional vertigo (BPPV) in patients with post-CRP dizziness. In this retrospective study, we analyzed 292 patients at the referral center for ENT diseases with a first episode of BPPV treated with a single CRP following clinical practice guidelines. In 178 patients (67.9%) who presented dizziness after BPPV recovery at the follow-up visit, 94 patients underwent CRP (treated group) and 84 did not (non-treated group). A subjective evaluation of vertigo was made by way of a questionnaire. The rates of recurrence of BPPV and residual dizziness were statistically compared between the treated and the non-treated groups; survival analysis was carried out as well. In an observational period ranging from 1 to 6years, BPPV recurred in 122 subjects (46.6%) of the investigated population. Among the patients with residual dizziness, the difference in rate of recurrence of BPPV between the treated group and the non-treated group was not statistically significant (p=0.84). The treated group presented a significantly higher rate of recovery from dizziness compared to the non-treated group (p<0.001). A repeated CRP in patients with post-CRP dizziness increased the rate of recovery from dizziness but had no influence on BBPV recurrence.
BibTeX: @article{Tirelli2017, author = {Tirelli, Giancarlo and Nicastro, Luca and Gatto, Annalisa and Tofanelli, Margherita}, title = {Repeated canalith repositioning procedure in BPPV: Effects on recurrence and dizziness prevention.}, journal = {American journal of otolaryngology}, year = {2017}, volume = {38}, issue = {1}, pages = {38--43}, doi = {https://doi.org/10.1016/j.amjoto.2016.09.009}, keywords = {Aged; Benign Paroxysmal Positional Vertigo, complications, diagnosis, therapy; Cohort Studies; Dizziness, diagnosis, etiology, therapy; Female; Follow-Up Studies; Humans; Male; Middle Aged; Patient Positioning; Recurrence; Retreatment; Retrospective Studies; Risk Assessment; Semicircular Canals, physiopathology; Treatment Outcome}, pmid = {27806891} }
Gordon, C.R. and Gadoth, N.	Repeated vs single physical maneuver in benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2004	Acta neurologica Scandinavica Vol. 110(3), pp. 166-169	article	DOI
Abstract: To evaluate the effectiveness and possible side effects of a single session of repeated particle repositioning maneuver (PRM) to treat posterior canal benign paroxysmal positional vertigo (BPPV) and the usefulness of post-treatment restrictions. A total of 125 consecutive patients with idiopathic BPPV participated in the study. Fifty patients received a single session of repeated PRM only (group I). Results were compared with those of 50 patients with BPPV who received a single PRM (group IIb), and 25 patients who received a single PRM followed by the use of a neck collar and keeping the head upright for 48 h (group IIa). Forty-six patients (92%) of group I, 40 patients (80%) of group IIb, and 21 patients (84%) of group IIa were completely free of signs and symptoms when re-examined 1 week after treatment. Transient nausea and disequilibrium following treatment were reported equally in all subgroups and well tolerated. Nearly all patients of group IIa considered the post-treatment restrictions very inconvenient. A single session of repeated physical procedure seems to be clinically superior to one single maneuver and well tolerated. Additional post-treatment measurements are inconvenient and should be abandoned.
BibTeX: @article{Gordon2004a, author = {Gordon, C R and Gadoth, N}, title = {Repeated vs single physical maneuver in benign paroxysmal positional vertigo.}, journal = {Acta neurologica Scandinavica}, year = {2004}, volume = {110}, issue = {3}, pages = {166--169}, doi = {https://doi.org/10.1111/j.1600-0404.2004.00296.x}, keywords = {Adult; Aged; Aged, 80 and over; Braces; Female; Humans; Male; Middle Aged; Musculoskeletal Manipulations, adverse effects, methods, statistics & numerical data; Otolithic Membrane, pathology, physiopathology; Recovery of Function, physiology; Saccule and Utricle, pathology, physiopathology; Semicircular Canals, pathology, physiopathology; Treatment Outcome; Vertigo, pathology, physiopathology, therapy}, pmid = {15285773} }
West, N., Hansen, S., Møller, M.N., Bloch, S.L. and Klokker, M.	Repositioning chairs in benign paroxysmal positional vertigo: implications and clinical outcome. [Abstract] [BibTeX]	2016	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 273(3), pp. 573-580	article	DOI
Abstract: The objective was to evaluate the clinical value of repositioning chairs in management of refractory benign paroxysmal positional vertigo (BPPV) and to study how different BPPV subtypes respond to treatment. We performed a retrospective chart review of 150 consecutive cases with refractory vertigo referred to our clinic within a 10-month period. The BPPV patients were managed with classical manual manoeuvres, the Epley Omniax(®) rotator (EO) or the TRV chair (TRV). In addition, a comprehensive review of the literature was performed. BPPV was identified in 95 cases. The number of needed treatments for posterior canalolithiasis versus posterior cupulolithiasis, horizontal cupulolithiasis and multi-canal affection was significant (p < 0.01). Thirty-seven (38 %) patients required only one repositioning manoeuvre and the overall symptom relief was 91.7-100 % after 3 treatments. Eleven patients (12 %) experienced relapse within the ½-year follow-up period. Horizontal cupulolithiasis and multi-canal affection constituted the most resilient cases. The literature search identified 9 repositioning chair studies. The EO and the TRV are highly valuable assets in diagnosis and management of BPPV of particularly complex and refractory cases. However, further validation is anticipated through controlled clinical trials.
BibTeX: @article{West2016, author = {West, Niels and Hansen, Søren and Møller, Martin Nue and Bloch, Sune Land and Klokker, Mads}, title = {Repositioning chairs in benign paroxysmal positional vertigo: implications and clinical outcome.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2016}, volume = {273}, issue = {3}, pages = {573--580}, doi = {https://doi.org/10.1007/s00405-015-3583-z}, keywords = {Benign Paroxysmal Positional Vertigo, therapy; Female; Humans; Male; Middle Aged; Patient Positioning, instrumentation, methods; Recurrence; Retrospective Studies; Biaxial chair; Epley Omniax chair; Repositioning manoeuvres; TRV chair; Treatment; Vertigo}, pmid = {25749489} }
Kahraman, S.S., Yildirim, Y.S., Tugrul, S. and Ozturan, O.	Repositioning intervals in the modified Epley's maneuver and their effect on benign paroxysmal positional vertigo treatment outcome. [Abstract] [BibTeX]	2017	Acta oto-laryngologica Vol. 137(5), pp. 490-494	article	DOI
Abstract: This study showed that short and long interval treatments achieved comparable success rates. There was no statistically significant difference in the rate of early and late recurrences between the two groups. Modified Epley maneuver can be applied in a short interval time with comparable success and recurrence rates which are as effective as in a long interval time. The Epley maneuver is called the particle repositioning or canalith repositioning procedure. If a short time interval in each position is effective, it will allow for reduced time and avoid unnecessary physical burden. How long of a stay in each position is not determined in the literature. There is an absence of comparative studies of the BPPV repositioning time. The aim of this study is to compare the treatment time in patients with benign paroxysmal positional vertigo (BPPV). Longitudinal prospective study. Outpatient practice in a tertiary care facility. Sixty consecutive patients with BPPV were included in this study. These patients were sequentially allocated to one of two groups (A or B). The interval times between each position in group A and B were 15 and 120 s, respectively. Modified Epley maneuver was performed in all patients. The maneuvers in both groups were exactly the same sequence of movements, except interval times. The mean age of the patients was 49.25 years (range =19-76 years). Of the 60 patients, 48 (80%) were women and 12 (20%) were men. Successful outcome was achieved in 26 patients (86.7%) after the first modified Epley maneuver in both groups. Three patients from each group (total six patients) responded to the third modified Epley maneuver and the remaining two patients did not respond to any modified Epley maneuver. Therefore, the Semont maneuver was applied with a successful result.
BibTeX: @article{Kahraman2017, author = {Kahraman, Serif Samil and Yildirim, Yavuz Selim and Tugrul, Selhattin and Ozturan, Orhan}, title = {Repositioning intervals in the modified Epley's maneuver and their effect on benign paroxysmal positional vertigo treatment outcome.}, journal = {Acta oto-laryngologica}, year = {2017}, volume = {137}, issue = {5}, pages = {490--494}, doi = {https://doi.org/10.1080/00016489.2016.1252852}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo, therapy; Female; Humans; Longitudinal Studies; Male; Middle Aged; Physical Therapy Modalities; Prospective Studies; Recurrence; Treatment Outcome; Young Adult; Epley maneuver; Vertigo; benign paroxysmal positional vertigo; compare; interval time; treatment time}, pmid = {27841050} }
Brooks, J.G. and Abidin, M.R.	Repositioning maneuver for benign paroxysmal positional vertigo (BPPV). [Abstract] [BibTeX]	1997	The Journal of the American Osteopathic Association Vol. 97(5), pp. 277-279	article
Abstract: With vertigo, the symptom of unsteadiness is a common presenting complaint and the etiology protean. However, the specific subset of this patient population with benign paroxysmal positional vertigo (BPPV) is more defined. Cupololithiasis and canalithiasis are perhaps the best known and best described pathologic conditions resulting in vertigo. This condition occurs when otoconia from the utricle are displaced into the Posterior semicircular canal-cupula. The abnormal position of the otoconia often results in a pathological condition. The location of displacement is most often in the posterior semicircular canal. A better understanding of the etiology of BPPV has led to a simple and effective particle repositioning maneuver that allows the practitioner to alleviate vertigo symptoms for most patients using a simple manipulation.
BibTeX: @article{Brooks1997, author = {Brooks, J G and Abidin, M R}, title = {Repositioning maneuver for benign paroxysmal positional vertigo (BPPV).}, journal = {The Journal of the American Osteopathic Association}, year = {1997}, volume = {97}, issue = {5}, pages = {277--279}, keywords = {Calculi, complications; Female; Humans; Manipulation, Orthopedic, methods; Middle Aged; Osteopathic Medicine, methods; Posture; Semicircular Canals; Vertigo, etiology, rehabilitation}, pmid = {9195789} }
Ciniglio Appiani, G., Catania, G., Gagliardi, M. and Cuiuli, G.	Repositioning maneuver for the treatment of the apogeotropic variant of horizontal canal benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2005	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 26(2), pp. 257-260	article
Abstract: The purpose of this study was to determine the effectiveness of a new physical maneuver in the treatment of the apogeotropic variant of horizontal canal benign paroxysmal positional vertigo. Case review. Outpatient clinic. The diagnosis of apogeotropic horizontal canal benign paroxysmal positional vertigo was based on the history of recurrent sudden crisis of vertigo associated with bursts of horizontal apogeotropic paroxysmal nystagmus provoked by turning the head from the supine to either lateral position. The patients were three men and five women ranging in age from 31 to 73 years (average, 49.2 yr). All patients were treated with a repositioning maneuver based on the hypothesis that the syndrome is caused by the presence of free-floating dense particles inside the endolymph of the anterior arm of the horizontal canal. The maneuver favors their shifting into the posterior arm of the canal. Patients were reexamined immediately after the treatment and underwent Gufoni's liberatory maneuver for the geotropic variant of horizontal canal benign paroxysmal positional vertigo. The treatment outcome was considered as responsive when, after one repositioning maneuver, nystagmus shifted from apogeotropic to geotropic. The repositioning maneuver resulted in a transformation from the apogeotropic variant into a geotropic variant of horizontal canal benign paroxysmal positional vertigo in all patients. This maneuver represents a simple and effective approach to the treatment of the apogeotropic variant of horizontal canal benign paroxysmal positional vertigo. It favors the shifting of the canaliths from the anterior into the posterior arm of the horizontal canal from where they can migrate into the utricle with Gufoni's maneuver.
BibTeX: @article{CiniglioAppiani2005, author = {Ciniglio Appiani, Giuseppe and Catania, Giuseppe and Gagliardi, Mario and Cuiuli, Giuseppe}, title = {Repositioning maneuver for the treatment of the apogeotropic variant of horizontal canal benign paroxysmal positional vertigo.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2005}, volume = {26}, issue = {2}, pages = {257--260}, keywords = {Adult; Aged; Electronystagmography; Endolymph, physiology; Female; Gravitation; Gravitropism, physiology; Head Movements, physiology; Humans; Male; Middle Aged; Orientation, physiology; Otolithic Membrane, physiology; Physical Therapy Modalities; Supine Position, physiology; Treatment Outcome; Vertigo, etiology, physiopathology, therapy}, pmid = {15793415} }
Gold, D.R., Morris, L., Kheradmand, A. and Schubert, M.C.	Repositioning maneuvers for benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2014	Current treatment options in neurology Vol. 16(8), pp. 307	article	DOI
Abstract: There are few conditions in neurology that are diagnosed with such ease and certainty as benign paroxysmal positional vertigo (BPPV). Repositioning maneuvers are highly effective in treating BPPV, inexpensive, and easy to apply. Surgery has a very minor role in the management of BPPV, and although medications may transiently ameliorate symptoms, they do not treat the underlying process. There is good evidence to support treatment of posterior canal BPPV with Epley or Semont maneuvers and horizontal canal BPPV with Gufoni maneuvers or BBQ roll (also known as Lempert 360 roll or log roll); and weaker evidence for head hanging maneuvers in the least common anterior canal variant. Since the therapeutic efficacy amongst maneuvers for each canal is comparable, the choice of treatment is generally based on clinician preference, complexity of the maneuvers themselves, poor treatment response to specific maneuvers, and musculoskeletal considerations such as arthritic changes and range of motion of the cervical spine. Treating posterior canal BPPV with Epley or Semont manuevers is comparable as far as efficacy and the ease with which maneuvers are performed. For horizontal canal BPPV, the Gufoni maneuver is easier to perform compared to the BBQ roll, as it requires that the clinician only identify the side of weaker nystagmus (regardless of whether it's geotropic or apogeotropic) and not necessarily the side involved. Anterior canal BPPV is rare and generally short-lived, but there is weak evidence that deep head hanging and a variety of eponymous maneuvers may hasten recovery. The advantage of deep head hanging maneuvers is that they can be effectively performed without knowledge of the side involved.
BibTeX: @article{Gold2014, author = {Gold, Daniel R and Morris, Laura and Kheradmand, Amir and Schubert, Michael C}, title = {Repositioning maneuvers for benign paroxysmal positional vertigo.}, journal = {Current treatment options in neurology}, year = {2014}, volume = {16}, issue = {8}, pages = {307}, doi = {https://doi.org/10.1007/s11940-014-0307-4}, pmid = {25007983} }
Marques, P.S., Castillo, R., Santos, M. and Perez-Fernandez, N.	Repositioning nystagmus: prognostic usefulness? [Abstract] [BibTeX]	2014	Acta oto-laryngologica Vol. 134(5), pp. 491-496	article	DOI
Abstract: The presence of orthotropic nystagmus (ON), in multiple positions, appears to predict the success of canalith repositioning maneuvers (CRMs). In this sense CRMs under video-Frenzel are informative for the immediate follow-up, although not related to the degree of disability or emotional distress. Still, attention should be given to psychological assistance even in cases of clinically cured benign paroxysmal positional vertigo (BPPV). The aim of the study was to highlight the prognostic value of nystagmus in CRMs for BPPV and its relevance for emotional and patient-perceived disability. A group of 57 patients were selected from 3 balance disorders centers. CRMs were performed under video-Frenzel control. Assessment of patient disability and positional nystagmus was performed 2 months later. Emotional (Cuestionario de Impacto Emocional del Vértigo, CIEV) and quality of life (Dizziness Handicap Inventory, DHI) impact were evaluated. The posterior semicircular canal (SCC) was affected in 84.2% of cases, the horizontal SCC in 10.5%, and the anterior SCC in 5.1%. Appropriate CRMs were performed. ON was present in 67% of cases. Overall resolution after the first treatment was achieved in 56% of cases. With ON present the success rate was 63% and when not observed the rate was 42%. DHI or CIEV scores were not significantly different when comparing the presence vs absence of ON. In nine patients (16%) an abnormal CIEV score was observed after treatment, even though a cured status was achieved in six of these nine patients.
BibTeX: @article{Marques2014, author = {Marques, Pedro Santos and Castillo, Rosa and Santos, Margarida and Perez-Fernandez, Nicolas}, title = {Repositioning nystagmus: prognostic usefulness?}, journal = {Acta oto-laryngologica}, year = {2014}, volume = {134}, issue = {5}, pages = {491--496}, doi = {https://doi.org/10.3109/00016489.2013.872291}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, diagnosis, physiopathology, therapy; Female; Humans; Middle Aged; Nystagmus, Pathologic; Nystagmus, Physiologic; Prognosis}, pmid = {24702229} }
Giommetti, G., Lapenna, R., Panichi, R., Mobaraki, P.D., Longari, F., Ricci, G. and Faralli, M.	Residual Dizziness after Successful Repositioning Maneuver for Idiopathic Benign Paroxysmal Positional Vertigo: A Review. [Abstract] [BibTeX]	2017	Audiology research Vol. 7(1), pp. 178	article	DOI
Abstract: The benign paroxysmal positional vertigo (BPPV) is a vestibular disorder cause of vertigo. The BPPV may be corrected mechanically by repositioning maneuvers but even after successful maneuvers, some patients report residual dizziness for a certain period afterward. Early recognition and treatment might decrease the incidence of residual dizziness in patients with BPPV, especially in those patients with psychiatric comorbidities and in the elderly, lowering the risk of falling. Many pathogenetic hypotheses for residual dizziness are under debate. The purpose of this review was to identify, evaluate and review recent researches about possible causal factors involved in residual dizziness and the implications on clinical practice. A literature search was performed using different databases such as Pubmed and Scopus. The following search terms were used: The search found a total of 1192 titles, which were reduced to 963 after a procedure of de-duplication of the found titles. The research was then restricted to an interval of time comprised between 2000 and 2016 for a total of 800 titles. Among these titles, only those including the terms were considered eligible for this review. Only publications in English language were taken into consideration and we excluded those with not available abstract. Finally, 90 abstracts were obtained and critically evaluated by two different Authors, and additional studies were identified by hand searching from the references of artiche of interest. Only 53 were included in this work.
BibTeX: @article{Giommetti2017, author = {Giommetti, Giorgia and Lapenna, Ruggero and Panichi, Roberto and Mobaraki, Puya Dehgani and Longari, Fabrizio and Ricci, Giampietro and Faralli, Mario}, title = {Residual Dizziness after Successful Repositioning Maneuver for Idiopathic Benign Paroxysmal Positional Vertigo: A Review.}, journal = {Audiology research}, year = {2017}, volume = {7}, issue = {1}, pages = {178}, doi = {https://doi.org/10.4081/audiores.2017.178}, keywords = {Residual dizziness; benign paroxysmal positional vertigo; repositioning maneuver}, pmid = {28603599} }
Teggi, R., Giordano, L., Bondi, S., Fabiano, B. and Bussi, M.	Residual dizziness after successful repositioning maneuvers for idiopathic benign paroxysmal positional vertigo in the elderly. [Abstract] [BibTeX]	2011	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 268(4), pp. 507-511	article	DOI
Abstract: Even after successful repositioning maneuvers for benign paroxysmal positional vertigo (BPPV), some patients report dizziness lasting for a certain period afterwards. We studied the prevalence and clinical factors associated with residual dizziness in a sample of elderly patients. Sixty outpatients over 65 years of age, affected by idiopathic BPPV were recruited; the exclusion criterion was a history of previous episodes of vertigo, including positional. The patients were asked to describe their self-perceived anxiety for vertigo on a Visual Analogue Scale (VAS) and successively treated with appropriate maneuvers till resolution of nystagmus. Data concerning the demographic and clinical features of BPPV were collected. Patients were followed until complete resolution of subjective dizziness and imbalance without positional nystagmus. Data about residual dizziness were collected from the second day from resolution of BPPV. Clinical and demographic factors related to residual dizziness were analyzed. Twenty-two subjects (37%) reported residual dizziness. In these subjects, the mean duration of residual dizziness was 13.4 ± 7.5 days. No association was observed between residual dizziness and gender, involved canal and the number of repositioning maneuvers before resolution. On the other hand, age older than 72 years, symptom duration greater than 9 days and VAS scale for anxiety greater than 10/100 were associated with an increased risk of residual dizziness. The odds ratio were respectively 6.5 (age-residual dizziness, Confidence Interval 95%), 6.5 (duration of vertigo-residual dizziness, Confidence Interval 95%) and 15.5 (anxiety levels-residual dizziness, Confidence Interval 95%). Longer symptom duration before diagnosis was associated with higher anxiety levels. The results underline the necessity for an early and correct diagnosis of BPPV, especially in the elderly.
BibTeX: @article{Teggi2011, author = {Teggi, Roberto and Giordano, Leone and Bondi, Stefano and Fabiano, Beatrice and Bussi, Mario}, title = {Residual dizziness after successful repositioning maneuvers for idiopathic benign paroxysmal positional vertigo in the elderly.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2011}, volume = {268}, issue = {4}, pages = {507--511}, doi = {https://doi.org/10.1007/s00405-010-1422-9}, keywords = {Aged; Benign Paroxysmal Positional Vertigo; Dizziness, etiology, physiopathology; Female; Follow-Up Studies; Humans; Male; Nystagmus, Physiologic, physiology; Patient Positioning; Prospective Studies; Vertigo, complications, diagnosis, physiopathology; Vestibular Function Tests, methods}, pmid = {21069369} }
Teggi, R., Quaglieri, S., Gatti, O., Benazzo, M. and Bussi, M.	Residual dizziness after successful repositioning maneuvers for idiopathic benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2013	ORL; journal for oto-rhino-laryngology and its related specialties Vol. 75(2), pp. 74-81	article	DOI
Abstract: To establish a possible causal factor for residual dizziness (RD) after successful repositioning maneuvers in patients with benign paroxysmal positional vertigo (BPPV). Ninety consecutive patients with idiopathic BPPV were treated with repositioning maneuvers, and the rate of RD was assessed as well as clinical data. Posturography and assessment of anxiety levels were performed on patients reporting RD. Results were compared with a control group of BPPV patients of the sample after repositioning maneuvers and without RD. Twenty-eight subjects (31.1%) reported RD on the second day after successful repositioning maneuvers. The mean duration of RD was 11.6 ± 3.9 days. Patients with RD presented a higher duration of BPPV (14.1 vs. 10.9 days, p = 0.01). A correlation was demonstrated between the duration of BPPV and duration of RD (p < 0.01). Subjects with RD presented increased body sways, above all in eyes-closed conditions. RD is mainly correlated with duration of vertigo in BPPV patients. Anxiety was demonstrated to play a role in increased body sways.
BibTeX: @article{Teggi2013, author = {Teggi, Roberto and Quaglieri, Silvia and Gatti, Omar and Benazzo, Marco and Bussi, Mario}, title = {Residual dizziness after successful repositioning maneuvers for idiopathic benign paroxysmal positional vertigo.}, journal = {ORL; journal for oto-rhino-laryngology and its related specialties}, year = {2013}, volume = {75}, issue = {2}, pages = {74--81}, doi = {https://doi.org/10.1159/000350255}, keywords = {Adult; Anxiety, psychology; Benign Paroxysmal Positional Vertigo; Dizziness, physiopathology, psychology, therapy; Female; Humans; Male; Middle Aged; Migraine Disorders, physiopathology; Patient Positioning, methods; Prospective Studies; Recurrence; Semicircular Canals, physiopathology; Treatment Outcome; Vertigo, physiopathology, psychology, therapy; Young Adult}, pmid = {23774304} }
Seok, J.I., Lee, H.M., Yoo, J.H. and Lee, D.K.	Residual dizziness after successful repositioning treatment in patients with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2008	Journal of clinical neurology (Seoul, Korea) Vol. 4(3), pp. 107-110	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most common form of vertigo. Although the repositioning maneuver dramatically improves the vertigo, some patients complain of residual dizziness. We evaluated the incidence and characteristics of persistent dizziness after successful particle repositioning and the clinical factors associated with the residual dizziness. We performed a prospective investigation in 49 consecutive patients with confirmed BPPV. The patients were treated with a repositioning maneuver appropriate for the type of BPPV. Success was defined by the resolution of nystagmus and positional vertigo. All patients were followed up until complete resolution of all dizziness, for a maximum of 3 months. We collected data on the characteristics and duration of any residual dizziness and analyzed the clinical factors associated with the residual dizziness. Of the 49 patients, 11 were men and 38 were women aged 60.4+/-13.0 years (mean +/-SD), and 30 (61%) of them complained of residual dizziness after successful repositioning treatment. There were two types of residual dizziness: continuous lightheadedness and short-lasting unsteadiness occurring during head movement, standing, or walking. The dizziness lasted for 16.4+/-17.6 days (range=2-80 days, median=10 days). A longer duration of BPPV before treatment was significantly associated with residual dizziness (p=0.04). Residual dizziness after successful repositioning was observed in two-thirds of the patients with BPPV and disappeared within 3 months without specific treatment in all cases. The results indicate that early successful repositioning can reduce the incidence of residual dizziness.
BibTeX: @article{Seok2008, author = {Seok, Jung Im and Lee, Hyo Min and Yoo, Ji Hoon and Lee, Dong Kuck}, title = {Residual dizziness after successful repositioning treatment in patients with benign paroxysmal positional vertigo.}, journal = {Journal of clinical neurology (Seoul, Korea)}, year = {2008}, volume = {4}, issue = {3}, pages = {107--110}, doi = {https://doi.org/10.3988/jcn.2008.4.3.107}, keywords = {Benign paroxysmal positional vertigo; Dizziness; Repositioning maneuver}, pmid = {19513312} }
Seo, T., Shiraishi, K., Kobayashi, T., Mutsukazu, K., Fujita, T., Saito, K., Watanabe, H. and Doi, K.	Residual dizziness after successful treatment of idiopathic benign paroxysmal positional vertigo originates from persistent utricular dysfunction. [Abstract] [BibTeX]	2017	Acta oto-laryngologica Vol. 137(11), pp. 1149-1152	article	DOI
Abstract: We used ocular vestibular evoked myogenic potentials to investigate the relationship between residual dizziness and utricular function following the canalith repositioning procedure for benign paroxysmal positional vertigo. Ocular vestibular evoked myogenic potentials were measured in 44 patients (40 included in analyses, four excluded) with successful results from the canalith repositioning procedure. The patients were examined before treatment and again one week after treatment. We analyzed how various general factors and ocular vestibular evoked myogenic potentials related to residual dizziness. Residual dizziness was not related to gender, affected side, age, duration of symptoms, recurrence, or the results of the initial ocular vestibular evoked myogenic potential test (p > .05). However, residual dizziness was significantly associated with the results of the second ocular vestibular evoked myogenic potential test (p = .007). Residual dizziness after a successful canalith repositioning procedure may be caused by persistent utricular dysfunction.
BibTeX: @article{Seo2017, author = {Seo, Toru and Shiraishi, Ko and Kobayashi, Takaaki and Mutsukazu, Kitano and Fujita, Takeshi and Saito, Kazuya and Watanabe, Hiroyasu and Doi, Katsumi}, title = {Residual dizziness after successful treatment of idiopathic benign paroxysmal positional vertigo originates from persistent utricular dysfunction.}, journal = {Acta oto-laryngologica}, year = {2017}, volume = {137}, issue = {11}, pages = {1149--1152}, doi = {https://doi.org/10.1080/00016489.2017.1347824}, keywords = {Adult; Benign Paroxysmal Positional Vertigo, complications, physiopathology, therapy; Dizziness, etiology; Humans; Male; Middle Aged; Saccule and Utricle, physiopathology; Residual dizziness; benign paroxysmal positional vertigo; canalith repositioning procedure; oVEMP; utricle}, pmid = {28681630} }
Faralli, M., Lapenna, R., Giommetti, G., Pellegrino, C. and Ricci, G.	Residual dizziness after the first BPPV episode: role of otolithic function and of a delayed diagnosis. [Abstract] [BibTeX]	2016	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 273(10), pp. 3157-3165	article	DOI
Abstract: Residual dizziness (RD) following the resolution of a benign paroxysmal positional vertigo (BBPV) episode is frequently reported by patients. Possible causes are still under debate in the literature. This study discusses the possible role of otolithic function and of elapsed time from onset of symptoms to diagnosis in the genesis of RD. In total, 116 patients younger than 65 years with their first episode of BPPV and without any other comorbidities were enrolled in the study. Before a bedside examination, subjective visual vertical (SVV) was determined in the case of a history suggestive of BPPV. SVV was tested 1 week later in those patients with BPPV of the posterior semicircular canal, and in whom positioning maneuvers showed resolution of BPPV. At 1 week control, reported RD and Dizziness Handicap Inventory (DHI) were recorded. Diagnosis and treatment of BPPV occurred within 4 days in 43 patients (group A), between 5 and 8 days in 38 patients (group B) and in more than 9 days in 35 patients (group C). Higher values of reported RD and DHI were recorded in group C, while higher values of SVV deviation were recorded in group A with an inverse relationship between SVV and DHI. Initial peripheral vestibular function asymmetry due to BPPV can induce a new central adaptation. This adaptation becomes better established the longer otoconia remain floating in the endolymph. Because of these changes, the brain is unable to quickly readapt to the old pattern after resolution resulting in more persistent RD.
BibTeX: @article{Faralli2016, author = {Faralli, Mario and Lapenna, Ruggero and Giommetti, Giorgia and Pellegrino, Cristina and Ricci, Giampietro}, title = {Residual dizziness after the first BPPV episode: role of otolithic function and of a delayed diagnosis.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2016}, volume = {273}, issue = {10}, pages = {3157--3165}, doi = {https://doi.org/10.1007/s00405-016-3947-z}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo, complications, diagnosis, therapy; Cohort Studies; Delayed Diagnosis; Dizziness, etiology; Female; Humans; Male; Middle Aged; Otolithic Membrane, physiopathology; Patient Positioning; Semicircular Canals, physiopathology; BPPV; DHI; Otolithic function; Residual dizziness; SVV}, pmid = {26926693} }
Moshtaghi, O., Mahboubi, H., Haidar, Y.M., Sahyouni, R., Lin, H.W. and Djalilian, H.R.	Resolution of Persistent Post-Stapedotomy Vertigo With Migraine Prophylactic Medication. [Abstract] [BibTeX]	2017	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 38(10), pp. 1500-1504	article	DOI
Abstract: To describe persistent post-stapedotomy vertigo (PSV) and its treatment using migraine prophylaxis. A retrospective review of all patients with persistent PSV spanning 10 years at a tertiary academic hospital was performed. Patients who experienced persistent vertigo for a minimum of 3 months after surgery were included. Those with possible perilymph fistula, long prosthesis, and benign paroxysmal positional vertigo were excluded. All patients received instructions on migraine dietary and lifestyle changes and Vitamin B2 and magnesium. In addition, prophylactic treatment with nortriptyline, verapamil, or a combination thereof was started. Changes in vertigo frequency was the main outcome variable. The secondary outcome variables included the time period and medications necessary to achieve symptomatic resolution. Four women and one man with an average age of 53 years were identified that met criteria for persistent PSV indicating an incidence of 0.9% at our institution. The onset of vertigo symptoms was on average 20 days postoperatively. All five patients had daily vertigo episodes and experienced complete resolution with no vertigo episodes after treatment. Symptomatic resolution was achieved over an average of 9 weeks after initiating treatments. Persistent PSV beyond 3 months is a rare occurrence and its treatment can be challenging when there is no evidence of an underlying pathology. This subset of patients may be suffering from migraine, which was triggered postoperatively. Treatment with migraine prophylaxis in this cohort of patients may result in resolution of vertigo.
BibTeX: @article{Moshtaghi2017, author = {Moshtaghi, Omid and Mahboubi, Hossein and Haidar, Yarah M and Sahyouni, Ronald and Lin, Harrison W and Djalilian, Hamid R}, title = {Resolution of Persistent Post-Stapedotomy Vertigo With Migraine Prophylactic Medication.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2017}, volume = {38}, issue = {10}, pages = {1500--1504}, doi = {https://doi.org/10.1097/MAO.0000000000001596}, keywords = {Adrenergic Uptake Inhibitors, therapeutic use; Adult; Aged; Calcium Channel Blockers, therapeutic use; Diet; Female; Humans; Life Style; Male; Middle Aged; Nortriptyline, therapeutic use; Postoperative Complications, drug therapy; Retrospective Studies; Stapes Surgery, adverse effects; Verapamil, therapeutic use; Vertigo, drug therapy, etiology}, pmid = {29065085} }
Sung, W.L., Kohli, N., Qu'adir, S., Golding, J.F., Bronstein, A.M. and Gresty, M.A.	Respiratory vulnerability to vehicle buffeting. [Abstract] [BibTeX]	2011	Clinical autonomic research : official journal of the Clinical Autonomic Research Society Vol. 21(6), pp. 365-371	article	DOI
Abstract: Buffeting in a jerky ride in a bus or ambulance normally provokes a sustained tachypnoea driven by vibration and sensory mechanisms including vestibular signals. Tachypnoea reinforces the torso against mechanical shocks but results in overbreathing, causing a mild fall in CO(2). However, normal CO(2) is rapidly restored by a reduction in depth of breathing. We test the hypothesis that vulnerable subjects, exemplified by elderly individuals and patients with vestibular disorders, may fail to adapt to buffeting. Respiratory and cardiovascular functions were recorded from five elderly subjects, two patients with bilateral loss of vestibular function and five patients with 'BPPV,' while being exposed to 15-min buffeting in a flight simulator which simulated transport in an ambulance over rough pavement. Results were compared with published norms. Some subjects sustained overbreathing during motion, through either tachypnoea or deep breathing, causing a marked reduction in CO(2) levels (3/5, 2/2 avestibular, 4/5 elderly, 4/5 BPPV). Others failed to raise breathing frequency which would render them susceptible to mechanical shock (4/5 elderly, 1/2 avestibular). Overbreathing was particularly evident in three anxious subjects. Overbreathing during buffeting could be caused by (1) resetting of CO(2) rest levels lower; (2) change in receptor sensitivity; (3) adjustment of central drive to breathing; and (4) stiffening of posture because of motion discomfort reduced the ability to modulate breathing. The buffeting experienced was moderately violent. More profound hypocapnia and mechanical shock are likely to result in vulnerable individuals failing to adapt to severe buffeting in transport on unpaved roads, in war zones or by sea ambulance.
BibTeX: @article{Sung2011, author = {Sung, Wei Lin and Kohli, Neeraj and Qu'adir, Shamim and Golding, John F and Bronstein, Adolfo M and Gresty, Michael A}, title = {Respiratory vulnerability to vehicle buffeting.}, journal = {Clinical autonomic research : official journal of the Clinical Autonomic Research Society}, year = {2011}, volume = {21}, issue = {6}, pages = {365--371}, doi = {https://doi.org/10.1007/s10286-011-0124-8}, keywords = {Aged; Ambulances; Automobile Driving; Female; Humans; Inhalation, physiology; Male; Middle Aged; Respiration; Vestibular Diseases; Vulnerable Populations}, pmid = {21547607} }
Choi, S.J. and Choung, Y.-H.	Response to "possible errors in the article 'clinical features of recurrent or persistent benign paroxysmal positional vertigo'" from Entong Wang. [BibTeX]	2013	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 149(5), pp. 797	article	DOI
BibTeX: @article{Choi2013, author = {Choi, Seong Jun and Choung, Yun-Hoon}, title = {Response to "possible errors in the article 'clinical features of recurrent or persistent benign paroxysmal positional vertigo'" from Entong Wang.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2013}, volume = {149}, issue = {5}, pages = {797}, doi = {https://doi.org/10.1177/0194599813505838}, keywords = {Female; Humans; Male; Vertigo, diagnosis}, pmid = {24190893} }
Sorgun, M.H., Aksun, Z., Atalay, Y.B. and Yücesan, C.	Restless legs syndrome in multiple sclerosis. [Abstract] [BibTeX]	2015	Turkish journal of medical sciences Vol. 45(6), pp. 1268-1273	article
Abstract: There have been conflicting results in the literature regarding the relationship between functional system involvement, the expanded disability status scale (EDSS), and the presence of restless legs syndrome (RLS) in patients with multiple sclerosis (MS). Ninety-one patients with MS and 40 patients in a control group (headache, essential tremor, and benign positional paroxysmal vertigo) were studied. The patients underwent a complete neurological examination and Kurtzke functional system scores were calculated. In order to assess the temporal relation between the onset of RLS and MS, a semistructured interview guided by a questionnaire about RLS was applied to all of the patients. Sixteen (17.6%) of the patients with MS and 1 (2.5%) patient in the control group had RLS. The prevalence of RLS was higher in patients with MS, compared to the control group (P = 0.018). Among the patients with MS, none of them suffered from RLS before the onset of MS, whereas sixteen patients (16%) suffered RLS after the onset of MS. There was no significant relationship between functional system involvement and the presence of RLS. The prevalence of RLS was higher in MS patients than it was in the control group. No association was found between RLS and functional system involvement in MS patients.
BibTeX: @article{Sorgun2015, author = {Sorgun, Mine Hayriye and Aksun, Zerin and Atalay, Yahya Burak and Yücesan, Canan}, title = {Restless legs syndrome in multiple sclerosis.}, journal = {Turkish journal of medical sciences}, year = {2015}, volume = {45}, issue = {6}, pages = {1268--1273}, keywords = {Adult; Case-Control Studies; Female; Humans; Male; Multiple Sclerosis, complications; Prevalence; Prospective Studies; Restless Legs Syndrome, complications}, pmid = {26775381} }
Kasse, C.A., Santana, G.G., Scharlach, R.C., Gazzola, J.M., Branco, F.C.B. and Doná, F.	Results from the balance rehabilitation unit in benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2010	Brazilian journal of otorhinolaryngology Vol. 76(5), pp. 623-629	article
Abstract: Posturography is a useful new tool to study the influence of vestibular diseases on balance. to compare the results from the Balance Rehabilitation Unit (BRU) static posturography in elderly patients with Benign Paroxysmal Positional Vertigo (BPPV), before and after Epley's maneuver. a prospective study of 20 elderly patients with a diagnosis of BPPV. The patients underwent static posturography and the limit of stability (LE) and ellipse area were measured. We also applied the Dizziness Handicap Inventory (DHI) questionnaire to study treatment effectiveness. 80% were females, with a mean age of 68.15 years. After the maneuver, the LE increased significantly (p=0.001). The elliptical area of somatosensory, visual and vestibular conflicts (2,7,8,9 situations) in BRU and the DHI scores decreased significantly (p<0.05) after treatment. the study suggests that elderly patients with BPPV may present static postural control impairment and that the maneuver is effective for the remission of symptoms, to increase in the stability and improvement in postural control in situations of visual, somatosensory and vestibular conflicts.
BibTeX: @article{Kasse2010, author = {Kasse, Cristiane Akemi and Santana, Graziela Gaspar and Scharlach, Renata Coelho and Gazzola, Juliana Maria and Branco, Fátima Cristina Barreiro and Doná, Flávia}, title = {Results from the balance rehabilitation unit in benign paroxysmal positional vertigo.}, journal = {Brazilian journal of otorhinolaryngology}, year = {2010}, volume = {76}, issue = {5}, pages = {623--629}, keywords = {Aged; Dizziness, physiopathology; Female; Humans; Male; Middle Aged; Physical Therapy Modalities; Postural Balance; Posture; Prospective Studies; Semicircular Canals, physiopathology; Statistics, Nonparametric; Surveys and Questionnaires; Treatment Outcome; Vertigo, complications, rehabilitation; Vestibular Diseases, complications, rehabilitation}, pmid = {20963347} }
Proctor, L.R.	Results of serial vestibular testing in unilateral Ménière's disease. [Abstract] [BibTeX]	2000	The American journal of otology Vol. 21(4), pp. 552-558	article
Abstract: To determine the prevalence and character of vestibular abnormalities and the changes in vestibular function that occur in unilateral Ménière's disease. Retrospective case review. Ambulatory patients at a tertiary care facility. Entry criteria included a diagnosis of unilateral Ménière's disease and test results from at least two vestibular test sessions at the Johns Hopkins Otologic Vestibular Laboratory. One hundred twenty-two cases were evaluated. Electronystagmographic evaluation, including caloric testing; audiometric tests; and medical records. Caloric weakness was demonstrated in 58% of patients on the involved side and in 19% on the normal side. Complete paralysis was found in 7%. Directional preponderance was seen in 33% of patients and completely normal scores in 27%. During the course of the disease, responses become weaker in 26% of patients and stronger in 11%. Of 39 patients tested more than twice, 26% showed both increases and decreases in caloric responses. After an acute attack, only one of eight patients showed a depressed response on the diseased side, and three showed an increased response. Spontaneous nystagmus, seen within 24 hours of an attack in 54 cases, was directed away from the diseased ear in only about one half of the cases. Benign paroxysmal positional vertigo was found in 44% of these patients. Possible pathophysiologic explanations for the various test results in Ménière's disease are discussed. Interpretation of caloric test results should take into account the absolute value of the slow phase eye speed scores, in addition to the right-left difference score. Also, established standards for the normal range of fluctuation in both absolute and comparative scores should be used when more than one test session has been undertaken.
BibTeX: @article{Proctor2000, author = {Proctor, L R}, title = {Results of serial vestibular testing in unilateral Ménière's disease.}, journal = {The American journal of otology}, year = {2000}, volume = {21}, issue = {4}, pages = {552--558}, keywords = {Acute Disease; Adolescent; Adult; Aged; Audiometry; Disease Progression; Female; Humans; Male; Meniere Disease, complications, diagnosis, physiopathology; Middle Aged; Nystagmus, Physiologic; Retrospective Studies; Severity of Illness Index; Vestibular Function Tests, methods}, pmid = {10912702} }
Gacek, R.R. and Gacek, M.R.	Results of singular neurectomy in the posterior ampullary recess. [Abstract] [BibTeX]	2002	ORL; journal for oto-rhino-laryngology and its related specialties Vol. 64(6), pp. 397-402	article	DOI
Abstract: To determine the effect on hearing and balance symptoms following singular neurectomy (SN) for benign paroxysmal positional vertigo (BPPV) in the ampullary recess of the posterior semicircular canal. The charts of 242 patients with chronic disabling BPPV who were treated with SN over a 29-year period (1972-2001) were reviewed. The results on relief of BPPV and hearing function were recorded. A subset of 16 patients where the posterior ampullary recess was entered to expose the SN is described in detail with regard to an effect on hearing and balance. A total of 252 SN were performed in 242 patients. Ten patients underwent bilateral SN sequentially; the remaining 232 patients had unilateral SN. The ages of the patients ranged from 21 to 86 years, with a mean at 57 years. The female:male ratio was 174:68. Complete relief of BPPV was achieved in 244 patients (96.8%), incomplete relief in 3 (1%), and no relief in 5 (2%). Sensorineural hearing loss (SNHL) occurred in 9 patients (3.7%). A subset of 16 patients in whom the ampullary recess was opened during SN ranged in age from 21 to 79 years, with a mean at 56 years. The female:male ratio was 12:4, with right and left sides divided almost equally. Relief of BPPV was achieved in all 16 patients with no loss of hearing function. Five patients complained of a fistula response postoperatively (31%). The fistula response resolved by 6 months postoperatively in all 5 patients. SN is effective in relief of BPPV with little risk of SNHL (3.7%). The risk of SNHL is not increased when the posterior ampullary recess must be entered in order to transect the singular nerve. A positive fistula response may be present temporarily in almost one third of these patients.
BibTeX: @article{Gacek2002, author = {Gacek, Richard R and Gacek, Mark R}, title = {Results of singular neurectomy in the posterior ampullary recess.}, journal = {ORL; journal for oto-rhino-laryngology and its related specialties}, year = {2002}, volume = {64}, issue = {6}, pages = {397--402}, doi = {https://doi.org/10.1159/000067572}, keywords = {Adult; Aged; Aged, 80 and over; Chronic Disease; Female; Hearing Loss, Sensorineural, diagnosis, etiology; Humans; Male; Middle Aged; Peripheral Nerves, surgery; Postoperative Complications; Semicircular Canals, innervation; Vertigo, etiology, surgery}, pmid = {12499762} }
McGinnis, P.Q., Nebbia, M., Saez, L. and Rudolph, K.	Retrospective comparison of outcomes for patients with benign paroxysmal positional vertigo based on length of postural restrictions. [Abstract] [BibTeX]	2009	Journal of geriatric physical therapy (2001) Vol. 32(4), pp. 168-173	article
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo in older adults. The effectiveness of the repositioning maneuver as an intervention has been established in the literature; however, the efficacy of the posttreatment instructions has not been established. The purpose of this retrospective study was compare treatment outcomes for patients receiving 24 hour postural restrictions posttreatment versus 48 hour restrictions. Medical records of 76 patients diagnosed with BPPV at an outpatient physical therapy practice were reviewed. The average age was 61.05 years (SD 16.16). A positive outcome was determined by partial or complete resolution of symptoms, defined as a reduction in the number of special tests or positions that provoked symptoms from initial examination to discharge, as well as a reduction in vertigo intensity ratings. Patients in both groups experienced significant reductions in the number of symptom provoking positions, positive special tests, and ratings of vertigo intensity following treatment. Mean ratings of vertigo intensity on a 10 point scale were 5.71 pre and 1.83 post for the 24 hour group, and 6.75 pre and 3.00 post for the 48 hour group. Positive treatment outcomes were experienced by 95.4% of patients in the 24 hour group (n=63), with 53% (n=35) achieving complete resolution. Patients experienced positive treatment outcomes regardless of the length of postural restrictions following repositioning maneuver for BPPV. Therapists can reduce the length of postural restrictions to 24 hours upright following a repositioning maneuver without adversely affecting patient outcomes.
BibTeX: @article{McGinnis2009, author = {McGinnis, Patricia Q and Nebbia, Marissa and Saez, Lisa and Rudolph, Katherine}, title = {Retrospective comparison of outcomes for patients with benign paroxysmal positional vertigo based on length of postural restrictions.}, journal = {Journal of geriatric physical therapy (2001)}, year = {2009}, volume = {32}, issue = {4}, pages = {168--173}, keywords = {Adult; Age Distribution; Aged; Aged, 80 and over; Ambulatory Care; Exercise Therapy, methods; Eye Movements; Female; Head Movements; Humans; Male; Middle Aged; Otolithic Membrane, physiopathology; Posture; Retrospective Studies; Risk Factors; Severity of Illness Index; Time Factors; Treatment Outcome; Vertigo, diagnosis, epidemiology, etiology, rehabilitation}, pmid = {20469566} }
D'Silva, L.J., Staecker, H., Lin, J., Sykes, K.J., Phadnis, M.A., McMahon, T.M., Connolly, D., Sabus, C.H., Whitney, S.L. and Kluding, P.M.	Retrospective data suggests that the higher prevalence of benign paroxysmal positional vertigo in individuals with type 2 diabetes is mediated by hypertension. [Abstract] [BibTeX]	2016	Journal of vestibular research : equilibrium & orientation Vol. 25(5-6), pp. 233-239	article	DOI
Abstract: Benign Paroxysmal Positional Vertigo (BPPV) has been linked to comorbidities like diabetes and hypertension. However, the relationship between type 2 diabetes (DM) and BPPV is unclear. The purpose of this retrospective study was to examine the relationship between DM and BPPV in the presence of known contributors like age, gender and hypertension. A retrospective review of the records of 3933 individuals was categorized by the specific vestibular diagnosis and for the presence of type 2 DM and hypertension. As the prevalence of BPPV was higher in people with type 2 DM compared to those without DM, multivariable logistic regressions were used to identify variables predictive of BPPV. The relationship between type 2 DM, hypertension and BPPV was analyzed using mediation analysis. BPPV was seen in 46% of individuals with type 2 DM, compared to 37% of individuals without DM (p< 0.001). Forty two percent of the association between type 2 DM and BPPV was mediated by hypertension, and supported hypertension as a complete mediator in the relationship between type 2 DM and BPPV. Hypertension may provide the mediating pathway by which diabetes affects the vestibular system. Individuals with complaints of dizziness, with comorbidities including hypertension and diabetes, may benefit from a screening for BPPV.
BibTeX: @article{DSilva2016, author = {D'Silva, Linda J and Staecker, Hinrich and Lin, James and Sykes, Kevin J and Phadnis, Milind A and McMahon, Tamara M and Connolly, Dan and Sabus, Carla H and Whitney, Susan L and Kluding, Patricia M}, title = {Retrospective data suggests that the higher prevalence of benign paroxysmal positional vertigo in individuals with type 2 diabetes is mediated by hypertension.}, journal = {Journal of vestibular research : equilibrium & orientation}, year = {2016}, volume = {25}, issue = {5-6}, pages = {233--239}, doi = {https://doi.org/10.3233/VES-150563}, keywords = {Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, epidemiology, physiopathology; Diabetes Mellitus, Type 2, complications, physiopathology; Dizziness; Female; Humans; Hypertension, etiology, physiopathology; Male; Middle Aged; Prevalence; Retrospective Studies; Sex Factors; Vestibular Function Tests; Young Adult; Type 2 Diabetes; benign paroxysmal positional vertigo; hypertension}, pmid = {26890424} }
Lee, S.-H., Kim, M.-K., Cho, K.-H. and Kim, J.S.	Reversal of initial positioning nystagmus in benign paroxysmal positional vertigo involving the horizontal canal. [Abstract] [BibTeX]	2009	Annals of the New York Academy of Sciences Vol. 1164, pp. 406-408	article	DOI
Abstract: In benign paroxysmal positional vertigo (BPPV), spontaneous reversal of the initial positioning nystagmus rarely occurs without further position changes. We analyzed the characteristics of spontaneous reversal of the initial head-turning nystagmus in 21 patients with BPPV involving the horizontal semicircular canal. All patients showed initial geotropic nystagmus (first-phase nystagmus) on head turning to either side while supine, which was followed by spontaneous reversal (second-phase nystagmus). The reversal was either unilateral (n = 16) or bilateral (n = 5). The maximal slow phase velocity (SPV) and duration of the first-phase nystagmus were greater and shorter than those of the second-phase nystagmus. The reversal group showed greater maximal SPVs of the initial nystagmus in either ipsi- or contralesional direction than the control group. BPPV resolved after particle repositioning maneuver (PRM) in most patients. However, one patient showed persistent apogeotropic nystagmus after PRM. Short-term adaptation of the vestibulo-ocular reflex seems to be the main mechanism of spontaneous reversal of the initial positioning nystagmus. However, coexistence of canalo- and cupulolithiasis should be considered in the patient showing bilateral spontaneous reversal.
BibTeX: @article{Lee2009, author = {Lee, Seung-Han and Kim, Myeong-Kyu and Cho, Ki-Hyun and Kim, Ji Soo}, title = {Reversal of initial positioning nystagmus in benign paroxysmal positional vertigo involving the horizontal canal.}, journal = {Annals of the New York Academy of Sciences}, year = {2009}, volume = {1164}, pages = {406--408}, doi = {https://doi.org/10.1111/j.1749-6632.2008.03739.x}, keywords = {Adaptation, Physiological; Aged; Ear Canal, physiopathology; Humans; Male; Middle Aged; Nystagmus, Pathologic, physiopathology; Reflex, Vestibulo-Ocular; Vertigo, physiopathology}, pmid = {19645938} }
Justicz, N., Strickland, K.F., Motamedi, K.K. and Mattox, D.E.	Review of a single surgeon's stapedotomy cases performed with a nickel titanium prosthesis over a 14-year period. [Abstract] [BibTeX]	2017	Acta oto-laryngologica Vol. 137(4), pp. 442-446	article	DOI
Abstract: Stapes surgery with a nickel titanium prosthesis is a safe and well-tolerated procedure that leads to a significant improvement in hearing outcomes. To identify the efficacy and safety of stapedotomy procedures performed with a nickel titanium prosthesis for patients with otosclerosis. A review of 431 unique stapedotomies performed over 14 years by a single surgeon at an academic tertiary care center yielded 312 cases with nickel titanium prosthesis that met inclusion criteria of otosclerosis diagnosis, initial surgery in operative ear, and presence of pre-operative and post-operative audiograms. Pure-tone averages (PTA) at baseline and 8 weeks after surgery were calculated over four frequencies; 0.5, 1, 2, and 4 kHz. Average air-bone gaps (ABG) were calculated from pre-operative and post-operative audiograms. Average pre-operative baseline PTA was 56.7 dB in the affected ear. Post-operative PTA was 30.1 dB, a 26.6 dB improvement. Initial average ABG was 29.7 dB, while post-operative ABG averaged 5.4 dB, a 24.2 dB improvement. Surgical success (closure of ABG within 10 dB) was achieved in 263 (84%) patients. Rate of surgical success was not correlated with age, gender, race, or affected ear. Complications included recurrent conductive hearing loss (14), progressive SNHL (4), and post-operative BPPV (3).
BibTeX: @article{Justicz2017, author = {Justicz, Natalie and Strickland, Kaitlyn F and Motamedi, Kevin K and Mattox, Douglas E}, title = {Review of a single surgeon's stapedotomy cases performed with a nickel titanium prosthesis over a 14-year period.}, journal = {Acta oto-laryngologica}, year = {2017}, volume = {137}, issue = {4}, pages = {442--446}, doi = {https://doi.org/10.1080/00016489.2016.1258732}, keywords = {Adolescent; Adult; Aged; Audiometry; Female; Humans; Male; Middle Aged; Nickel; Ossicular Prosthesis, statistics & numerical data; Retrospective Studies; Stapes Surgery, instrumentation, statistics & numerical data; Titanium; Young Adult; Otosclerosis; SNHL; hearing; middle ear; stapedotomy}, pmid = {28350269} }
Mohr, D.N.	Review of benign paroxysmal positional vertigo. [BibTeX]	1984	Minnesota medicine Vol. 67(12), pp. 673	article
BibTeX: @article{Mohr1984, author = {Mohr, D N}, title = {Review of benign paroxysmal positional vertigo.}, journal = {Minnesota medicine}, year = {1984}, volume = {67}, issue = {12}, pages = {673}, keywords = {Humans; Nystagmus, Physiologic; Posture; Vertigo, diagnosis, physiopathology}, pmid = {6513909} }
Wanner, L., Manegold-Brauer, G. and Brauer, H.U.	Review of unusual intraoperative and postoperative complications associated with endosseous implant placement. [Abstract] [BibTeX]	2013	Quintessence international (Berlin, Germany : 1985) Vol. 44(10), pp. 773-781	article	DOI
Abstract: Common complications associated with dental implant surgery are well recognized and are usually explained to patients during the process of informed consent. For the general dental practitioner, the periodontist, and the oral and maxillofacial surgeon, it is relevant to also be familiar with less frequent complications. This review gathers unusual complications of this surgical procedure and presents unique complications from single case reports. Studies were located using systematic searches in Medline and the Cochrane Library electronic databases. Key words included the terms "implant", "dental", "oral", "complication", "unusual", and "rare". References from the relevant articles were also double-checked. The review was limited to English and German language articles, published within the last 15 years. 17 different unusual complications were identified. The majority of studies report five different complications: permanent nerve injury, damage to teeth adjacent to the implant, excessive bleeding resulting in hematoma of the floor of the mouth, mandibular fracture, and displacement of implants into the maxillary sinus. Benign paroxysmal positional vertigo and a plunging ranula were reported sporadically. Another 10 complications were only described once in our literature search. Unusual complications are challenging. It is important for the dental practitioner to be aware of all the possible complications and to recognize them early so that adequate therapy can immediately be ensured.
BibTeX: @article{Wanner2013, author = {Wanner, Laura and Manegold-Brauer, Gwendolin and Brauer, Hans Ulrich}, title = {Review of unusual intraoperative and postoperative complications associated with endosseous implant placement.}, journal = {Quintessence international (Berlin, Germany : 1985)}, year = {2013}, volume = {44}, issue = {10}, pages = {773--781}, doi = {https://doi.org/10.3290/j.qi.a29936}, keywords = {Dental Implantation, Endosseous, adverse effects; Humans; Intraoperative Complications; Postoperative Complications}, pmid = {23772438} }
Soto-Varela, A., Rossi-Izquierdo, M., Sánchez-Sellero, I. and Santos-Pérez, S.	Revised criteria for suspicion of non-benign positional vertigo. [Abstract] [BibTeX]	2013	QJM : monthly journal of the Association of Physicians Vol. 106(4), pp. 317-321	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most commonly diagnosed vestibular vertigo. BPPV can be diagnosed by clinical examination and its treatment is based on particle repositioning manoeuvres, and specialized equipment is not required. Therefore, most patients could be diagnosed and treated by their general practitioner. Unfortunately, not all positional vertigos are benign. Symptoms similar to those of BPPV can be caused by diseases that affect the central nervous system. It must be possible to define criteria that allow us to suspect, in a patient with symptoms of positional vertigo, the possibility of a cerebral origin ('non-benign PV'). Requests for magnetic resonance imaging must be justified by the fulfillment of these criteria. That is especially relevant in primary care, because these criteria should make possible to distinguish between patients with positional vertigo that could be treated by general practitioner and patients that need to be directed to especialized units. We propose the following revised criteria for suspected non-benign PV: (i) association with signs or symptoms of neurological disorder, (ii) nystagmus without dizziness in positional diagnostic tests, (iii) atypical nystagmus direction, (iv) poor response to therapeutic manoeuvres and (v) recurrence (confirmed by positional tests) on at least three occasions.
BibTeX: @article{Soto-Varela2013a, author = {Soto-Varela, A and Rossi-Izquierdo, M and Sánchez-Sellero, I and Santos-Pérez, S}, title = {Revised criteria for suspicion of non-benign positional vertigo.}, journal = {QJM : monthly journal of the Association of Physicians}, year = {2013}, volume = {106}, issue = {4}, pages = {317--321}, doi = {https://doi.org/10.1093/qjmed/hct006}, keywords = {Benign Paroxysmal Positional Vertigo; Central Nervous System Diseases, complications; Diagnosis, Differential; Humans; Nystagmus, Pathologic, etiology; Patient Positioning, methods; Recurrence; Vertigo, diagnosis, etiology, therapy}, pmid = {23404787} }
Marom, T., Oron, Y., Watad, W., Levy, D. and Roth, Y.	Revisiting benign paroxysmal positional vertigo pathophysiology. [Abstract] [BibTeX]	2009	American journal of otolaryngology Vol. 30(4), pp. 250-255	article	DOI
Abstract: Benign paroxysmal positional vertigo is the most common peripheral cause of vertigo. Although its pathophysiologic mechanisms remain unclear, different locations have been attributed throughout the last century, from the days of Bárány. Disease was initially located by Dix and Hallpike in the utricle, but later, Schuknecht's works elicited the cupulolithiasis and canalolithiasis theories, localizing the pathology to the semicircular canal system and mainly to the posterior one. However, conflicting evidences from temporal bone studies accumulated against this theory, which suggest other explanations. Although this clinical entity is well defined, and can usually be effectively treated with certain physical maneuvers, its pathophysiology is still obscure and is being critically discussed in this article, which reviews the milestones of benign paroxysmal positional vertigo understanding.
BibTeX: @article{Marom2009, author = {Marom, Tal and Oron, Yahav and Watad, Waseem and Levy, Dalia and Roth, Yehudah}, title = {Revisiting benign paroxysmal positional vertigo pathophysiology.}, journal = {American journal of otolaryngology}, year = {2009}, volume = {30}, issue = {4}, pages = {250--255}, doi = {https://doi.org/10.1016/j.amjoto.2008.06.009}, keywords = {Diagnosis, Differential; Ear, Inner, physiopathology; Humans; Prognosis; Vertigo, diagnosis, etiology, physiopathology; Vestibular Nerve, physiopathology}, pmid = {19563936} }
Kim, M., Lee, D.-S., Hong, T.H. and Joo Cho, H.	Risk factor of benign paroxysmal positional vertigo in trauma patients: A retrospective analysis using Korean trauma database. [Abstract] [BibTeX]	2018	Medicine Vol. 97(49), pp. e13150	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is a comorbid condition prevalent in patients recovering from trauma. Due to the paucity of studies investigating the etiology of this condition, the present study sought to analyze the high-risk group of BPPV patients following trauma.Trauma patients visiting the emergency department from January to December 2016 were enrolled. The study excluded patients with minor superficial injuries, those who were dead, and those discharged within 2 days after their visit. The medical records were reviewed, and every abbreviated injury score, injury severity score, and other clinical characteristics, such as age and sex, were gathered. A diagnosis of BPPV was reached only after a provocation test was administered by an otolaryngologist. The correlation was statistically analyzed.A total of 2219 trauma patients were analyzed. The mean age of the patients was 52.6 years, and the mean injury severity score (ISS) was 7.9. About 70% of the patients were men. Additional BPPV patients were identified among patients with injuries to head and neck, chest, and abdomen, and those with external injuries. However, patients with head and neck (odds ratio [OR] (95% confidence interval [CI]) = 10.556 (1.029-108.262), and abdominal injury (OR [95% CI] = 78.576 [1.263-4888.523]) showed statistically significant correlation with BPPV in the logistic regression analysis. Patients-not only those with head and neck injuries but those with abdominal injuries-who complain of dizziness need to be evaluated for BPPV using provocation tests. Further studies investigating traumatic BPPV are needed.
BibTeX: @article{Kim2018, author = {Kim, Maru and Lee, Dae-Sang and Hong, Tae Hwa and Joo Cho, Hang}, title = {Risk factor of benign paroxysmal positional vertigo in trauma patients: A retrospective analysis using Korean trauma database.}, journal = {Medicine}, year = {2018}, volume = {97}, issue = {49}, pages = {e13150}, doi = {https://doi.org/10.1097/MD.0000000000013150}, keywords = {Benign Paroxysmal Positional Vertigo, complications, epidemiology; Comorbidity; Female; Humans; Male; Middle Aged; Prevalence; Republic of Korea, epidemiology; Retrospective Studies; Risk Factors; Wounds and Injuries, complications, epidemiology}, pmid = {30544375} }
Sato, G., Sekine, K., Matsuda, K. and Takeda, N.	Risk factors for poor outcome of a single Epley maneuver and residual positional vertigo in patients with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2013	Acta oto-laryngologica Vol. 133(11), pp. 1124-1127	article	DOI
Abstract: The findings suggest that in patients with posterior semicircular canal (PSCC) benign paroxysmal positional vertigo (P-BPPV), head trauma and prolonged bedrest, but not inner ear disease, are risk factors for poor outcome of a single Epley maneuver and persistent residual positional vertigo. We first examined the efficacy of a single Epley maneuver and then assessed the time course in remission of residual positional vertigo in patients with idiopathic P-BPPV and secondary P-BPPV. A total of 157 patients with idiopathic P-BPPV and 40 patients with secondary P-BPPV (secondary to head trauma in 8 patients, to prolonged bedrest in 14 patients, and to inner ear disease in 18 patients) were treated with a single Epley maneuver. The negative rates of the Dix-Hallpike test on day 7 after a single Epley maneuver in both patients with P-BPPV secondary to head trauma (25%) and those with prolonged bedrest (36%) were significantly lower than that (73%) in patients with idiopathic P-BPPV. Additionally, the remission of residual positional vertigo in the former groups of patients was significantly delayed in comparison with that of the latter group. However, there were no significant differences in the efficacy of a single Epley maneuver and persistent residual positional vertigo between idiopathic P-BPPV and P-BPPV secondary to inner ear disease.
BibTeX: @article{Sato2013, author = {Sato, Go and Sekine, Kazunori and Matsuda, Kazunori and Takeda, Noriaki}, title = {Risk factors for poor outcome of a single Epley maneuver and residual positional vertigo in patients with benign paroxysmal positional vertigo.}, journal = {Acta oto-laryngologica}, year = {2013}, volume = {133}, issue = {11}, pages = {1124--1127}, doi = {https://doi.org/10.3109/00016489.2013.817681}, keywords = {Adult; Aged; Aged, 80 and over; Female; Follow-Up Studies; Humans; Male; Middle Aged; Physical Therapy Modalities, statistics & numerical data; Treatment Outcome; Vertigo, etiology, therapy; Young Adult}, pmid = {23848235} }
Tanimoto, H., Doi, K., Nishikawa, T. and Nibu, K.-i.	Risk factors for recurrence of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2008	Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale Vol. 37(6), pp. 832-835	article
Abstract: To assess the results of treatment for a first episode of benign paroxysmal positional vertigo (BPPV) and risk factors for recurrence. Retrospective chart review of 148 BPPV patients at a tertiary care referral centre. The canalith repositioning procedure (CRP) was performed until vertigo and nystagmus were resolved. Using multivariate logistic regression, we estimated the relationship between the rate of BPPV recurrence within 1 year and various risk factors for BPPV. Among the 145 patients after successful manoeuvre or spontaneous resolution, BPPV recurred in 31 patients (21%) within 1 year. Patients with recurrent BPPV in the posterior semicircular canal required more CRP sessions and a longer period. The rate of BPPV recurrence in patients with endolymphatic hydrops (75%) was significantly higher than in those without (odds ratio 17; 95% confidence interval 2.9-101). Both the first episode of BPPV and recurrent BPPV affected the same ear associated with endolymphatic hydrops in all patients with this complication. Our data suggest that endolymphatic hydrops is a risk factor for recurrence of BPPV and that prevention of recurrent BPPV is important for control of endolymphatic hydrops.
BibTeX: @article{Tanimoto2008, author = {Tanimoto, Hitoshi and Doi, Kiyoshi and Nishikawa, Tasuku and Nibu, Ken-ichi}, title = {Risk factors for recurrence of benign paroxysmal positional vertigo.}, journal = {Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale}, year = {2008}, volume = {37}, issue = {6}, pages = {832--835}, keywords = {Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Cohort Studies; Female; Humans; Male; Middle Aged; Musculoskeletal Manipulations; Recurrence; Retrospective Studies; Risk Factors; Sex Factors; Treatment Outcome; Vertigo, diagnosis, etiology, therapy; Young Adult}, pmid = {19128712} }
Su, P., Liu, Y.-C. and Lin, H.-C.	Risk factors for the recurrence of post-semicircular canal benign paroxysmal positional vertigo after canalith repositioning. [Abstract] [BibTeX]	2016	Journal of neurology Vol. 263(1), pp. 45-51	article	DOI
Abstract: This retrospective study was conducted to determine the relationship between variable factors and the recurrence rate of post-semicircular canal benign paroxysmal positional vertigo (PSC-BPPV) after canalith repositioning procedure (CRP). Patients with PSC-BPPV were diagnosed by history and the presence of a positive Dix-Hallpike maneuver between 2008 and 2010. In total, 243 patients (47 males and 196 females, average age = 57.5 -years) treated with Epley's maneuver or canalith repositioning procedure (CRP) were included in the study. The demographic factors studied were age, sex, sleep disorders, inner ear diseases, head trauma history, and cardiovascular diseases. Multivariate statistics using SPSS version 15, Pearson's Chi-squared test (χ2), Kaplan-Meier analysis, log-rank test, and Cox proportional hazards regression model were used for the analysis. The success rate of vertigo control after the initial CRP was 83.1 %. Pearson's χ2 test results showed that females and participants with sleep disorders exhibited a significant difference in the recurrence of vertigo after the initial CRP. In addition, the Kaplan-Meier analysis and log-rank test survival analysis revealed that the recurrence was associated with females and participants with sleep disorders and inner ear diseases.However, Cox proportional hazards regression showed no differences in recurrences associated with old age, sex, sleep disorders, inner ear diseases, head trauma, and cardiovascular diseases. Epley's maneuver or CRP is an effective, safe, and simple treatment for BPPV. Females and participants with sleep disorders and inner ear diseases are likely associated with the recurrence of BPPV after CRP.
BibTeX: @article{Su2016, author = {Su, Peijen and Liu, Yun-Chih and Lin, Hung-Ching}, title = {Risk factors for the recurrence of post-semicircular canal benign paroxysmal positional vertigo after canalith repositioning.}, journal = {Journal of neurology}, year = {2016}, volume = {263}, issue = {1}, pages = {45--51}, doi = {https://doi.org/10.1007/s00415-015-7931-0}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, rehabilitation; Female; Follow-Up Studies; Humans; Male; Middle Aged; Neurological Rehabilitation, methods; Otolithic Membrane, physiopathology; Outcome Assessment (Health Care); Recurrence; Retrospective Studies; Risk Factors; Semicircular Canals, physiopathology}, pmid = {26477026} }
Gupta, S.K., Upadhyay, A. and Mundra, R.K.	Role of Electronystagmography in Diagnosis of Secondary BPPV in Elderly Patients with Vertigo: A Retrospective Study. [Abstract] [BibTeX]	2018	Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India Vol. 70(3), pp. 428-433	article	DOI
Abstract: Elderly population is frequently affected by vertigo which affects their mobility and makes them vulnerable to fall and other morbidities. Often these patient visit neurologist and are often subjected to CT scan, MRI brain etc. to rule out a central cause of vertigo; whereas majority of these patients suffer from vestibular cause of vertigo. A schematic approach by detailed history, simple tests for vestibular functions like Dix Hallpike, supine roll and head impulse test give important clue to diagnosis. Often the diagnosis is benign paroxysmal positional vertigo (BPPV) which is treated by repositioning maneuver. There are often other vestibular causes which may be diagnosed by Electronystagmography (ENG), electrocochleography and other tests. This study was undertaken to study occurrence of secondary BPPV utilizing various parameters of ENG. The study group comprised of 131 patients from the neuro-otology proforma data base at ENT centre and vertigo clinic from January 2015 to December 2017. Inclusion criterion was male and female aged 51 years and above presenting with dizziness, imbalance, rotational vertigo, unsteadiness as the chief complaint. Exclusion criterion was BPPV relieved after Epley's maneuver, Otitis externa, acute Otitis media, Suppurative Otitis media, pre existing neurological condition and history of ear surgery. Neuro-otology Data obtained and the ENG findings were tabulated in the master chart and the observations interpreted and transferred to Claussen's butterfly chart. The study group comprised of 58 male (44.27%) and 73 female (55.73%) with a male female ratio of 1:1.25. ENG exhibited 36 patients (27.49) to have recurrent BPPV, 53 (40.45%) were found to have unilateral/bilateral canal paresis. Meniere's disease was diagnosed in 39 (29.77%) patients and brain stem pathology identified in 3 (2.29%) cases.
BibTeX: @article{Gupta2018, author = {Gupta, Sanjay Kumar and Upadhyay, Aparaajita and Mundra, R K}, title = {Role of Electronystagmography in Diagnosis of Secondary BPPV in Elderly Patients with Vertigo: A Retrospective Study.}, journal = {Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India}, year = {2018}, volume = {70}, issue = {3}, pages = {428--433}, doi = {https://doi.org/10.1007/s12070-018-1449-6}, keywords = {BPPV; Electronystagmography; Vertigo}, pmid = {30211103} }
Mendeš, T., Maslovara, S., Včeva, A. and Butković Soldo, S.	Role of Vestibular Evoked Myogenic Potentials as an Indicator of Recovery in Patients with Benign Paroxysmal Positional Vertigo. [Abstract] [BibTeX]	2017	Acta clinica Croatica Vol. 56(4), pp. 756-764	article	DOI
Abstract: Ocular vestibular evoked myogenic potentials (oVEMP) and cervical VEMP (cVEMP) are newer diagnostic methods, which allow an insight into the otolith senses. Our aim was to determine changes in certain parameters of the VEMP wave complex after successfully performed repositioning procedure, as an indicator of the state of recovery in patients with benign paroxysmal positional vertigo (BPPV). This may confirm the theory of otolith returning into the area of otolithic senses. The study included 48 patients with unilateral posterior semicircular canal BPPV. On their first arrival, otoneurological examinations, oVEMP and cVEMP tests were performed. The same were included in follow up check-ups scheduled at seven days and six months after successful implementation of Epley maneuvers. The initial measurement revealed a significantly reduced amplitude of oVEMP on the affected side. On the 7-day measurement, the amplitude increase was observed on the affected side, with significant reduction in the amplitude ratio (p=0.693), which reached statistical significance on the last measurement at 6 months (p=0.006). These findings confirmed the hypothesis of the return of otoconia into the utricular area.
BibTeX: @article{Mendes2017, author = {Mendeš, Tihana and Maslovara, Siniša and Včeva, Andrijana and Butković Soldo, Silva}, title = {Role of Vestibular Evoked Myogenic Potentials as an Indicator of Recovery in Patients with Benign Paroxysmal Positional Vertigo.}, journal = {Acta clinica Croatica}, year = {2017}, volume = {56}, issue = {4}, pages = {756--764}, doi = {https://doi.org/10.20471/acc.2017.56.04.25}, keywords = {Benign paroxysmal positional vertigo; Otolithic membrane; Quality of life; Semicircular canals; Vestibular evoked myogenic potentials}, pmid = {29590733} }
López-Escámez, J.A.	Role of vestibular testing in diagnosis of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2009	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 141(1), pp. 7-9; author reply 10-1	article	DOI
Abstract: Diagnosis and treatment of benign paroxysmal positional vertigo (BPPV) is a mixture of empiricism of particle repositioning with the rationally-based knowledge obtained from clinical observations, histopathology, and neurophysiological experiments. The recently published clinical practice guideline on BPPV makes recommendations on the management of BPPV. One of the statements discourages the use of radiographic or vestibular testing, unless the diagnosis was uncertain or there were additional signs or symptoms unrelated to BPPV. The role of video-oculography in diagnosis and treatment of BPPV is argued, since vestibular testing has provided key relevant information to understand positional nystagmus in patients with BPPV.
BibTeX: @article{Lopez-Escamez2009, author = {López-Escámez, José A}, title = {Role of vestibular testing in diagnosis of benign paroxysmal positional vertigo.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2009}, volume = {141}, issue = {1}, pages = {7--9; author reply 10-1}, doi = {https://doi.org/10.1016/j.otohns.2009.03.016}, keywords = {Adolescent; Audiometry; Diagnosis, Differential; Eye Movement Measurements; Humans; Physical Examination; Practice Patterns, Physicians', standards; Reflex, Vestibulo-Ocular, physiology; Severity of Illness Index; Vertigo, diagnosis, physiopathology; Vestibule, Labyrinth, physiopathology; Video Recording}, pmid = {19559949} }
Hornibrook, J.	Saccular otoconia as a cause of Ménière's disease: hypothesis based on two theories. [Abstract] [BibTeX]	2018	The Journal of laryngology and otology Vol. 132(9), pp. 771-774	article	DOI
Abstract: The cause of Ménière's disease remains enigmatic after 156 years. Schuknecht's rupture and potassium intoxication theory of attacks was based on histological studies. This paper aimed to: present the most contemporary evidence indicating that ruptures do not usually occur, and discuss the possibility that detached saccular otoconia are the main cause of Ménière's disease; and to establish an unequivocal definition of the age of Ménière's disease onset. The paper reviews the electrophysiological basis of the Gibson-Arenberg drainage theory used to explain vertigo attacks. The current, limited knowledge of the likely fate of detached saccular otoconia is discussed. Electrophysiological studies during attacks do not support endolymph ruptures, but rather endolymph flowing in one direction and then in the opposite direction. Age of onset for Ménière's disease parallels that for benign paroxysmal positional vertigo. The similarity of age of onset spectrum for Ménière's disease and benign paroxysmal positional vertigo raises the possibility that the two conditions have the same fundamental cause.
BibTeX: @article{Hornibrook2018, author = {Hornibrook, J}, title = {Saccular otoconia as a cause of Ménière's disease: hypothesis based on two theories.}, journal = {The Journal of laryngology and otology}, year = {2018}, volume = {132}, issue = {9}, pages = {771--774}, doi = {https://doi.org/10.1017/S0022215118001366}, keywords = {Adult; Aged; Animals; Benign Paroxysmal Positional Vertigo, etiology, physiopathology; Electronystagmography, methods; Endolymph, physiology; Guinea Pigs; Humans; Meniere Disease, etiology, pathology, physiopathology; Mice; Middle Aged; Models, Animal; Nystagmus, Physiologic, physiology; Otolithic Membrane, abnormalities; Potassium, toxicity; Rupture, pathology; Saccule and Utricle, anatomy & histology; Benign Paroxysmal Positional Vertigo; Meniere Disease; Otolithic Membrane}, pmid = {30149814} }
Korkmaz, T., Bicer, Y.O., Serin, E., Seyhan, S. and Sanal, S.K.	Salivary α-amylase levels in vertigo: Can it be an autonomic dysfunction? [Abstract] [BibTeX]	2018	Ear, nose, & throat journal Vol. 97(9), pp. 278-282	article
Abstract: We aim to demonstrate possible autonomic dysfunction based on salivary α-amylase measurements during and after the vertigo attacks associated with Ménière disease (MD) and benign paroxysmal positional vertigo (BPPV). Patients admitted to the emergency room with a diagnosis of vertigo attacks caused by either MD (n = 15) or BPPV (n = 9) constituted the study groups. The control group (n = 10) consisted of volunteer patients admitted to the emergency department with minor soft-tissue trauma. The first saliva samples were obtained immediately during the attacks and the second and third samples were obtained on the third and fifteenth days of the attack, respectively. In the controls, the first sample was obtained after admission to the hospital and the second sample was obtained on the third day. Salivary α-amylase levels were evaluated. The difference between salivary α-amylase levels in patients with MD and BPPV was not significant. The amylase value measured early after the BPPV attack was significantly lower than that of the controls (p = 0.008). Although not significant, an undulating pattern of salivary α-amylase levels was observed with both diseases. An autonomic imbalance could be partly demonstrated by salivary α-amylase measurement early after the attack in patients with BPPV. Therefore, amylase may be a promising marker that is worth further investigation.
BibTeX: @article{Korkmaz2018, author = {Korkmaz, Tanzer and Bicer, Yusuf Ozgur and Serin, Erdinc and Seyhan, Sinan and Sanal, Serap Koybasi}, title = {Salivary α-amylase levels in vertigo: Can it be an autonomic dysfunction?}, journal = {Ear, nose, & throat journal}, year = {2018}, volume = {97}, issue = {9}, pages = {278--282}, keywords = {Adolescent; Adult; Autonomic Nervous System Diseases, etiology; Benign Paroxysmal Positional Vertigo, complications, metabolism; Biomarkers, metabolism; Case-Control Studies; Female; Humans; Male; Meniere Disease, complications, metabolism; Middle Aged; Salivary alpha-Amylases, metabolism; Vertigo, etiology, metabolism; Young Adult}, pmid = {30273427} }
Seemungal, B.M.	Screening for BPPV in falls: an easy but big clinical "win". [BibTeX]	2016	BMJ (Clinical research ed.) Vol. 353, pp. i3004	article	DOI
BibTeX: @article{Seemungal2016, author = {Seemungal, Barry M}, title = {Screening for BPPV in falls: an easy but big clinical "win".}, journal = {BMJ (Clinical research ed.)}, year = {2016}, volume = {353}, pages = {i3004}, doi = {https://doi.org/10.1136/bmj.i3004}, keywords = {Accidental Falls, prevention & control, statistics & numerical data; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, complications, diagnosis, physiopathology; Humans; Mass Screening, organization & administration; Posture; Primary Prevention, organization & administration; Risk Assessment}, pmid = {27250837} }
Polensek, S.H., Sterk, C.E. and Tusa, R.J.	Screening for vestibular disorders: a study of clinicians' compliance with recommended practices. [Abstract] [BibTeX]	2008	Medical science monitor : international medical journal of experimental and clinical research Vol. 14(5), pp. CR238-CR242	article
Abstract: Dizziness and vertigo are very common patient complaints encountered by clinicians in both primary as well as specialty care in otolaryngology and neurology. Vestibular impairment is an underlying cause in as many as 45% of people complaining of dizziness. Most causes of vestibular impairment can be effectively treated; however, the diagnosis is frequently missed. The aim of this study was to examine clinical assessments used by providers in evaluating dizzy patients in outpatient clinics and the emergency department. Computerized medical records of all patients receiving an ICD-9 diagnosis code for dizziness, including benign paroxysmal positional vertigo, Meniere's disease, and vestibular hypofunction over a six-month period at the Atlanta VA Medical Center were reviewed. 476 patients were identified and of these, 157 patients were included. Over two-thirds of providers (69%) used the patient's description of the dizziness for identifying the cause; however, significant variability was evident across disciplines, ranging from 84% of audiologists asking for a description of the dizziness to only 33% of geriatricians asking. 89% of providers did not evaluate a patient for BPPV by examining for positional nystagmus. Primary care clinicians referred 22% of dizzy patients to a specialist (neurotologist), geriatricians referred 17%, and emergency physicians referred only 16%. Dizzy patients were not routinely screened for vestibular impairment based on available recommended practices, likely contributing to underdiagnosis and treatment. Results indicate a need for effective dissemination of guidelines to improve health care quality, increase awareness of medical risks, and enhance patient access to appropriate treatment.
BibTeX: @article{Polensek2008, author = {Polensek, Sharon H and Sterk, Claire E and Tusa, Ronald J}, title = {Screening for vestibular disorders: a study of clinicians' compliance with recommended practices.}, journal = {Medical science monitor : international medical journal of experimental and clinical research}, year = {2008}, volume = {14}, issue = {5}, pages = {CR238--CR242}, keywords = {Aged; Diagnosis, Differential; Female; Humans; Male; Medical Records Systems, Computerized; Meniere Disease, diagnosis; Middle Aged; Nystagmus, Physiologic; Primary Health Care, methods; Quality of Health Care; Risk; Vertigo, diagnosis; Vestibular Diseases, diagnosis; Vestibular Function Tests}, pmid = {18443546} }
Whitman, G.T. and Baloh, R.W.	Seasonality of benign paroxysmal positional vertigo. [BibTeX]	2015	JAMA otolaryngology-- head & neck surgery Vol. 141(2), pp. 188-189	article	DOI
BibTeX: @article{Whitman2015, author = {Whitman, Gregory T and Baloh, Robert W}, title = {Seasonality of benign paroxysmal positional vertigo.}, journal = {JAMA otolaryngology-- head & neck surgery}, year = {2015}, volume = {141}, issue = {2}, pages = {188--189}, doi = {https://doi.org/10.1001/jamaoto.2014.2941}, keywords = {Academic Medical Centers; Benign Paroxysmal Positional Vertigo, epidemiology, etiology; Boston, epidemiology; Humans; Office Visits, statistics & numerical data; Seasons; Vitamin D, blood; Vitamin D Deficiency, epidemiology}, pmid = {25411771} }
von Brevern, M., Lempert, T., Bronstein, A.M. and Kocen, R.	Selective vestibular damage in neurosarcoidosis. [Abstract] [BibTeX]	1997	Annals of neurology Vol. 42(1), pp. 117-120	article	DOI
Abstract: We report a patient with neurosarcoidosis who developed bilateral benign paroxysmal positional vertigo (BPPV) of the posterior canals, deafness, and absent responses to conventional caloric and rotational vestibular testing. Additional rotation in the planes of the vertical semicircular canals revealed relative sparing of vertical canal function. This vertical-horizontal canal dissociation explains the presence of BPPV and suggests that the vestibular damage in this patient is secondary to a vasculitic neuropathy.
BibTeX: @article{Brevern1997, author = {von Brevern, M and Lempert, T and Bronstein, A M and Kocen, R}, title = {Selective vestibular damage in neurosarcoidosis.}, journal = {Annals of neurology}, year = {1997}, volume = {42}, issue = {1}, pages = {117--120}, doi = {https://doi.org/10.1002/ana.410420119}, keywords = {Adult; Humans; Male; Nervous System Diseases, complications; Posture; Sarcoidosis, complications; Semicircular Canals, physiopathology; Vertigo, etiology; Vestibular Diseases, etiology, physiopathology; Vestibular Function Tests}, pmid = {9225694} }
Sommer, D.	Self treatment after Epley procedure was effective for benign paroxysmal positional vertigo of the posterior semicircular canal. [BibTeX]	2006	Evidence-based medicine Vol. 11(3), pp. 78	article	DOI
BibTeX: @article{Sommer2006, author = {Sommer, Doron}, title = {Self treatment after Epley procedure was effective for benign paroxysmal positional vertigo of the posterior semicircular canal.}, journal = {Evidence-based medicine}, year = {2006}, volume = {11}, issue = {3}, pages = {78}, doi = {https://doi.org/10.1136/ebm.11.3.78}, pmid = {17213100} }
Fenton, R.S. and Smith, O.D.	Self-induced vertigo. [Abstract] [BibTeX]	1990	The Journal of otolaryngology Vol. 19(4), pp. 264-266	article
Abstract: Benign paroxysmal positional vertigo is the most commonly recognized form of self-induced vertigo. This paper describes other means by which patients have been able to induce vertigo to the extent that at times it has been incapacitating. Hypotheses for the production of these phenomena are suggested in a number of the cases. Some of the features cannot be explained on the basis of our present knowledge of the vestibular system.
BibTeX: @article{Fenton1990, author = {Fenton, R S and Smith, O D}, title = {Self-induced vertigo.}, journal = {The Journal of otolaryngology}, year = {1990}, volume = {19}, issue = {4}, pages = {264--266}, keywords = {Acoustic Stimulation, adverse effects; Adult; Female; Humans; Middle Aged; Nystagmus, Pathologic, etiology, physiopathology; Physical Stimulation, adverse effects; Touch, physiology; Vertigo, etiology, physiopathology}, pmid = {2214000} }
Amir, I., Young, E. and Belloso, A.	Self-limiting benign paroxysmal positional vertigo following use of whole-body vibration training plate. [Abstract] [BibTeX]	2010	The Journal of laryngology and otology Vol. 124(7), pp. 796-798	article	DOI
Abstract: We describe a case of benign paroxysmal positional vertigo which occurred after use of a whole-body vibration training plate. Case report and literature review concerning the secondary causes of benign paroxysmal positional vertigo and the physiological effects of whole-body vibration training plates. A 44-year-old woman was referred with classic symptoms of benign paroxysmal positional vertigo following use of a whole-body vibration training plate, a popular form of fitness equipment widely used in sports, rehabilitation and beauty treatments. The condition resolved spontaneously after several days. There have been reports of negative side effects in users of this equipment, such as dizziness, headache and a sensation of imbalance; however, there have been no reported cases involving vertigo. Based on a literature review, this equipment may cause side effects, including vertigo, by generating forces that can increase the original amplitude of internal organs, which may potentially cause labyrinthine trauma or dislocation of otoconia, leading to benign paroxysmal positional vertigo. We suggest that whole-body vibration training plates may potentially induce benign paroxysmal positional vertigo. Manufacturers may need to make users of this equipment aware of this risk, and remind them to use it with caution.
BibTeX: @article{Amir2010, author = {Amir, I and Young, E and Belloso, A}, title = {Self-limiting benign paroxysmal positional vertigo following use of whole-body vibration training plate.}, journal = {The Journal of laryngology and otology}, year = {2010}, volume = {124}, issue = {7}, pages = {796--798}, doi = {https://doi.org/10.1017/S0022215109992441}, keywords = {Adult; Ear, Inner, physiopathology; Female; Humans; Posture; Sports Equipment, adverse effects; Vertigo, etiology, physiopathology; Vibration, adverse effects}, pmid = {20003605} }
Piker, E.G. and Jacobson, G.P.	Self-report symptoms differ between younger and older dizzy patients. [Abstract] [BibTeX]	2014	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 35(5), pp. 873-879	article	DOI
Abstract: To determine whether the responses of elders compared with younger patients differed significantly on a structured dizziness case history. Retrospective case reviews. Outpatient balance function testing center. Two-hundred thirty-three adults who underwent vestibular function testing and completed a structured case history. The mean age of the adult group (18-64 yr) was 46.4 years. The mean age of the old adult group (65 yr and older) was 76.2 years. Patient's self-reported symptoms on a structured case history questionnaire. Younger adults reported significantly more complaints of true vertigo and associated nausea and vomiting compared with older patients. Older patients tended to report symptoms of unsteadiness or falling. Despite the lack of vertiginous symptoms, BPPV was common in older adults. The clinician should be aware of differences in self-report dizziness symptoms in older patients. Older patients who do not have vertigo may be told that their symptoms are normal for their age, when, in fact, they may have an undiagnosed vestibular system impairment.
BibTeX: @article{Piker2014, author = {Piker, Erin G and Jacobson, Gary P}, title = {Self-report symptoms differ between younger and older dizzy patients.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2014}, volume = {35}, issue = {5}, pages = {873--879}, doi = {https://doi.org/10.1097/MAO.0000000000000391}, keywords = {Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Diagnostic Self Evaluation; Dizziness, diagnosis, physiopathology; Female; Humans; Male; Middle Aged; Retrospective Studies; Self Report; Severity of Illness Index; Surveys and Questionnaires; Vertigo, diagnosis, physiopathology; Vestibular Function Tests; Young Adult}, pmid = {24759419} }
Tanimoto, H., Doi, K., Katata, K. and Nibu, K.-i.	Self-treatment for benign paroxysmal positional vertigo of the posterior semicircular canal. [Abstract] [BibTeX]	2005	Neurology Vol. 65(8), pp. 1299-1300	article	DOI
Abstract: The authors compared the efficacy of the Epley procedure with and without self-treatment in 80 patients with benign paroxysmal positional vertigo of the posterior semicircular canal. The self-treatment group (88%) had better results than the Epley-alone group (69%) based on both symptoms and nystagmus (p = 0.048). Complications occurred in 2.6% of the Epley-alone group and in 7.5% of the self-treatment group (p = 0.62).
BibTeX: @article{Tanimoto2005, author = {Tanimoto, Hitosh and Doi, Kiyosh and Katata, Ket and Nibu, Ken-ich}, title = {Self-treatment for benign paroxysmal positional vertigo of the posterior semicircular canal.}, journal = {Neurology}, year = {2005}, volume = {65}, issue = {8}, pages = {1299--1300}, doi = {https://doi.org/10.1212/01.wnl.0000180518.34672.3d}, keywords = {Adult; Aged; Aged, 80 and over; Female; Head Movements, physiology; Humans; Male; Middle Aged; Otolithic Membrane, pathology, physiopathology; Postural Balance, physiology; Saccule and Utricle, pathology, physiopathology; Self Care, methods; Semicircular Canals, physiopathology; Treatment Outcome; Vertigo, etiology, physiopathology, therapy}, pmid = {16247062} }
Brehmer, D.	Self-treatment of benign paroxysmal positional vertigo with DizzyFix, a new dynamic visual device. [Abstract] [BibTeX]	2010	Expert review of medical devices Vol. 7(5), pp. 605-609	article	DOI
Abstract: Benign paroxysmal positional vertigo is one of the most common disorders of the vestibular system. It is characterized by episodes of recurrent vertigo triggered by head movements or position changes associated with nystagmus. There is scientific evidence that in the majority of cases this condition responds well to the particle repositioning maneuver (PRM) correctly performed by the physician. However, the PRM needs to be repeated in approximately 30% of the cases. Although the maneuver is simple, patients often find it difficult to perform correctly as self-treatment, with the result that it fails to bring about an improvement in the symptoms. DizzyFix (Clearwater Clinical Limited, Canada) is the name given to a new dynamic visual device designed to provide a visual representation of the PRM based on the canalith theory. The DizzyFiX consists of a specially curved acrylic tube containing a nontoxic viscous fluid and a bead, the purpose of which is to help the patient and the inexperienced physician to perform the PRM correctly. A randomized clinical trial has shown that it reliably enables the maneuver to be performed correctly, and a study investigating the effectiveness of patient self-treatment of benign paroxysmal positional vertigo with the device in comparison with standard office treatment revealed both techniques to be equally effective. The device has now been approved by the US FDA.
BibTeX: @article{Brehmer2010, author = {Brehmer, Detlef}, title = {Self-treatment of benign paroxysmal positional vertigo with DizzyFix, a new dynamic visual device.}, journal = {Expert review of medical devices}, year = {2010}, volume = {7}, issue = {5}, pages = {605--609}, doi = {https://doi.org/10.1586/erd.10.30}, keywords = {Humans; Treatment Outcome; Vertigo, surgery, therapy; Visual Prosthesis, adverse effects; Watchful Waiting}, pmid = {20822384} }
Honrubia, V.	Self-treatment of benign paroxysmal positional vertigo: Semont maneuver vs Epley procedure. [BibTeX]	2005	Neurology Vol. 64(3), pp. 583-4; author reply 583-4	article
BibTeX: @article{Honrubia2005, author = {Honrubia, Vicente}, title = {Self-treatment of benign paroxysmal positional vertigo: Semont maneuver vs Epley procedure.}, journal = {Neurology}, year = {2005}, volume = {64}, issue = {3}, pages = {583--4; author reply 583-4}, keywords = {Contraindications; Gravitation; Head Movements; Humans; Otolithic Membrane, physiopathology; Physical Therapy Modalities; Self Care; Treatment Outcome; Vertigo, etiology, physiopathology, therapy}, pmid = {15699415} }
Radtke, A., von Brevern, M., Tiel-Wilck, K., Mainz-Perchalla, A., Neuhauser, H. and Lempert, T.	Self-treatment of benign paroxysmal positional vertigo: Semont maneuver vs Epley procedure. [Abstract] [BibTeX]	2004	Neurology Vol. 63(1), pp. 150-152	article
Abstract: The authors compared the efficacy of a self-applied modified Semont maneuver (MSM) with self-treatment with a modified Epley procedure (MEP) in 70 patients with posterior canal benign paroxysmal positional vertigo. The response rate after 1 week, defined as absence of positional vertigo and torsional/upbeating nystagmus on positional testing, was 95% in the MEP group (n = 37) vs 58% in the MSM group (n = 33; p < 0.001). Treatment failure was related to incorrect performance of the maneuver in the MSM group, whereas treatment-related side effects did not differ significantly between the groups.
BibTeX: @article{Radtke2004, author = {Radtke, A and von Brevern, M and Tiel-Wilck, K and Mainz-Perchalla, A and Neuhauser, H and Lempert, T}, title = {Self-treatment of benign paroxysmal positional vertigo: Semont maneuver vs Epley procedure.}, journal = {Neurology}, year = {2004}, volume = {63}, issue = {1}, pages = {150--152}, keywords = {Adult; Aged; Aged, 80 and over; Exercise Movement Techniques; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, etiology, therapy; Otolithic Membrane; Physical Therapy Modalities; Posture; Self Care; Semicircular Canals, physiopathology, ultrastructure; Treatment Outcome; Vertigo, complications, therapy}, pmid = {15249626} }
Rabbitt, R.D.	Semicircular canal biomechanics in health and disease. [Abstract] [BibTeX]	2018	Journal of neurophysiology	article	DOI
Abstract: The semicircular canals are responsible for sensing angular head motion in three-dimensional space and for providing neural inputs to the central nervous system (CNS) essential for agile mobility, stable vision, and autonomic control of the cardiovascular and other gravity sensitive systems. Sensation relies on fluid mechanics within the labyrinth to selectively convert angular head acceleration into sensory hair bundle displacements in each of three inner ear sensory organs. Canal afferent neurons encode the direction and time course of head movements over a broad range of movement frequencies and amplitudes. Disorders altering canal mechanics result in pathological inputs to the CNS, often leading to debilitating symptoms. Vestibular disorders and conditions with mechanical substrates include benign paroxysmal positional nystagmus (BPPV), direction-changing positional nystagmus, alcohol positional nystagmus, caloric nystagmus, Tullio phenomena and others. Here, the mechanics of angular motion transduction and how it contributes to neural encoding by the semicircular canals is reviewed in both health and disease.
BibTeX: @article{Rabbitt2018, author = {Rabbitt, Richard D}, title = {Semicircular canal biomechanics in health and disease.}, journal = {Journal of neurophysiology}, year = {2018}, doi = {https://doi.org/10.1152/jn.00708.2018}, keywords = {BPPV; Tullio; alcohol; caloric; dehiscence}, pmid = {30565972} }
Teo, S.P.	Semont manoeuvre for vertigo assessment. [Abstract] [BibTeX]	2015	Australian family physician Vol. 44(7), pp. 471-473	article
Abstract: The Dix-Hallpike manoeuvre is performed for diagnosis and the Epley manoeuvre used for treatment of posterior canal benign paroxysmal positional vertigo (BPPV). However, musculoskeletal conditions may restrict utility of these manoeuvres. The Semont and liberatory manoeuvres are described in this article. These manoeuvres are simple and highly effective for the diagnosis and treatment of posterior canal BPPV. The diagnosis of BPPV should not be missed as it can be diagnosed clinically and it is easily treated.
BibTeX: @article{Teo2015, author = {Teo, Shyh Poh}, title = {Semont manoeuvre for vertigo assessment.}, journal = {Australian family physician}, year = {2015}, volume = {44}, issue = {7}, pages = {471--473}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis, therapy; Head Movements; Humans; Patient Positioning, methods; Posture}, pmid = {26590491} }
Karkos, P.D., Leong, S.C., Papouliakos, S.M., Korres, S.G. and Thong, J.F.	Semont's manoeuvre in BPPV: a forgotten technique. [BibTeX]	2006	Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery Vol. 31(5), pp. 464-465	article	DOI
BibTeX: @article{Karkos2006, author = {Karkos, P D and Leong, S C and Papouliakos, S M and Korres, S G and Thong, J F}, title = {Semont's manoeuvre in BPPV: a forgotten technique.}, journal = {Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery}, year = {2006}, volume = {31}, issue = {5}, pages = {464--465}, doi = {https://doi.org/10.1111/j.1749-4486.2006.01272.x}, keywords = {Dizziness, etiology; Humans; Nystagmus, Pathologic, therapy; Posture; Semicircular Canals, physiopathology; Vertigo, complications, diagnosis, physiopathology, therapy}, pmid = {17014473} }
Norré, M.E.	Sensory interaction posturography in patients with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	1993	Clinical otolaryngology and allied sciences Vol. 18(3), pp. 226-230	article
Abstract: BPPV (benign paroxysmal positional vertigo) is a very common peripheral vestibular disturbance. The dysfunction becomes manifest mainly by vertigo and typical nystagmus. However, the vestibulospinal reflex (VSR) can also be disturbed. This can be shown by the SPGIII (static posturography type III), which is a platform technique evaluating 'sensory interaction' in a way comparable to that of the Equi-test. Half the patients with BPPV show disturbed posturographic results. By interfering with the sensory input of vision and/or proprioception, the separate contribution of each input can be evaluated. Different 'formulae' are seen, from complete normal results, through 'overall' formulae, i.e. an undifferentiated influence in all test-conditions, to specific formulae, where we find 'eye-closure' and 'head retroflexed'-effect and so-called 'vestibular formulae'. These formulae are an expression of the different degrees of compensation achieved by the centres and especially of the 'substituting' compensation by vision and proprioception. These results confirm that posturography does not provide a typical results-pattern, thus the type of peripheral vestibular disorder cannot be diagnosed by it alone. The results give functional information on how the standing position is achieved in these patients with a disturbed VSR-input. The several formulae prove that indeed different compensatory patterns are possible, as has been shown by experiments on vestibular compensation.
BibTeX: @article{Norre1993, author = {Norré, M E}, title = {Sensory interaction posturography in patients with benign paroxysmal positional vertigo.}, journal = {Clinical otolaryngology and allied sciences}, year = {1993}, volume = {18}, issue = {3}, pages = {226--230}, keywords = {Adolescent; Adult; Aged; Child; Female; Humans; Male; Middle Aged; Posture, physiology; Proprioception; Vertigo, complications, diagnosis, physiopathology; Vestibular Diseases, diagnosis, physiopathology; Vestibule, Labyrinth, physiopathology; Vision Disorders, complications, diagnosis}, pmid = {8365015} }
Norré, M.E.	Sensory interaction testing in platform posturography. [Abstract] [BibTeX]	1993	The Journal of laryngology and otology Vol. 107(6), pp. 496-501	article
Abstract: Mostly techniques measuring the vestibulo-ocular reflex (VOR) have been used for the evaluation of patients with dizziness problems. Some investigators, however, have also tried to take into account the vestibulospinal reflex (VSR). So recording techniques for the Romberg-test have been proposed and called posturography (PG). By interfering with the visual and proprioceptive sensory inputs during this PG-testing one tries to find out how 'sensory interaction' is organized in the balance performance of the patient examined. To interfere with vision, closure of the eyes has been commonly used and to interfere with proprioception, the patient can be put on foam-rubber, which makes the contribution of the foot-ankle proprioception less adequate. These interferences are applied once separately and once combined. The degree of 'abnormality' is assessed by a score-system for parameters surface (S) and velocity (V), which measure the postural sway. A comparison of tests with and without influence on the sensory inputs gives an idea of the sensory interaction. Patients with peripheral vestibular disorders were examined: patients with BPPV, with spontaneous vertigo attacks and with a sudden vestibular deficit. When applying this evaluation technique different formulae or patterns can be found. Firstly complete normal evaluation, which means that there is no influence of the vestibular disturbance upon the PG results. Secondly a normal balance when using all available sensory information, but disturbed balance as soon as one of the sensory inputs is influenced by the test conditions. Thirdly striking destabilization when closing the eyes. Fourthly striking destabilization when misleading the ankle and foot proprioceptor.(ABSTRACT TRUNCATED AT 250 WORDS)
BibTeX: @article{Norre1993a, author = {Norré, M E}, title = {Sensory interaction testing in platform posturography.}, journal = {The Journal of laryngology and otology}, year = {1993}, volume = {107}, issue = {6}, pages = {496--501}, keywords = {Adult; Female; Humans; Male; Meniere Disease, diagnosis; Middle Aged; Posture, physiology; Proprioception, physiology; Vertigo, diagnosis; Vestibular Diseases, diagnosis; Vestibular Function Tests, methods; Vision, Ocular, physiology}, pmid = {8345297} }
Celikbilek, A., Gencer, Z.K., Saydam, L., Zararsiz, G., Tanik, N. and Ozkiris, M.	Serum uric acid levels correlate with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2014	European journal of neurology Vol. 21(1), pp. 79-85	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is a frequently encountered condition that can severely affect the quality of life. In this study, we aimed to assess the possible relations between serum uric acid (SUA) levels and BPPV. Fifty patients with BPPV, and 40 age- and sex-matched control subjects were enrolled in the study. All the patients and controls underwent a complete audio-vestibular test battery including the Dix-Hallpike maneuver and supine roll test for posterior semicircular canal (PSC) and horizontal semicircular canal, respectively. Routine hematological and biochemical analyses were performed in both groups. In the BPPV group, measurements of SUA levels were repeated 1 month after the vertigo attack. The lipid profiles and SUA levels were higher in patients with BPPV than detected in controls (P < 0.05 and P < 0.001, respectively). Albumin and SUA values were independently associated with BPPV in multiple logistic regression models (P < 0.05 and P < 0.001, respectively). A cutoff value of 4 for SUA level with a sensitivity of 0.72 (0.58-0.84) and a specificity of 0.60 (0.43-0.75) was obtained in the receiver operating characteristic analyses. There was a significant decrement in SUA level 1 month after the vertigo attack compared with the values obtained during the attack (P < 0.001). Among the most involved type of BPPV (PSC BPPV), the right side was affected in 26 patients (57.8%) and the left side in 19 patients (42.2%). SUA levels did not differ statistically in patients with PSC BPPV for either the right or left sides (P > 0.05). Elevated SUA is positively correlated with BPPV, requiring further efforts to clarify the exact mechanism.
BibTeX: @article{Celikbilek2014a, author = {Celikbilek, A and Gencer, Z K and Saydam, L and Zararsiz, G and Tanik, N and Ozkiris, M}, title = {Serum uric acid levels correlate with benign paroxysmal positional vertigo.}, journal = {European journal of neurology}, year = {2014}, volume = {21}, issue = {1}, pages = {79--85}, doi = {https://doi.org/10.1111/ene.12248}, keywords = {Adult; Area Under Curve; Benign Paroxysmal Positional Vertigo; Female; Humans; Male; ROC Curve; Sensitivity and Specificity; Uric Acid, blood; Vertigo, blood; benign paroxysmal positional vertigo; uric acid}, pmid = {23952220} }
Rhim, G.I.	Serum vitamin D and recurrent benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2016	Laryngoscope investigative otolaryngology Vol. 1(6), pp. 150-153	article	DOI
Abstract: The objective of the present study was to examine the effects of serum 25-hydroxyvitamin D concentrations on patients diagnosed with benign paroxysmal positional vertigo (BPPV) on BPPV recurrence. Case series. A retrospective review of 232 patients diagnosed with BPPV visiting the clinic between June 2014 and June 2015 was performed. All patients underwent a complete otolaryngological, audiologic, and neurologic evaluation. The appropriate particle-repositioning maneuver was performed depending on the type of BPPV. The patients were divided into the recurrence group and the nonrecurrence group. Age, gender, follow-up period, type of BPPV, and vitamin D concentrations in the two groups were compared and analyzed through binary logistic regression analyses. The average follow-up period after treatment was 10.2 months. Forty-one (17.7%) of 232 patients suffered a recurrence during the follow-up period. The mean vitamin D concentration of 191 patients who did not suffer any recurrence was 16.63 ng/mL, whereas that of 41 patients who suffered a recurrence was 13.64 ng/mL. This difference in vitamin D concentrations was statistically significant ( < 0.019). The patients' age, gender, follow-up period, and type of BPPV had no statistically significant impact. Vitamin D is assumed to affect BPPV as a recurrence factor independent of age, gender, follow-up period, and type of BPPV. 4.
BibTeX: @article{Rhim2016, author = {Rhim, Gu Il}, title = {Serum vitamin D and recurrent benign paroxysmal positional vertigo.}, journal = {Laryngoscope investigative otolaryngology}, year = {2016}, volume = {1}, issue = {6}, pages = {150--153}, doi = {https://doi.org/10.1002/lio2.35}, keywords = {Vitamin D; benign paroxysmal positional vertigo; logistic regression; recurrence}, pmid = {28894811} }
Chen, J.J., Cheng, W.J., Rao, J., Lu, Y.F. and Qiu, W.W.	Severe hydrocephalus complicated with benign paroxysmal positional vertigo: one case report. [Abstract] [BibTeX]	2015	International journal of clinical and experimental medicine Vol. 8(11), pp. 21807-21812	article
Abstract: In this study, we reported one female patient diagnosed with severe hydrocephalus who presented with benign paroxysmal positional vertigo (BPPV). She presented with progressive headache and dizziness prior to hospitalization as chief complaints. She received Diagnostic Dix-Hallpike and Roll tests to make a definite diagnosis. The patient was cured after Gufoni maneuver and did not recur after 6-month follow-up. The diagnostic procedures of this female case prompted that prior to formal treatment, patients developing severe hydrocephalus complicated with BPPV should receive provocative test for positional dizziness, performed by experienced physicians from the Department of neurology and otolaryngology.
BibTeX: @article{Chen2015, author = {Chen, Jian Jun and Cheng, Wei Jin and Rao, Jie and Lu, Ye Fen and Qiu, Wei Wen}, title = {Severe hydrocephalus complicated with benign paroxysmal positional vertigo: one case report.}, journal = {International journal of clinical and experimental medicine}, year = {2015}, volume = {8}, issue = {11}, pages = {21807--21812}, keywords = {Severe hydrocephalus; complication; paroxysmal positional vertigo}, pmid = {26885146} }
Nunez, R.A., Cass, S.P. and Furman, J.M.	Short- and long-term outcomes of canalith repositioning for benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2000	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 122(5), pp. 647-652	article	DOI
Abstract: This is a prospective, nonrandomized study of the canalith repositioning procedure (CRP) for treatment of benign paroxysmal positional vertigo (BPPV). CRP was used to treat 168 patients with BPPV. Patient data were gathered by yearly telephone interviews to determine whether symptoms of position-induced vertigo had returned. After 1 or 2 treatment sessions 91.3% of patients reported complete symptom resolution. Average follow-up for the study population after the initial treatment was 26 months. A recurrence rate of 26.8% was found among those patients who initially reported resolution of symptoms after CRP. Application of recurrence data to a Kaplan-Meier estimation suggests a 15% recurrence rate per year of BPPV, with a 50% recurrence rate of BPPV at 40 months after treatment. There was no significant association between cure or recurrence rate and sex, age, duration of symptoms, presumed cause, or treating physician.
BibTeX: @article{Nunez2000, author = {Nunez, R A and Cass, S P and Furman, J M}, title = {Short- and long-term outcomes of canalith repositioning for benign paroxysmal positional vertigo.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2000}, volume = {122}, issue = {5}, pages = {647--652}, doi = {https://doi.org/10.1016/S0194-5998(00)70190-2}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Child; Female; Humans; Male; Middle Aged; Posture; Prospective Studies; Recurrence; Treatment Outcome; Vertigo, therapy}, pmid = {10793340} }
von Brevern, M., Seelig, T., Radtke, A., Tiel-Wilck, K., Neuhauser, H. and Lempert, T.	Short-term efficacy of Epley's manoeuvre: a double-blind randomised trial. [Abstract] [BibTeX]	2006	Journal of neurology, neurosurgery, and psychiatry Vol. 77(8), pp. 980-982	article	DOI
Abstract: Benign paroxysmal positional vertigo of the posterior canal (PC-BPPV) is a common vestibular disorder and can be easily treated with Epley's manoeuvre. Thus far, the short-term efficacy of Epley's manoeuvre for treatment of PC-BPPV is unknown. To evaluate the efficacy of Epley's manoeuvre for treatment of PC-BPPV 24 h after applying the manoeuvre. The short-term efficacy of Epley's manoeuvre was compared with a sham procedure in 66 patients with PC-BPPV by using a double-blind randomised study design. 24 h after treatment, 28 of 35 (80%) patients in the Epley's manoeuvre group had neither vertigo nor nystagmus on positional testing compared with 3 of 31 (10%) patients in the sham group (p<0.001). Epley's manoeuvre is shown to resolve PC-BPPV both effectively and rapidly.
BibTeX: @article{Brevern2006, author = {von Brevern, M and Seelig, T and Radtke, A and Tiel-Wilck, K and Neuhauser, H and Lempert, T}, title = {Short-term efficacy of Epley's manoeuvre: a double-blind randomised trial.}, journal = {Journal of neurology, neurosurgery, and psychiatry}, year = {2006}, volume = {77}, issue = {8}, pages = {980--982}, doi = {https://doi.org/10.1136/jnnp.2005.085894}, keywords = {Adult; Aged; Aged, 80 and over; Double-Blind Method; Female; Head Movements; Humans; Male; Middle Aged; Otolithic Membrane, pathology; Posture; Semicircular Canals, pathology; Treatment Outcome; Vertigo, therapy; Vestibular Diseases, complications, therapy}, pmid = {16549410} }
Chen, Y., Zhuang, J., Zhang, L., Li, Y., Jin, Z., Zhao, Z., Zhao, Y. and Zhou, H.	Short-term efficacy of Semont maneuver for benign paroxysmal positional vertigo: a double-blind randomized trial. [Abstract] [BibTeX]	2012	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 33(7), pp. 1127-1130	article	DOI
Abstract: To assess the short-term efficacy of Semont maneuver for unilateral posterior semicircular canal benign paroxysmal positional vertigo (PC-BPPV). The short-term efficacy of Semont maneuver was compared with a sham procedure in 128 patients with PC-BPPV by using a double-blinded prospective randomized controlled trial in the setting of a neurologic outpatient clinic in China. Analysis was based on the symptomatic status and the Dix-Hallpike maneuver on the fourth day. At this time, patients in both groups with a still positive Dix-Hallpike test were treated with Semont maneuver, and outcome was again assessed on the seventh day. On the fourth day, 55 (84.62%) of 65 patients in the treatment group showed complete resolution of symptoms compared with 9 (14.29%) of 63 patients in the control group. (p < 0.001) 59 (90.77%) of 65 and 52 (82.54%) of 63 patients reported resolution of symptoms in the treatment and original sham group, respectively (p = 0.17). Semont maneuver is shown to resolve PC-BPPV effectively, and patients should receive Semont maneuver once the PC-BPPV diagnosis was confirmed.
BibTeX: @article{Chen2012b, author = {Chen, Ying and Zhuang, Jianhua and Zhang, Lin and Li, Yancheng and Jin, Zhe and Zhao, Zhongxin and Zhao, Ying and Zhou, Hui}, title = {Short-term efficacy of Semont maneuver for benign paroxysmal positional vertigo: a double-blind randomized trial.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2012}, volume = {33}, issue = {7}, pages = {1127--1130}, doi = {https://doi.org/10.1097/MAO.0b013e31826352ca}, keywords = {Adult; Benign Paroxysmal Positional Vertigo; Double-Blind Method; Female; Humans; Male; Middle Aged; Patient Positioning, methods; Posture; Treatment Outcome; Vertigo, therapy}, pmid = {22892804} }
Yetiser, S.	Should the clinician do the tests for benign paroxysmal positional vertigo even in the presence of spontaneous nystagmus at primary gaze? [Abstract] [BibTeX]	2016	Clinical case reports Vol. 4(7), pp. 708-709	article	DOI
Abstract: Different balance problems may occur in the same patient simultaneously, and the other problem may be overlooked if the clinician does not pay much attention. Spontaneous nystagmus of Meniere's disease and positional nystagmus of posterior canal BPPV in the same patient is presented. Positional tests must always be considered even in the presence of spontaneous nystagmus.
BibTeX: @article{Yetiser2016, author = {Yetiser, Sertac}, title = {Should the clinician do the tests for benign paroxysmal positional vertigo even in the presence of spontaneous nystagmus at primary gaze?}, journal = {Clinical case reports}, year = {2016}, volume = {4}, issue = {7}, pages = {708--709}, doi = {https://doi.org/10.1002/ccr3.594}, keywords = {Benign paroxysmal positional vertigo; Meniere's disease; nystagmus}, pmid = {27386136} }
Cohen, H.S.	Side-lying as an alternative to the Dix-Hallpike test of the posterior canal. [Abstract] [BibTeX]	2004	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 25(2), pp. 130-134	article
Abstract: Limitations in passive or active range of motion preclude testing some patients suspected of benign paroxysmal positional vertigo of the posterior semicircular canal (BPPV) with the Dix-Hallpike maneuver. The goal of this study was to determine if an alternative test, brisk side-lying with the nose turned 45 degrees away from the tested side, yields the same results as the Dix-Hallpike maneuver. Prospective, within-groups. Diagnostic laboratory at a tertiary care center. The 61 patients, seen before their physicians had determined their diagnoses, were all referred by their physicians for objective diagnostic tests. All subjects complained of vertigo elicited by up or down rotations of the head or turning over in bed, often provocative positions for BPPV. Results from the Dix-Hallpike maneuver and side-lying maneuver were compared. Group 1 was tested with the Dix-Hallpike maneuver followed up by side-lying; Group 2 was tested in reverse order. Slow-phase eye velocity of nystagmus. With the groups collapsed to eliminate possible order effects, no significant differences were found between the tests. Significantly more subjects had no response to testing than minimal or stronger responses. Side-lying is a valid alternative test to the Dix-Hallpike maneuver, which could be useful when range-of-motion limitations or other problems preclude use of the Dix-Hallpike maneuver.
BibTeX: @article{Cohen2004a, author = {Cohen, Helen S}, title = {Side-lying as an alternative to the Dix-Hallpike test of the posterior canal.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2004}, volume = {25}, issue = {2}, pages = {130--134}, keywords = {Adult; Aged; Aged, 80 and over; Electrooculography, methods; Female; Humans; Male; Middle Aged; Posture; Prospective Studies; Semicircular Canals, pathology, physiopathology; Vertigo, diagnosis, physiopathology; Vestibular Diseases, diagnosis, physiopathology}, pmid = {15021771} }
Brantberg, K. and Baloh, R.W.	Similarity of vertigo attacks due to Meniere's disease and benign recurrent vertigo, both with and without migraine. [Abstract] [BibTeX]	2011	Acta oto-laryngologica Vol. 131(7), pp. 722-727	article	DOI
Abstract: Vertigo attacks in patients with benign recurrent vertigo (BRV) cannot be distinguished from those in patients with Meniere's disease on the basis of duration, triggers or associated symptoms (other than auditory). A subset of BRV is associated with migraine. To investigate whether clinical features of vertigo attacks can distinguish patients with BRV from those with Meniere's disease and whether subtypes of BRV can be identified. A structured interview was used to analyze features in patients with BRV, i.e. those who have normal audiograms and caloric test results even though they have had recurrent vertigo (n = 63). A group of patients with definite Meniere's disease (n = 112) served as the comparison group. Compared with the Meniere's disease group, patients with BRV had a female preponderance, earlier age of onset, and increased incidence of migraine headaches (IHS criteria). With regard to the vertigo attacks, duration tended to be shorter in patients with BRV but there was a large overlap in the duration of attacks between the two groups. Triggers (stress/emotional upset, fatigue, menstrual periods) and associated symptoms (imbalance, nausea and vomiting, headache, sensitivity to light) were not significantly different in the two groups.
BibTeX: @article{Brantberg2011, author = {Brantberg, Krister and Baloh, Robert W}, title = {Similarity of vertigo attacks due to Meniere's disease and benign recurrent vertigo, both with and without migraine.}, journal = {Acta oto-laryngologica}, year = {2011}, volume = {131}, issue = {7}, pages = {722--727}, doi = {https://doi.org/10.3109/00016489.2011.556661}, keywords = {Adult; Audiometry; Benign Paroxysmal Positional Vertigo; Caloric Tests; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Male; Meniere Disease, complications, diagnosis; Middle Aged; Migraine Disorders, complications, diagnosis; Recurrence; Vertigo, diagnosis, etiology; Vestibular Function Tests}, pmid = {21469911} }
Zapala, D.A., Shapiro, S.A., Lundy, L.B. and Leming, D.T.	Simultaneous acute superior nerve neurolabyrinthitis and benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2006	Journal of the American Academy of Audiology Vol. 17(7), pp. 481-6; quiz 531-2	article
Abstract: An acutely vertiginous 47-year-old woman presented to the emergency department with simultaneous acute left neurolabyrinthitis and left posterior canal benign paroxysmal positional vertigo (BPPV). Gaze nystagmus from the neurolabyrinthitis hampered diagnosis of the BPPV. However, once the BPPV was identified and treated, the patient's subjective vertigo improved rapidly. Concomitant BPPV should not be overlooked when a diagnosis of acute neurolabyrinthitis is made in the emergency department.
BibTeX: @article{Zapala2006, author = {Zapala, David A and Shapiro, Shane A and Lundy, Larry B and Leming, Deborah T}, title = {Simultaneous acute superior nerve neurolabyrinthitis and benign paroxysmal positional vertigo.}, journal = {Journal of the American Academy of Audiology}, year = {2006}, volume = {17}, issue = {7}, pages = {481--6; quiz 531-2}, keywords = {Ear, Middle; Female; Head Movements; Humans; Middle Aged; Nystagmus, Pathologic; Posture; Treatment Outcome; Vertigo, diagnosis, physiopathology, therapy; Vestibular Function Tests; Vestibular Neuronitis, diagnosis, physiopathology, therapy}, pmid = {16927512} }
Herdman, S.J., Tusa, R.J., Zee, D.S., Proctor, L.R. and Mattox, D.E.	Single treatment approaches to benign paroxysmal positional vertigo. [Abstract] [BibTeX]	1993	Archives of otolaryngology--head & neck surgery Vol. 119(4), pp. 450-454	article
Abstract: To determine the effectiveness of two different physical therapy approaches for benign paroxysmal positional vertigo. Randomized study. Outpatient clinic. Consecutive sample of 60 patients with benign paroxysmal positional vertigo. Patients received either a single treatment based on the hypothesis that the vertigo and nystagmus of benign paroxysmal positional vertigo are due to debris adhering to the cupula of the posterior semicircular canal (cupulolithiasis) or a single treatment based on the hypothesis that the debris is free floating in the long arm of the posterior canal (canalithiasis). Patients were reevaluated 1 to 2 weeks after the treatment and again 4 to 6 months later. Treatment outcome was classified as either asymptomatic, more than 70% improved as rated by the patient, or no change. The treatment designed for cupulolithaisis resulted in remission of vertigo and nystagmus in 70% of the patients and in improvement of the symptoms in another 20%. The treatment designed for canalithiasis resulted in remission of vertigo and nystagmus in 57% of the patients and in improvement in another 33%. There was no statistically significant difference between treatments. These single-treatment approaches are equally effective treatments for benign paroxysmal positional vertigo. Further studies are needed to look at the long-term effectiveness of these treatments.
BibTeX: @article{Herdman1993, author = {Herdman, S J and Tusa, R J and Zee, D S and Proctor, L R and Mattox, D E}, title = {Single treatment approaches to benign paroxysmal positional vertigo.}, journal = {Archives of otolaryngology--head & neck surgery}, year = {1993}, volume = {119}, issue = {4}, pages = {450--454}, keywords = {Adult; Aged; Female; Head; Humans; Male; Middle Aged; Physical Therapy Modalities, methods, standards; Posture; Range of Motion, Articular; Recurrence; Treatment Outcome; Vertigo, physiopathology, therapy}, pmid = {8457308} }
Fernandes, C.M.	Singular neurectomy in South African practice. [Abstract] [BibTeX]	1993	South African journal of surgery. Suid-Afrikaanse tydskrif vir chirurgie Vol. 31(2), pp. 79-80	article
Abstract: Singular neurectomy was used in intractable or prolonged benign paroxysmal positional vertigo, which was incapacitating in 7 patients. Six patients were cured, 1 patient suffered a severe sensorineural loss and 1 patient a mild-to-moderate loss. Singular neurectomy is an effective treatment for this condition.
BibTeX: @article{Fernandes1993, author = {Fernandes, C M}, title = {Singular neurectomy in South African practice.}, journal = {South African journal of surgery. Suid-Afrikaanse tydskrif vir chirurgie}, year = {1993}, volume = {31}, issue = {2}, pages = {79--80}, keywords = {Adult; Aged; Ear, Middle, innervation, surgery; Female; Humans; Male; Middle Aged; Vertigo, surgery; Vestibular Nerve, surgery}, pmid = {8211413} }
Gacek, R.R.	Singular neurectomy update. [Abstract] [BibTeX]	1982	The Annals of otology, rhinology, and laryngology Vol. 91(5 Pt 1), pp. 469-473	article	DOI
Abstract: The results of a poll revealed that 96 singular neurectomies have been performed by ten surgeons in this country. Eighty-eight of these (91.7%) resulted in complete relief of benign paroxysmal positional vertigo (BPPV). In seven patients (7.3%) there was a sensorineural hearing loss as a result of this procedure. The average hospital stay for patients having this procedure ranged from 2-6 days, and the return to work time ranged from 1 to 3 weeks. These results indicate that singular neurectomy is an effective selective vestibular ablation procedure for BPPV and that the risks and disability are comparable to other routine middle ear procedures. The causes for failure of this procedure to relieve positional vertigo are a) misdiagnosis of BPPV and b) failure to recognize the singular nerve in the middle ear. Knowledge of the pathophysiology of the disorder and of the anatomical variation in the location of the singular canal will reduce these causes of failure.
BibTeX: @article{Gacek1982, author = {Gacek, R R}, title = {Singular neurectomy update.}, journal = {The Annals of otology, rhinology, and laryngology}, year = {1982}, volume = {91}, issue = {5 Pt 1}, pages = {469--473}, doi = {https://doi.org/10.1177/000348948209100501}, keywords = {Ear, Inner, innervation, surgery; Ear, Middle, innervation; Hearing Loss, Sensorineural, etiology; Humans; Methods; Postoperative Complications; Round Window, Ear, innervation; Vertigo, surgery}, pmid = {7137783} }
Epley, J.M.	Singular neurectomy: hypotympanotomy approach. [Abstract] [BibTeX]	1980	Otolaryngology and head and neck surgery Vol. 88(3), pp. 304-309	article
Abstract: A modified surgical technique is described for singular neurectomy. The hypotympanotomy approach provides greater ease in exposing the singular canal. Delayed round window overhang removal provides decreased risk of round window trauma. Eight cases done by this technique indicated a lower complication rate than any reported transmeatal series. Selection criteria, results, and complications are discussed. The risk of cochlear damage limits singular neurectomy to patients who are severely incapacitated by benign paroxysmal positional vertigo. Compared with vestibular neurectomy, singular neurectomy avoid risks inherent in intracranial procedures, and the vertigo caused by surgical intervention is less pronounced.
BibTeX: @article{Epley1980a, author = {Epley, J M}, title = {Singular neurectomy: hypotympanotomy approach.}, journal = {Otolaryngology and head and neck surgery}, year = {1980}, volume = {88}, issue = {3}, pages = {304--309}, keywords = {Adult; Aged; Female; Humans; Male; Methods; Middle Aged; Round Window, Ear, anatomy & histology; Semicircular Canals, anatomy & histology, innervation; Vertigo, surgery}, pmid = {7402672} }
Crespi, R., Capparè, P. and Gherlone, E.	Sinus floor elevation by osteotome: hand mallet versus electric mallet. A prospective clinical study. [Abstract] [BibTeX]	2012	The International journal of oral & maxillofacial implants Vol. 27(5), pp. 1144-1150	article
Abstract: The aim of this clinical study was to compare a hand mallet with an electric mallet in osteotome-assisted sinus elevation. Eighty patients, all of whom were edentulous in the maxillary premolar and molar regions, were included in this prospective study. The patients were divided into two groups. In one group (40 patients, control group) sinus floor elevation was performed with an osteotome pushed by a hand mallet, and in the second group (40 patients, test group) sinus floor elevation was performed with the use of an electric mallet. One-hundred twenty dental implants (60 test, 60 control) were positioned. Intraoral digital radiographic examinations were made at baseline and at 6, 12, and 24 months after implant placement. Alveolar bone height was measured and reported at 6, 12, and 24 months. After 24 months, a survival rate of 98.33% was reported. Three control group patients developed benign paroxysmal positional vertigo following the use of osteotomes and percussion with the hand mallet. The mean alveolar bone gain at 6 months after implant placement was 2.64 ± 1.21 mm in the control group and 2.45 ± 1.55 mm in the test group. After 12 months, the bone height had increased in both groups, and at 24 months it was stable (4.17 ± 1.70 mm in the control group and 4.07 ± 1.03 mm in the test group). No statistically significant differences were seen between groups. A significant increase in bone height was achieved between 6 and 12 months, and bone levels remained stable at 2 years. The use of an electric mallet provided some essential advantages during surgery in comparison with the hand mallet.
BibTeX: @article{Crespi2012, author = {Crespi, Roberto and Capparè, Paolo and Gherlone, Enrico}, title = {Sinus floor elevation by osteotome: hand mallet versus electric mallet. A prospective clinical study.}, journal = {The International journal of oral & maxillofacial implants}, year = {2012}, volume = {27}, issue = {5}, pages = {1144--1150}, keywords = {Adult; Aged; Case-Control Studies; Dental Implantation, Endosseous, methods; Dental Implants; Female; Follow-Up Studies; Humans; Male; Maxilla; Maxillary Sinus, diagnostic imaging, surgery; Middle Aged; Osteotomy, adverse effects, instrumentation, methods; Prospective Studies; Radiography; Sinus Floor Augmentation, instrumentation, methods}, pmid = {23057028} }
Pjetursson, B.E. and Lang, N.P.	Sinus floor elevation utilizing the transalveolar approach. [Abstract] [BibTeX]	2014	Periodontology 2000 Vol. 66(1), pp. 59-71	article	DOI
Abstract: A transalveolar approach for sinus floor elevation with subsequent placement of dental implants was first suggested by Tatum in 1986. In 1994, Summers described a different transalveolar approach using a set of tapered osteotomes with increasing diameters. The transalveolar approach of sinus floor elevation, also referred to as 'osteotome sinus floor elevation', the 'Summers technique' or the 'Crestal approach', may be considered as being more conservative and less invasive than the conventional lateral window approach. This is reflected by the fact that more than nine out of 10 patients who experienced the surgical procedure would be willing to undergo it again. The main indication for transalveolar sinus floor elevation is reduced residual bone height, which does not allow standard implant placement. Contraindications for transalveolar sinus floor elevation may be intra-oral, local or medical. The surgical approach utilized over the last two decades is the technique described by Summers, with or without minor modifications. The surgical care after implant placement using the osteotome technique is similar to the surgical care after standard implant placement. The patients are usually advised to take antibiotic prophylaxis and to utilize antiseptic rinses. The main complications reported after performing a transalveolar sinus floor elevation were perforation of the Schneiderian membrane in 3.8% of patients and postoperative infections in 0.8% of patients. Other complications reported were postoperative hemorrhage, nasal bleeding, blocked nose, hematomas and benign paroxysmal positional vertigo. Whether it is necessary to use grafting material to maintain space for new bone formation after elevating the sinus membrane utilizing the osteotome technique is still controversial. Positive outcomes have been reported with and without using grafting material. A prospective study, evaluating both approaches, concluded that significantly more bone gain was seen when grafting material was used (4.1 mm mean bone gain compared with 1.7 mm when no grafting material was utilized). In a systematic review, including 19 studies reporting on 4388 implants inserted using the transalveolar sinus floor elevation technique, the 3-year implant survival rate was 92.8% (95% confidence interval: 87.4-96.0%). Furthermore, a subject-based analysis of the same material revealed an annual failure rate of 3.7%. Hence, one in 10 subjects experienced implant loss over 3 years. Several of the included studies demonstrated that transalveolar sinus floor elevation was most predictable when the residual alveolar bone height was ≥ 5 mm and the sinus floor anatomy was relatively flat.
BibTeX: @article{Pjetursson2014, author = {Pjetursson, Bjarni E and Lang, Niklaus P}, title = {Sinus floor elevation utilizing the transalveolar approach.}, journal = {Periodontology 2000}, year = {2014}, volume = {66}, issue = {1}, pages = {59--71}, doi = {https://doi.org/10.1111/prd.12043}, keywords = {Alveolar Process, surgery; Bone Substitutes, therapeutic use; Contraindications; Dental Implants; Humans; Nasal Mucosa, injuries; Osteotomy, instrumentation, methods; Postoperative Complications; Sinus Floor Augmentation, methods; Survival Analysis}, pmid = {25123761} }
Büki, B., Simon, L., Garab, S., Lundberg, Y.W., Jünger, H. and Straumann, D.	Sitting-up vertigo and trunk retropulsion in patients with benign positional vertigo but without positional nystagmus. [Abstract] [BibTeX]	2011	Journal of neurology, neurosurgery, and psychiatry Vol. 82(1), pp. 98-104	article	DOI
Abstract: Presently, the unambiguous diagnosis of benign paroxysmal positioning vertigo (BPPV) requires the detection of positioning or positional nystagmus provoked by Dix-Hallpike (for vertical semicircular canals) or supine roll (for horizontal semicircular canals) manoeuvres, which indicates canalo- or cupolithiasis of affected semicircular canals. There are patients, however, in whom--despite typical complaints of BPPV--no positional nystagmus can be documented; this is called 'subjective BPPV' (sBPPV). These patients usually complain of short vertigo spells during and after sitting up, sometimes with abnormal retropulsion of the trunk. In this study, the authors aimed to ascertain whether these patients in fact demonstrate abnormal sitting-up trunk oscillations when measured by posturography. Of 200 unselected patients with vertigo or dizziness, 43% had sBPPV with vertigo spells while sitting up, and 20% classical BPPV. Posturographic recordings were performed in 20 patients with sBPPV and sitting-up vertigo. Seven of the 20 patients had trunk oscillations during the act of sitting up and for a short time immediately afterwards. Based on their findings, the authors propose a new type of BPPV, the so-called Type 2 BPPV (typical complaints of BPPV, no nystagmus in Dix-Hallpike positions but short vertigo spell while sitting up), which may be the result of chronic canalolithiasis within the short arm of a posterior canal. Furthermore, the authors suggest that Type 2 BPPV, which could be identical to sBPPV or constitute a major subgroup of it, occurs frequently among patients with vertigo. For therapy, the authors recommend repetitive sit-ups from the Dix-Hallpike positions to liberate the short arm of the posterior canal from canaloliths.
BibTeX: @article{Bueki2011, author = {Büki, Béla and Simon, László and Garab, Sándor and Lundberg, Yunxia W and Jünger, Heinz and Straumann, Dominik}, title = {Sitting-up vertigo and trunk retropulsion in patients with benign positional vertigo but without positional nystagmus.}, journal = {Journal of neurology, neurosurgery, and psychiatry}, year = {2011}, volume = {82}, issue = {1}, pages = {98--104}, doi = {https://doi.org/10.1136/jnnp.2009.199208}, keywords = {Aged; Benign Paroxysmal Positional Vertigo; Data Interpretation, Statistical; Dizziness, etiology; Ear Canal, pathology; Exercise Therapy; Female; Humans; Lithiasis, complications; Male; Middle Aged; Nystagmus, Physiologic; Posture, physiology; Thorax, physiology; Vertigo, physiopathology, therapy; Vestibular Function Tests}, pmid = {20660923} }
Sowerby, L.J., Rotenberg, B., Brine, M., George, C.F.P. and Parnes, L.S.	Sleep apnea, daytime somnolence, and idiopathic dizziness--a novel association. [Abstract] [BibTeX]	2010	The Laryngoscope Vol. 120(6), pp. 1274-1278	article	DOI
Abstract: To determine if an association exists between sleep apnea, daytime somnolence, and chronic idiopathic dizziness. Case-control study of new patients presenting to a tertiary neuro-otologic practice. A total of 46 subjects with idiopathic dizziness (ID), 20 positive controls with dizziness (benign paroxysmal positional vertigo [BPV]), and 69 negative controls with hearing loss (HL) but no dizziness were enrolled. Participants who were patients diagnosed with the above conditions and who met all other inclusion criteria completed a sleep questionnaire and had a complete physical exam and investigations to establish or exclude a neuro-otologic diagnosis. They were subsequently evaluated for risk of symptomatic sleep disturbance based on the Epworth Sleepiness Scale (ESS), the Berlin Questionnaire, and the Multivariable Apnea Risk Index (MAP). Statistical analysis was carried out using SPSS (SPSS Inc., Chicago, IL). There was no significant demographic difference among the groups in terms of age, sex, body mass index, neck size, alcohol consumption, or smoking. Using a cutoff of both 10 and 12 on the ESS, the ID were more likely to have significant daytime somnolence than the HL group, with a likelihood ratio (LR) of 7.8 for the ESS 12 score (P = .021) and 7.1 for the ESS 10 score (P = .029). Using the MAP score, a statistically significant difference between the ID group and both the BPV group (LR 3.99, P = .046) and the HL group (LR 5.46, P = .019) was found. This study suggests that a previously undescribed link between idiopathic dizziness, daytime somnolence, and sleep apnea might exist. Prospective investigation is warranted to determine whether treatment of any sleep issues resolves symptoms of idiopathic dizziness.
BibTeX: @article{Sowerby2010, author = {Sowerby, Leigh J and Rotenberg, Brian and Brine, Meggan and George, Charles F P and Parnes, Lorne S}, title = {Sleep apnea, daytime somnolence, and idiopathic dizziness--a novel association.}, journal = {The Laryngoscope}, year = {2010}, volume = {120}, issue = {6}, pages = {1274--1278}, doi = {https://doi.org/10.1002/lary.20899}, keywords = {Analysis of Variance; Case-Control Studies; Chi-Square Distribution; Chronic Disease; Disorders of Excessive Somnolence, complications; Dizziness, complications; Female; Hearing Loss, complications; Humans; Male; Middle Aged; Risk Factors; Sleep Apnea Syndromes, complications; Surveys and Questionnaires}, pmid = {20513051} }
Korres, S.G., Papadakis, C.E., Riga, M.G., Balatsouras, D.G., Dikeos, D.G. and Soldatos, C.R.	Sleep position and laterality of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2008	The Journal of laryngology and otology Vol. 122(12), pp. 1295-1298	article	DOI
Abstract: The aim of this study was to investigate the frequency of posterior semicircular canal benign paroxysmal positional vertigo in each ear, and to assess the association between the ear affected by benign paroxysmal positional vertigo and the head-lying side during sleep onset. Based on a previous study which used objective methods to prove the preference of the elderly for the right head-lying side during sleep, we hypothesised that a predominance of the same head-lying side in benign paroxysmal positional vertigo patients may affect the pathophysiology of otoconia displacement. We conducted a prospective study of out-patients with posterior semicircular canal benign paroxysmal positional vertigo, confirmed by a positive Dix-Hallpike test. One hundred and forty-two patients with posterior semicircular canal benign paroxysmal positional vertigo were interviewed about their past medical history, focusing on factors predisposing to benign paroxysmal positional vertigo. All patients included in the study were able to define a predominant, favourite head-lying side, right or left, during sleep onset. The Dix-Hallpike test was found to be positive on the right side in 82 patients and positive on the left side in 54; six patients were found to be positive bilaterally. During sleep onset, 97 patients habitually laid their head on the right side and the remaining 45 laid their head on the left. The association between the affected ear and the head-lying side during sleep onset was statistically significant (p < 0.001). Our study found a predominance of right-sided benign paroxysmal positional vertigo, a subjective preference amongst patients for a right head-lying position during sleep onset, and an association between the ear affected by benign paroxysmal positional vertigo and the preferred head-lying side during sleep onset. The clinical and therapeutical implications of this observation are discussed.
BibTeX: @article{Korres2008a, author = {Korres, S G and Papadakis, C E and Riga, M G and Balatsouras, D G and Dikeos, D G and Soldatos, C R}, title = {Sleep position and laterality of benign paroxysmal positional vertigo.}, journal = {The Journal of laryngology and otology}, year = {2008}, volume = {122}, issue = {12}, pages = {1295--1298}, doi = {https://doi.org/10.1017/S0022215108002168}, keywords = {Adult; Aged; Aged, 80 and over; Female; Functional Laterality, physiology; Humans; Male; Middle Aged; Nystagmus, Pathologic, etiology, pathology, physiopathology; Otolithic Membrane, injuries, physiopathology; Prospective Studies; Semicircular Canals, physiopathology; Sleep, physiology; Supine Position, physiology; Vertigo, etiology, pathology, physiopathology; Vestibule, Labyrinth, physiopathology; Young Adult}, pmid = {18384700} }
Shah, M.U., Lotterman, S., Roberts, D. and Eisen, M.	Smartphone telemedical emergency department consults for screening of nonacute dizziness. [Abstract] [BibTeX]	2019	The Laryngoscope Vol. 129(2), pp. 466-469	article	DOI
Abstract: Each year, the United States spends over $4 billion on emergency department visits for evaluation of dizziness. Benign paroxysmal positional vertigo (BPPV) is a common cause of dizziness that can easily be diagnosed by observing characteristic eye movements during the Dix-Hallpike test (DHT). The DHT is easily performed; however, interpretation requires more advanced training. This may be part of the reason it is not commonly performed in emergency departments, and instead, patients undergo costly imaging tests. We evaluated whether smartphone-based video recordings of DHT could be assessed telemedically for screening of nonacute dizziness. Feasibility study. Dizzy patients underwent objective vestibular testing, but also had videos of their eye movements recorded via a smartphone during the DHT. The videos were remotely reviewed by two neuro-otologists for BPPV screening and were compared to objective and in-person exam findings. Overall, 30 dizzy patients were evaluated with seven cases of BPPV. The sensitivity for diagnosing BPPV via a smartphone-recording of eye movements of the DHT was 92.86%, with a specificity of 100% and a negative predictive value of 97.87%. Our initial proof-of-concept study shows that remote screening of BPPV is possible with high specificity. Because the DHT is easily taught, having a remote otolaryngologist interpret the resulting eye movements may increase usage of the test and may lead to cost savings. 4 Laryngoscope, 129:466-469, 2019.
BibTeX: @article{Shah2019, author = {Shah, Manan U and Lotterman, Seth and Roberts, Daniel and Eisen, Marc}, title = {Smartphone telemedical emergency department consults for screening of nonacute dizziness.}, journal = {The Laryngoscope}, year = {2019}, volume = {129}, issue = {2}, pages = {466--469}, doi = {https://doi.org/10.1002/lary.27424}, keywords = {Benign paroxysmal positional vertigo; cost-saving; dizziness; iPhone; smartphone; telemedicine; teleotology}, pmid = {30478898} }
Althaus, S.R. and Gutierrez, J.A.	Some observations on the localizing significance of ear-dependent positional nystagmus. [Abstract] [BibTeX]	1983	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 91(1), pp. 85-88	article	DOI
Abstract: Seventy-one patients who demonstrated unilateral ear-dependent positional nystagmus and unilateral labyrinthine weakness were studied to test the hypothesis that ear-dependent positional nystagmus almost always occurs on the side of unilateral labyrinthine impairment. Little, if any, correlation was found between these two parameters. The results of this study with regard to the critical question of selecting the correct ear for surgery in patients with incapacitating benign paroxysmal postural vertigo are discussed.
BibTeX: @article{Althaus1983, author = {Althaus, S R and Gutierrez, J A}, title = {Some observations on the localizing significance of ear-dependent positional nystagmus.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {1983}, volume = {91}, issue = {1}, pages = {85--88}, doi = {https://doi.org/10.1177/019459988309100116}, keywords = {Adult; Electronystagmography; Follow-Up Studies; Humans; Labyrinth Diseases, complications; Middle Aged; Nystagmus, Pathologic, etiology, physiopathology; Posture; Vertigo, etiology}, pmid = {6405356} }
Zhang, Y.-B., Dai, C.-F. and Sha, Y.	Sound-induced vertigo due to bone dehiscence of the lateral semicircular canal. [Abstract] [BibTeX]	2010	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 267(8), pp. 1319-1321	article	DOI
Abstract: Dehiscence of the lateral semicircular canal (LSCD) has been reported much but mainly in association with cholesteatoma and canal wall down mastoidectomy, while idiopathic LSCD was rarely reported. Bassim reported one case with lateral semicircular canal dehiscence, but presented no vestibular or auditory symptoms. The patient in this study complained significant sound-induced vertigo and autophony in his right ear. The axis of nystagmus was orthogonal to the lateral semicircular canal, and no torsional or vertical motions were observed, so pathology of the lateral semicircular canal was preferentially considered. Benign paroxysmal positional vertigo was excluded since vertigo attacks had no relation to the change of head position. The dehiscence of the right lateral semicircular canal was then confirmed through the high-resolution temporal bone computer tomography scan and the reconstructed images. The cause of the LSCD is poorly understood, since no history of head trauma, otological infection or surgery was documented.
BibTeX: @article{Zhang2010a, author = {Zhang, Yi-Bo and Dai, Chun-Fu and Sha, Yan}, title = {Sound-induced vertigo due to bone dehiscence of the lateral semicircular canal.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2010}, volume = {267}, issue = {8}, pages = {1319--1321}, doi = {https://doi.org/10.1007/s00405-010-1239-6}, keywords = {Acoustic Stimulation, adverse effects; Aged; Caloric Tests; Hearing Loss, Mixed Conductive-Sensorineural, etiology, physiopathology; Humans; Image Processing, Computer-Assisted; Labyrinth Diseases, diagnosis, physiopathology; Male; Semicircular Canals, physiopathology; Tomography, X-Ray Computed; Vertigo, etiology, physiopathology}, pmid = {20364384} }
Comacchio, F., Poletto, E. and Mion, M.	Spontaneous Canalith Jam and Apogeotropic Horizontal Canal Benign Paroxysmal Positional Vertigo: Considerations on a Particular Case Mimicking an Acute Vestibular Deficit. [Abstract] [BibTeX]	2018	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 39(9), pp. e843-e848	article	DOI
Abstract: Canalith jam refers to a condition caused by an otolithic clump blocked inside a semicircular canal, generally provoked by canalith repositioning procedure. We describe the first case of spontaneous canalith jam mimicking an acute vestibular deficit. We report the case of an 82-year-old woman who suffered a sudden episode of persistent rotational vertigo with nausea and vomiting, not provoked by head movements. Videonystagmography revealed a horizontal right-beating spontaneous nystagmus, inhibited by visual fixation. Surprisingly, the positional test showed a direction changing apogeotropic horizontal nystagmus weaker in the left side, compatible with a left side horizontal canal canalolithiasis of the apogetropic type. Returning to the sitting position, a spontaneous nystagmus was observed again, not tilt sensitive. A left side caloric paresis was found. After performing liberatory maneuvers, the spontaneous nystagmus disappeared and a horizontal canal benign paroxysmal positional vertigo of geotropic type was documented. The canal paresis also disappeared. Canalith jam is rarely described and is overall observed as a repositioning manoeuvre complication, not as a mimicker of a vestibular neuritis. Furthermore, our case represents the first observation of a recurrent canalith jam and apogeotropic variant of horizontal canal benign paroxysmal positional vertigo.
BibTeX: @article{Comacchio2018, author = {Comacchio, Francesco and Poletto, Elisabetta and Mion, Marta}, title = {Spontaneous Canalith Jam and Apogeotropic Horizontal Canal Benign Paroxysmal Positional Vertigo: Considerations on a Particular Case Mimicking an Acute Vestibular Deficit.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2018}, volume = {39}, issue = {9}, pages = {e843--e848}, doi = {https://doi.org/10.1097/MAO.0000000000001949}, pmid = {30106853} }
Ogawa, Y., Ichimura, A., Otsuka, K., Hagiwara, A., Inagaki, T., Shimizu, S., Nagai, N., Itani, S. and Suzuki, M.	Spontaneous inversion of nystagmus without a positional change in the horizontal canal variant of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2015	Journal of vestibular research : equilibrium & orientation Vol. 25(3-4), pp. 169-175	article	DOI
Abstract: We investigated the neuro-otological findings, including nystagmus, and the clinical course of patients with the horizontal canal variant of benign paroxysmal positional vertigo (HC-BPPV), who showed spontaneous inversion of nystagmus without a positional change. Furthermore, we speculated on the possible mechanism of spontaneous inversion of nystagmus without a positional change. The characteristics of spontaneous inversion of positional nystagmus without a positional change were analyzed in 7 patients with HC-BPPV. All patients were diagnosed as having HC-BPPV. During the positional test, the spontaneous inversion of nystagmus was observed in the same head position in all patients. Spontaneous inversion was observed on both sides in 5 patients, and only on 1 side in 2 patients. All patients presented with geotropic nystagmus in the first phase, and ageotropic nystagmus in the second phase. The coexistence of cupulolithiasis and canalolithiasis appears to be a possible mechanism of the spontaneous inversion of positional nystagmus.
BibTeX: @article{Ogawa2015, author = {Ogawa, Yasuo and Ichimura, Akihide and Otsuka, Koji and Hagiwara, Akira and Inagaki, Taro and Shimizu, Shigetaka and Nagai, Noriko and Itani, Shigeto and Suzuki, Mamoru}, title = {Spontaneous inversion of nystagmus without a positional change in the horizontal canal variant of benign paroxysmal positional vertigo.}, journal = {Journal of vestibular research : equilibrium & orientation}, year = {2015}, volume = {25}, issue = {3-4}, pages = {169--175}, doi = {https://doi.org/10.3233/VES-150552}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo, pathology, physiopathology; Female; Humans; Hypertension, complications; Labyrinth Diseases, pathology; Lithiasis, pathology; Magnetic Resonance Imaging; Male; Middle Aged; Nystagmus, Pathologic, pathology, physiopathology, therapy; Nystagmus, Physiologic; Semicircular Canals, pathology, physiopathology; Sleep Apnea, Obstructive, complications; Vestibular Function Tests; Horizontal canal BPPV; benign paroxysmal vertigo; lateral canal BPPV; positional nystagmus}, pmid = {26756132} }
Hajiabolhassan, F. and Tavanai, E.	Spontaneous nystagmus in benign paroxysmal positional vertigo: is it a new sign? [Abstract] [BibTeX]	2013	Acta medica Iranica Vol. 51(12), pp. 903-906	article
Abstract: Benign Paroxysmal Positional Vertigo (BPPV) is a condition that indicates a benign inner ear disorder. It is generally believed that BPPV is due to the dislodged otoconial particles from otolith organs and unusual collection of them within any of semicircular canals or even in all three semicircular canals. Although the typical features of nystagmus in BPPV have been well-studied, very few studies (just four articles) have highlighted the presence of spontaneous nystagmus in BPPV recently. During the past 10 years, 2850 patients have been examined at the audiology unit of our department, and 254 patients have received diagnoses of BPPV but recently 2 patients presented with BPPV and spontaneous nystagmus, a new symptom that has been never observed in our clinical records. We herein describe this rare symptom in 2 case of BPPV. A 50-year-old woman with BPPV who showed an 18 degree spontaneous nystagmus treated with Epley maneuver and a 53-year-old man with 3 degree spontaneous nystagmus.
BibTeX: @article{Hajiabolhassan2013, author = {Hajiabolhassan, Fahimeh and Tavanai, Elham}, title = {Spontaneous nystagmus in benign paroxysmal positional vertigo: is it a new sign?}, journal = {Acta medica Iranica}, year = {2013}, volume = {51}, issue = {12}, pages = {903--906}, keywords = {Benign Paroxysmal Positional Vertigo; Eye Movements; Female; Humans; Male; Middle Aged; Vertigo, complications}, pmid = {24442547} }
De Stefano, A., Kulamarva, G., Citraro, L., Neri, G. and Croce, A.	Spontaneous nystagmus in benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2011	American journal of otolaryngology Vol. 32(3), pp. 185-189	article	DOI
Abstract: The purpose of this study was to evaluate the presence and eventually to study the features of spontaneous nystagmus (Ny) in our patients with diagnosis of benign paroxysmal positional vertigo (BPPV). We retrospectively reviewed the clinical records of patients who presented with vertigo spells and were managed at our tertiary care referral center. Patients with only idiopathic BPPV presenting with typical vertigo spells and positioning Ny characteristic of the disease were included in this study. To investigate the positioning Ny, we studied the patients in the sitting position, during the head shaking test, and during the Dix-Hallpike test and the McClure-Pagnini test (Ny provoked by rotation of the head in a supine patient). Ny responses in all patients were observed using infrared videoscopy. We managed 412 patients affected by BPPV. Of the 412 patients, 292 (70.87%) were diagnosed to be having posterior canal-BPPV and 110 (26.99%) patients had horizontal canal-BPPV (HC-BPPV). The remaining 10 patients (2.44%) were identified to have anterior canal-BPPV. Spontaneous Ny in sitting position was observed, by infrared videoscopy, only in the patients affected by HC-BPPV. Spontaneous Ny in BPPV can be observed with infrared videoscopy in patients affected by HC-BPPV. The origin of this Ny is most likely due to a natural inclination of horizontal semicircular canal with respect to the horizontal plane. This Ny stops after flexion of the head in neutral position, and for this reason, it should be considered as a seemingly spontaneous Ny. This Ny, in our experience, is observed in most HC-BPPV patients but does not indicate the need for a different management protocol or any different prognostic value of HC-BPPV.
BibTeX: @article{DeStefano2011a, author = {De Stefano, Alessandro and Kulamarva, Gautham and Citraro, Leonardo and Neri, Giampiero and Croce, Adelchi}, title = {Spontaneous nystagmus in benign paroxysmal positional vertigo.}, journal = {American journal of otolaryngology}, year = {2011}, volume = {32}, issue = {3}, pages = {185--189}, doi = {https://doi.org/10.1016/j.amjoto.2010.01.005}, keywords = {Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Cohort Studies; Electronystagmography; Female; Humans; Incidence; Male; Middle Aged; Nystagmus, Pathologic, diagnosis, epidemiology; Prognosis; Retrospective Studies; Risk Assessment; Severity of Illness Index; Sex Distribution; Vertigo, diagnosis, epidemiology; Young Adult}, pmid = {20392532} }
De Stefano, A. and Dispenza, F.	Spontaneous nystagmus in horizontal canal benign paroxysmal positional vertigo. [BibTeX]	2013	Auris, nasus, larynx Vol. 40(1), pp. 117	article	DOI
BibTeX: @article{DeStefano2013, author = {De Stefano, Alessandro and Dispenza, Francesco}, title = {Spontaneous nystagmus in horizontal canal benign paroxysmal positional vertigo.}, journal = {Auris, nasus, larynx}, year = {2013}, volume = {40}, issue = {1}, pages = {117}, doi = {https://doi.org/10.1016/j.anl.2012.11.004}, keywords = {Ear, Inner, physiology; Head Movements, physiology; Humans; Nystagmus, Pathologic, physiopathology; Rotation; Semicircular Canals, physiology; Valsalva Maneuver; Vertigo, physiopathology}, pmid = {23238176} }
Son, E.J., Lim, H.J., Choung, Y.-H., Park, K. and Park, H.Y.	Spontaneous nystagmus in horizontal canal benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2013	Auris, nasus, larynx Vol. 40(3), pp. 247-250	article	DOI
Abstract: Benign paroxysmal positional vertigo of horizontal semicircular canal (HSC-BPPV) is characterized by either geotropic or apogeotropic nystagmus induced by head roll test. Some patients also present with spontaneous nystagmus. The aim of this study is to examine the clinical manifestation of spontaneous nystagmus in HSC-BPPV and evaluate the effect on the treatment outcome. Electronystagmography and video eye movement recordings of 125 patients diagnosed as HSC-BPPV were reviewed retrospectively. Presence of spontaneous nystagmus was analyzed and treatment outcome after repositioning therapy was compared. Overall, spontaneous nystagmus was observed in 19 patients (15.2%) with HSC-BPPV at initial presentation. In canalolithiasis group (n=64), the treatment outcome did not differ between patients with or without spontaneous nystagmus. However, in cupulolithiasis group (n=61), patients presenting with spontaneous nystagmus (n=10) required more repositioning therapy sessions. The presence of spontaneous nystagmus at initial presentation may implicate poorer treatment outcome in cupulolithiasis HSC-BPPV patients.
BibTeX: @article{Son2013, author = {Son, Eun Jin and Lim, Hye Jin and Choung, Yun-Hoon and Park, Keehyun and Park, Hun Yi}, title = {Spontaneous nystagmus in horizontal canal benign paroxysmal positional vertigo.}, journal = {Auris, nasus, larynx}, year = {2013}, volume = {40}, issue = {3}, pages = {247--250}, doi = {https://doi.org/10.1016/j.anl.2012.06.006}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Caloric Tests; Electronystagmography; Female; Humans; Lithiasis, physiopathology; Male; Middle Aged; Nystagmus, Pathologic, physiopathology, therapy; Retrospective Studies; Rotation; Semicircular Canals, physiopathology; Vertigo, physiopathology, therapy; Video Recording; Young Adult}, pmid = {22835731} }
Luis, L., Costa, J., Vaz Garcia, F., Valls-Solé, J., Brandt, T. and Schneider, E.	Spontaneous plugging of the horizontal semicircular canal with reversible canal dysfunction and recovery of vestibular evoked myogenic potentials. [Abstract] [BibTeX]	2013	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 34(4), pp. 743-747	article	DOI
Abstract: To evaluate the clinical pathophysiology of oculomotor changes in a patient presenting with a spontaneous semicircular horizontal canal plug. A 42-year-old man with acute spontaneous vertigo with spinning and persistent left-horizontal nystagmus, intensity but not direction dependent on head orientation with respect to gravity, indicating a benign paroxysmal positional vertigo due to otoconia causing a plug in the horizontal semicircular canal. Electrophysiological and video-oculographic testing; vestibular rehabilitation. Cervical and ocular vestibular evoked myogenic potentials (VEMPs); video head impulse testing. The video head-impulse test revealed an eye velocity cutoff at 80°/s in the time interval from 40 to 90 ms after initiation of head impulses to the right. This normalized within 2 days after liberatory maneuvers, documenting for the first time a reversible deficiency of the cupular-endolymph high-frequency system dynamics. Cervical and ocular vestibular myogenic potentials were absent during stimulation of the affected side before the liberatory maneuvers but normalized within 30 to 80 days. This case is special in 4 respects: 1) nystagmus intensity, but not direction, was dependent on head orientation with respect to gravity, indicating a horizontal canal plug; 2) VEMPs were asymmetrical before liberatory maneuvers; 3) VEMPs recovered after Day 30; and 4) video head-impulse test asymmetry recovered. These observations challenge the common belief that VEMPs are evoked by otolith stimulation only. Instead, the assumption of a reversible canal dysfunction by a plug offers a more plausible explanation for all effects.
BibTeX: @article{Luis2013, author = {Luis, Leonel and Costa, João and Vaz Garcia, Fernando and Valls-Solé, Josep and Brandt, Thomas and Schneider, Erich}, title = {Spontaneous plugging of the horizontal semicircular canal with reversible canal dysfunction and recovery of vestibular evoked myogenic potentials.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2013}, volume = {34}, issue = {4}, pages = {743--747}, doi = {https://doi.org/10.1097/MAO.0b013e318287f343}, keywords = {Adult; Humans; Male; Nystagmus, Pathologic, physiopathology; Semicircular Canals, physiopathology; Vertigo, physiopathology; Vestibular Evoked Myogenic Potentials, physiology; Vestibular Function Tests}, pmid = {23632787} }
Cohen, H.S., Mulavara, A.P., Peters, B.T., Sangi-Haghpeykar, H. and Bloomberg, J.J.	Standing balance tests for screening people with vestibular impairments. [Abstract] [BibTeX]	2014	The Laryngoscope Vol. 124(2), pp. 545-550	article	DOI
Abstract: To improve the test standards for a version of the Romberg test and to determine whether measuring kinematic variables improved its utility for screening. Healthy controls and patients with benign paroxysmal positional vertigo, postoperative acoustic neuroma resection, and chronic peripheral unilateral weakness were compared. Subjects wore Bluetooth-enabled inertial motion units while standing on the floor or medium-density, compliant foam, with eyes open or closed, with head still or moving in pitch or yaw. Dependent measures were time to perform each test condition, number of head movements made, and kinematic variables. Patients and controls did not differ significantly with eyes open or with eyes closed while on the floor. With eyes closed, on foam, some significant differences were found between patients and controls, especially for subjects older than 59 years. Head movement conditions were more challenging than with the head still. Significantly fewer patients than controls could make enough head movements to obtain kinematic measures. Kinematics indicated that lateral balance control is significantly reduced in these patients compared to controls. Receiver operator characteristics and sensitivity/specificity analyses showed moderately good differences with older subjects. Tests on foam with eyes closed, with head still or moving, may be useful as part of a screening battery for vestibular impairments, especially for older people. 3b.
BibTeX: @article{Cohen2014, author = {Cohen, Helen S and Mulavara, Ajitkumar P and Peters, Brian T and Sangi-Haghpeykar, Haleh and Bloomberg, Jacob J}, title = {Standing balance tests for screening people with vestibular impairments.}, journal = {The Laryngoscope}, year = {2014}, volume = {124}, issue = {2}, pages = {545--550}, doi = {https://doi.org/10.1002/lary.24314}, keywords = {Adult; Aged; Aged, 80 and over; Biomechanical Phenomena; Female; Humans; Male; Middle Aged; Postural Balance; Vestibular Diseases, diagnosis, physiopathology; Vestibular Function Tests; Young Adult; Balance testing; Romberg; screening; vestibular testing}, pmid = {23877965} }
Vanni, S., Pecci, R., Casati, C., Moroni, F., Risso, M., Ottaviani, M., Nazerian, P., Grifoni, S. and Vannucchi, P.	STANDING, a four-step bedside algorithm for differential diagnosis of acute vertigo in the Emergency Department. [Abstract] [BibTeX]	2014	Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale Vol. 34(6), pp. 419-426	article
Abstract: Vertigo is generally due to a benign disorder, but it is the most common symptom associated with misdiagnosis of stroke. In this pilot study, we preliminarily assessed the diagnostic performance of a structured bedside algorithm to differentiate central from non-central acute vertigo (AV). Adult patients presenting to a single Emergency Department with vertigo were evaluated with STANDING (SponTAneous Nystagmus, Direction, head Impulse test, standiNG) by one of five trained emergency physicians or evaluated ordinarily by the rest of the medical staff (control group). The gold standard was a complete audiologic evaluation by a clinicians who are experts in assessing dizzy patients and neuroimaging. Reliability, sensibility and specificity of STANDING were calculated. Moreover, to evaluate the potential clinical impact of STANDING, neuroimaging and hospitalisation rates were compared with control group. A total of 292 patients were included, and 48 (16.4%) had a diagnosis of central AV. Ninety-eight (33.4%) patients were evaluated with STANDING. The test had good interobserver agreement (k = 0.76), with very high sensitivity (100%, 95%CI 72.3-100%) and specificity (94.3%, 95%CI 90.7-94.3%). Furthermore, hospitalisation and neuroimaging test rates were lower in the STANDING than in the control group (27.6% vs. 50.5% and 31.6% vs. 71.1%, respectively). In conclusion, STANDING seems to be a promising simple structured bedside algorithm that in this preliminary study identified central AV with a very high sensitivity, and was associated with significant reduction of neuroimaging and hospitalisation rates.
BibTeX: @article{Vanni2014, author = {Vanni, S and Pecci, R and Casati, C and Moroni, F and Risso, M and Ottaviani, M and Nazerian, P and Grifoni, S and Vannucchi, P}, title = {STANDING, a four-step bedside algorithm for differential diagnosis of acute vertigo in the Emergency Department.}, journal = {Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale}, year = {2014}, volume = {34}, issue = {6}, pages = {419--426}, keywords = {Acute Disease; Algorithms; Diagnosis, Differential; Emergency Service, Hospital; Female; Humans; Male; Middle Aged; Physical Examination; Pilot Projects; Posture; Prospective Studies; Vertigo, diagnosis; Bedside algorithm; Benign paroxysmal positional vertigo; STANDING; Vestibular neuronitis}, pmid = {25762835} }
Magliulo, G., Gagliardi, M., Cuiuli, G., Celebrini, A., Parrotto, D. and D'Amico, R.	Stapedotomy and post-operative benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2005	Journal of vestibular research : equilibrium & orientation Vol. 15(3), pp. 169-172	article
Abstract: In our experience some patients subjected to stapedotomy presented vestibular symptoms characterized by brief episodes of vertigo that only lasted 10 to 20 seconds, accompanied by rapid paroxysmal nystagmus similar to that found in benign paroxysmal positional vertigo (BPPV). For this study, 141 otosclerotic patients were enroled and underwent stapedotomy following the Fisch and Dillier's technique. Twelve out (8.5%) of all the patients under study complained of post-operative vertigo and the physical examination of the positional nystagmus confirmed the presence of paroxymal positional vertigo. The percentage seems particularly high and does not agree with the data reported in literature. The onset of the vestibular symptoms appeared between the 5th and 21st day after surgery. To our knowledge, this is the first prospective study existing in literature on the incidence of BPPV after surgery of the stapes. It must also be stressed that the patient should be informed beforehand during the consultation phase of the possibility of post-stapedotomy BPPV together with the other causes of post-operative vertigo.
BibTeX: @article{Magliulo2005, author = {Magliulo, Giuseppe and Gagliardi, Mario and Cuiuli, Giuseppe and Celebrini, Alessandra and Parrotto, Donato and D'Amico, Raffaello}, title = {Stapedotomy and post-operative benign paroxysmal positional vertigo.}, journal = {Journal of vestibular research : equilibrium & orientation}, year = {2005}, volume = {15}, issue = {3}, pages = {169--172}, keywords = {Adult; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, etiology; Prospective Studies; Stapes Surgery, adverse effects; Vertigo, etiology}, pmid = {16179765} }
	StatPearls [Abstract] [BibTeX]	2018		article
Abstract: Vertebrobasilar insufficiency (VBI) is defined by inadequate blood flow through the posterior circulation of the brain, supplied by the 2 vertebral arteries that merge to form the basilar artery. The term was coined in the 1950s after C. Miller Fisher used carotid insufficiency to describe transient ischemic attacks (TIA) in the carotid supplied territories and is therefore often used to describe brief episodes of transient ischemic attacks in the vertebrobasilar territory. Also known as the posterior circulation, the vertebrobasilar vasculature supplies areas such as the brainstem, thalamus, hippocampus, cerebellum, occipital and medial temporal lobes. Although patients may initially be asymptomatic, the significant build-up of atherosclerotic plaques over time may lead to ischemic events. Stroke may occur either due to an occlusion of the vertebral or basilar artery or an embolus that that may lodge more proximal to the brain. In the emergency setting, VBI is an important diagnosis to consider as many symptoms can appear like other benign etiologies such as labyrinthitis, vestibular neuritis, and benign paroxysmal positional vertigo (BPPV).
BibTeX: @article{2018a,, title = {StatPearls}, publisher = {StatPearls Publishing}, year = {2018}, pmid = {29489229} }
	StatPearls [Abstract] [BibTeX]	2018		article
Abstract: Vertigo is the allusion of movement, a perception of motion though none exists. It is a sensation of swaying, tilting, spinning, or feeling unbalanced, which may be experienced as self-motion to some versus movement of the surrounding environment to others. Due to highly variable descriptions of the vertigo experience, it is often consolidated into the umbrella term “dizziness,” which is a very common complaint, accounting for over three million emergency department (ED) visits annually. Vertigo can be of vestibular or peripheral origin or be due to non-vestibular or central causes. With regards to peripheral vertigo, benign paroxysmal positional vertigo (BPPV) is the most common cause, accounting for over one-half of all cases. It is of great importance to identify BPPV versus other causes of vertigo as the differential diagnosis includes a spectrum of diseases processes ranging from benign to life-threatening.[1][2][3]
BibTeX: @article{2018b,, title = {StatPearls}, publisher = {StatPearls Publishing}, year = {2018}, pmid = {29261987} }
Gocmen-Mas, N., Kahveci, O., Karabekir, S., Kusbeci, O.Y., Altuntas, A. and Yazici, A.C.	Stereological volumetric evaluation of the cerebellum in benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2011	Neurosciences (Riyadh, Saudi Arabia) Vol. 16(4), pp. 358-362	article
Abstract: To evaluate cerebellar volume changes and the asymmetry of patients with benign paroxysmal positional vertigo (BPPV). The cerebellar hemispheres` volumetric symmetry were evaluated using a stereological method on MR images. The study included 15 patients with BPPV, and 14 age-, and gender-matched control subjects. The cases were admitted to the Departments of Otolaryngology, Neurology, and Neurosurgery in the Faculty of Medicine, Kocatepe University, Afyonkarahisar, Turkey with the complaint of vertigo between January 2004 and December 2008. The right hemi cerebellum volumes of the subjects with BPPV and the controls were measured smaller than the left hemi cerebellar volumes, however, there was no statistically significant quantitative evidence detected in terms of cerebellar asymmetry between sagittal and axial plane estimates in the cases with vertigo. There was statistical significance between the right and left cerebellum in both the patient and control groups (p=0.023), however, the difference did not change according to gender. There were no statistically significant age and gender dependent cerebellar atrophy and asymmetry between BPPV and control subjects. There was no cerebellar atrophy and asymmetry between BPPV and age matched control groups. The stereological evaluation of hemi cerebellar symmetry and atrophy in humans is important for both clinicians and anatomists. The technique is simple, inexpensive, and reliable.
BibTeX: @article{Gocmen-Mas2011, author = {Gocmen-Mas, Nuket and Kahveci, Orhan and Karabekir, Selim and Kusbeci, Ozge Y and Altuntas, Ali and Yazici, Ayse C}, title = {Stereological volumetric evaluation of the cerebellum in benign paroxysmal positional vertigo.}, journal = {Neurosciences (Riyadh, Saudi Arabia)}, year = {2011}, volume = {16}, issue = {4}, pages = {358--362}, keywords = {Adolescent; Adult; Aged; Atrophy; Benign Paroxysmal Positional Vertigo; Cerebellar Diseases, complications, pathology; Cerebellum, pathology; Female; Humans; Male; Middle Aged; Vertigo, etiology, pathology; Young Adult}, pmid = {21983380} }
Heidenreich, K.D., Carender, W.J., Heidenreich, M.J. and Telian, S.A.	Strategies to distinguish benign paroxysmal positional vertigo from rotational vertebrobasilar ischemia. [Abstract] [BibTeX]	2010	Annals of vascular surgery Vol. 24(4), pp. 553.e1-553.e5	article	DOI
Abstract: Vertigo provoked by head rotation is a classic symptom of rotational vertebrobasilar ischemia (RVBI). Inner ear disease can cause positional vertigo and mimic RVBI. We review the case of a patient with vertigo consistently triggered by leftward head rotation when supine. Computed tomography angiogram and dynamic arteriogram failed to show compression of the vertebral arteries with head rotation. Further evaluation revealed benign paroxysmal positional vertigo (BPPV) as the underlying etiology. Treatment of her BPPV led to complete resolution of her symptoms. A succinct overview of this common otologic disorder is provided, and strategies to help distinguish it from RVBI are discussed.
BibTeX: @article{Heidenreich2010a, author = {Heidenreich, Katherine D and Carender, Wendy J and Heidenreich, Michael J and Telian, Steven A}, title = {Strategies to distinguish benign paroxysmal positional vertigo from rotational vertebrobasilar ischemia.}, journal = {Annals of vascular surgery}, year = {2010}, volume = {24}, issue = {4}, pages = {553.e1--553.e5}, doi = {https://doi.org/10.1016/j.avsg.2009.09.018}, keywords = {Diagnosis, Differential; Female; Head Movements; Humans; Middle Aged; Nystagmus, Pathologic; Rotation; Supine Position; Tomography, X-Ray Computed; Vertebrobasilar Insufficiency, diagnosis, physiopathology; Vertigo, diagnosis, etiology, physiopathology, therapy; Vestibular Neuronitis, complications, diagnosis, physiopathology, therapy}, pmid = {20116206} }
Helminski, J.O., Janssen, I., Kotaspouikis, D., Kovacs, K., Sheldon, P., McQueen, K. and Hain, T.C.	Strategies to prevent recurrence of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2005	Archives of otolaryngology--head & neck surgery Vol. 131(4), pp. 344-348	article	DOI
Abstract: To determine if a daily routine of Brandt-Daroff exercises increases the time to recurrence and reduces the rate of recurrence of benign paroxysmal positional vertigo (BPPV). Random sample of convenience and retrospective case review. Tertiary referral center and outpatient clinic. One hundred sixteen patients diagnosed with BPPV involving the posterior semicircular canal (BPPV-PC) who were successfully treated with the canalith repositioning procedure. Patients in the treatment group (n = 43) performed daily Brandt-Daroff exercises, while patients in the no-treatment group (n = 73) performed no exercises. Follow-up was as long as 2 years. Every 2 months patients were mailed a questionnaire. If BPPV had recurred, patients contacted the principal investigator within 24 hours. Within 1 to 2 weeks, patients were evaluated in the clinic with the Dix-Hallpike maneuver or, if unable to travel to the clinic, interviewed by telephone. Symptoms recurred in 50 (43%) of the 116 subjects, 34 (47%) of 73 in the no-treatment group and 16 (37%) of 43 in the treatment group. There was no significant difference in the frequency of recurrence (Pearson chi(2), P = .33) or time to recurrence (survival analysis, log-rank test, P = .92). A history of recurrent BPPV-PC did not affect frequency of recurrence (Pearson chi(2), P = .33) or time to recurrence (survival analysis, log-rank test, P = .72). Our results suggest that a daily routine of Brandt-Daroff exercises does not significantly affect the time to recurrence or the rate of recurrence of BPPV-PC.
BibTeX: @article{Helminski2005, author = {Helminski, Janet Odry and Janssen, Imke and Kotaspouikis, Despina and Kovacs, Karen and Sheldon, Phil and McQueen, Kristin and Hain, Timothy Carl}, title = {Strategies to prevent recurrence of benign paroxysmal positional vertigo.}, journal = {Archives of otolaryngology--head & neck surgery}, year = {2005}, volume = {131}, issue = {4}, pages = {344--348}, doi = {https://doi.org/10.1001/archotol.131.4.344}, keywords = {Exercise; Female; Follow-Up Studies; Humans; Interviews as Topic; Male; Middle Aged; Recurrence; Retrospective Studies; Semicircular Canals; Surveys and Questionnaires; Vertigo, prevention & control}, pmid = {15837905} }
Kerber, K.A., Meurer, W.J., Brown, D.L., Burke, J.F., Hofer, T.P., Tsodikov, A., Hoeffner, E.G., Fendrick, A.M., Adelman, E.E. and Morgenstern, L.B.	Stroke risk stratification in acute dizziness presentations: A prospective imaging-based study. [Abstract] [BibTeX]	2015	Neurology Vol. 85(21), pp. 1869-1878	article	DOI
Abstract: To estimate the ability of bedside information to risk stratify stroke in acute dizziness presentations. Surveillance methods were used to identify patients with acute dizziness and nystagmus or imbalance, excluding those with benign paroxysmal positional vertigo, medical causes, or moderate to severe neurologic deficits. Stroke was defined as acute infarction or intracerebral hemorrhage on a clinical or research MRI performed within 14 days of dizziness onset. Bedside information comprised history of stroke, the ABCD(2) score (age, blood pressure, clinical features, duration, and diabetes), an ocular motor (OM)-based assessment (head impulse test, nystagmus pattern [central vs other], test of skew), and a general neurologic examination for other CNS features. Multivariable logistic regression was used to determine the association of the bedside information with stroke. Model calibration was assessed using low (<5%), intermediate (5% to <10%), and high (≥10%) predicted probability risk categories. Acute stroke was identified in 29 of 272 patients (10.7%). Associations with stroke were as follows: ABCD(2) score (continuous) (odds ratio [OR] 1.74; 95% confidence interval [CI] 1.20-2.51), any other CNS features (OR 2.54; 95% CI 1.06-6.08), OM assessment (OR 2.82; 95% CI 0.96-8.30), and prior stroke (OR 0.48; 95% CI 0.05-4.57). No stroke cases were in the model's low-risk probability category (0/86, 0%), whereas 9 were in the moderate-risk category (9/94, 9.6%) and 20 were in the high-risk category (20/92, 21.7%). In acute dizziness presentations, the combination of ABCD(2) score, general neurologic examination, and a specialized OM examination has the capacity to risk-stratify acute stroke on MRI.
BibTeX: @article{Kerber2015, author = {Kerber, Kevin A and Meurer, William J and Brown, Devin L and Burke, James F and Hofer, Timothy P and Tsodikov, Alexander and Hoeffner, Ellen G and Fendrick, A M and Adelman, Eric E and Morgenstern, Lewis B}, title = {Stroke risk stratification in acute dizziness presentations: A prospective imaging-based study.}, journal = {Neurology}, year = {2015}, volume = {85}, issue = {21}, pages = {1869--1878}, doi = {https://doi.org/10.1212/WNL.0000000000002141}, keywords = {Acute Disease; Adult; Aged; Dizziness, diagnosis, etiology, metabolism; Emergency Service, Hospital, trends; Female; Humans; Magnetic Resonance Imaging, methods; Male; Middle Aged; Prospective Studies; Risk Factors; Stroke, complications, diagnosis, metabolism}, pmid = {26511453} }
González-Aguado, R., Domènech-Vadillo, E., Álvarez-Morujo de Sande, M.G., Guerra-Jiménez, G. and Domínguez-Durán, E.	Subjective benign paroxysmal positional vertigo in patients with osteoporosis or migraine. [Abstract] [BibTeX]	2018	Brazilian journal of otorhinolaryngology	article	DOI
Abstract: Subjective benign paroxysmal positional vertigo is a form of benign paroxysmal positional vertigo in which during the diagnostic positional maneuvers patients only present vertigo symptoms with no nystagmus. To study the characteristics of subjects with subjective benign paroxysmal positional vertigo. Prospective multicenter case-control study. All patients presenting with vertigo in the Dix-Hallpike test that presented to the participating hospitals were included. The patients were separated into two groups depending on whether nystagmus was present or not. An Epley Maneuver of the affected side was performed. In the follow-up visit, patients were checked to see if nystagmus and vertigo was present. Both groups of patients were compared to assess the success rate of the Epley maneuver and also to compare the presence of 19 variables. 259 patients were recruited, of which 64 belonged to the subjective group. Nystagmus was eliminated in 67.2% of the patients with benign paroxysmal positional vertigo. 89.1% of the patients with subjective benign paroxysmal positional vertigo remained unaffected by nystagmus, thus showing a significant difference (p=0.001). Osteoporosis and migraine were the variables which reached the closest to the significance level. In those patients who were taking vestibular suppressors, the percentage of subjective benign paroxysmal positional vertigo was not significant higher. Subjective benign paroxysmal positional vertigo must be treated using the Epley maneuver. More studies are needed to establish a relationship between osteoporosis, migraine and sBPPV. The use of vestibular suppressants does not affect the detection of nystagmus.
BibTeX: @article{Gonzalez-Aguado2018, author = {González-Aguado, Rocío and Domènech-Vadillo, Esther and Álvarez-Morujo de Sande, María Guadalupe and Guerra-Jiménez, Gloria and Domínguez-Durán, Emilio}, title = {Subjective benign paroxysmal positional vertigo in patients with osteoporosis or migraine.}, journal = {Brazilian journal of otorhinolaryngology}, year = {2018}, doi = {https://doi.org/10.1016/j.bjorl.2018.10.003}, keywords = {BPPV; Distúrbios da migrânea; Migraine disorders; Osteoporose; Osteoporosis; VPPB}, pmid = {30482521} }
Balatsouras, D.G. and Korres, S.G.	Subjective benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2012	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 146(1), pp. 98-103	article	DOI
Abstract: To study the demographic, clinical, pathogenetic, and nystagmographic features and treatment outcomes of subjective benign paroxysmal positional vertigo (BPPV). Prospective clinical trial. Tertiary referral center. Sixty-three patients were studied (mean [SD] age 55.4 [9.4] years), 27 men and 36 women, who presented with a positive history for BPPV and Dix-Hallpike or supine roll tests positive for vertigo but negative for nystagmus. A comprehensive history was obtained, followed by clinical examination of the ears, nose, and throat and a complete audiologic and neurotologic examination, including videonystagmography. All patients were treated with the appropriate canalith repositioning procedure, depending on the type of provoking positioning test. A group of 204 patients with typical BPPV were used for comparison. Forty-five patients with subjective BPPV were successfully treated. Eighteen patients, in most of whom vertigo of other causes was identified, did not respond to treatment. Comparison between patients with subjective and typical BPPV showed similar epidemiological and clinical features. Treatment failed in 13.5% of patients with subjective disease, after excluding patients with different causes of positional vertigo, as compared with 7.8% of patients with typical BPPV (odds ratio = 1.8; 95% confidence interval, 0.7-4.7; P = .32). Subjective BPPV is quite common, accounting for more than one-fourth of patients with typical BPPV and sharing common features with it, with the exception of nystagmus. No statistical difference in treatment outcomes between patients with subjective and typical BPPV was found, but study of a larger sample is needed.
BibTeX: @article{Balatsouras2012a, author = {Balatsouras, Dimitrios G and Korres, Stavros G}, title = {Subjective benign paroxysmal positional vertigo.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2012}, volume = {146}, issue = {1}, pages = {98--103}, doi = {https://doi.org/10.1177/0194599811425158}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo; Confidence Intervals; Electronystagmography; Female; Follow-Up Studies; Greece, epidemiology; Humans; Male; Middle Aged; Nystagmus, Pathologic, epidemiology, etiology, physiopathology; Odds Ratio; Patient Positioning, methods; Physical Examination; Prevalence; Prospective Studies; Treatment Outcome; Vertigo, diagnosis, physiopathology, therapy}, pmid = {21998085} }
McCaslin, D.L.	Subjective BPPV: to reposition, or not to reposition, that is the question. [BibTeX]	2013	Journal of the American Academy of Audiology Vol. 24(7), pp. 534	article	DOI
BibTeX: @article{McCaslin2013, author = {McCaslin, Devin L}, title = {Subjective BPPV: to reposition, or not to reposition, that is the question.}, journal = {Journal of the American Academy of Audiology}, year = {2013}, volume = {24}, issue = {7}, pages = {534}, doi = {https://doi.org/10.3766/jaaa.24.7.1}, keywords = {Benign Paroxysmal Positional Vertigo; Female; Humans; Male; Outcome Assessment (Health Care), statistics & numerical data; Patient Positioning, methods; Vertigo, physiopathology, therapy}, pmid = {24047940} }
Ushio, M., Murofushi, T. and Iwasaki, S.	Subjective visual horizontal in patients with posterior canal benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2007	Acta oto-laryngologica Vol. 127(8), pp. 836-838	article	DOI
Abstract: Patients with posterior canal benign paroxysmal positional vertigo (p-BPPV) could have mild excitation in the vestibular system on the affected side. p-BPPV is considered to be caused by small particles dislodged from the utricular macula. While subjective visual horizontal (SVH) mainly reflects utricular function, there is less documentation on SVH in patients with p-BPPV. The purpose of this study was to clarify whether p-BPPV could affect SVH. Twenty-eight patients with unilateral idiopathic p-BPPV were enrolled. For comparison, 17 patients with vestibular neuritis and 45 patients with cerebello-pontine angle (CPA) tumor were also examined. For measurement of SVH, we used a device that has a red bar of light-emitting diodes (LEDs) in front of the patient. Subjects were asked to rotate the bar to the position that they felt was horizontal in a completely dark room. Deviation of SVH toward the unaffected side down was seen in 82.1% (23/28) of patients with p-BPPV. Mean+/-SD deviation of SVH from the true horizontal to the unaffected side down was 0.49+/-1.21 degrees. Conversely, deviation of SVH was toward the affected side down in 88.2% of patients with vestibular neuritis and in 75.6% of patients with CPA tumor.
BibTeX: @article{Ushio2007, author = {Ushio, Munetaka and Murofushi, Toshihisa and Iwasaki, Shinichi}, title = {Subjective visual horizontal in patients with posterior canal benign paroxysmal positional vertigo.}, journal = {Acta oto-laryngologica}, year = {2007}, volume = {127}, issue = {8}, pages = {836--838}, doi = {https://doi.org/10.1080/00016480601053115}, keywords = {Adult; Aged; Aged, 80 and over; Cerebellar Neoplasms, complications, physiopathology; Cerebellopontine Angle; Female; Follow-Up Studies; Humans; Male; Middle Aged; Posture, physiology; Reflex, Vestibulo-Ocular, physiology; Severity of Illness Index; Vertigo, etiology, physiopathology; Vestibular Neuronitis, complications, physiopathology; Vision, Ocular, physiology}, pmid = {17762994} }
Ferreira, M.M., Ganança, M.M. and Caovilla, H.H.	Subjective visual vertical after treatment of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2017	Brazilian journal of otorhinolaryngology Vol. 83(6), pp. 659-664	article	DOI
Abstract: Otolith function can be studied by testing the subjective visual vertical, because the tilt of the vertical line beyond the normal range is a sign of vestibular dysfunction. Benign paroxysmal positional vertigo is a disorder of one or more labyrinthine semicircular canals caused by fractions of otoliths derived from the utricular macula. To compare the subjective visual vertical with the bucket test before and immediately after the particle repositioning maneuver in patients with benign paroxysmal positional vertigo. We evaluated 20 patients. The estimated position where a fluorescent line within a bucket reached the vertical position was measured before and immediately after the particle repositioning maneuver. Data were tabulated and statistically analyzed. Before repositioning maneuver, 9 patients (45.0%) had absolute values of the subjective visual vertical above the reference standard and 2 (10.0%) after the maneuver; the mean of the absolute values of the vertical deviation was significantly lower after the intervention (p<0.001). There is a reduction of the deviations of the subjective visual vertical, evaluated by the bucket test, immediately after the particle repositioning maneuver in patients with benign paroxysmal positional vertigo.
BibTeX: @article{Ferreira2017, author = {Ferreira, Maristela Mian and Ganança, Maurício Malavasi and Caovilla, Heloisa Helena}, title = {Subjective visual vertical after treatment of benign paroxysmal positional vertigo.}, journal = {Brazilian journal of otorhinolaryngology}, year = {2017}, volume = {83}, issue = {6}, pages = {659--664}, doi = {https://doi.org/10.1016/j.bjorl.2016.08.014}, keywords = {Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, physiopathology, therapy; Female; Humans; Male; Middle Aged; Orientation, Spatial, physiology; Otolithic Membrane, physiopathology; Patient Positioning, methods; Posture, physiology; Reference Standards; Reference Values; Semicircular Canals, physiopathology; Statistics, Nonparametric; Treatment Outcome; Vestibular Function Tests, methods; Visual Perception, physiology; Benign paroxysmal positional vertigo; Equilíbrio postural; Inner ear; Orelha interna; Postural balance; Utricle; Utrículo; Vertigem posicional paroxística benigna}, pmid = {27746123} }
Faralli, M., Manzari, L., Panichi, R., Botti, F., Ricci, G., Longari, F. and Pettorossi, V.E.	Subjective visual vertical before and after treatment of a BPPV episode. [Abstract] [BibTeX]	2011	Auris, nasus, larynx Vol. 38(3), pp. 307-311	article	DOI
Abstract: The study analyses the behavior of subjective visual vertical (SVV) in benign paroxysmal positional vertigo (BPPV) before and after treatment, and offers a clinical-pathogenic interpretation. We studied 30 consecutive patients with BPPV of the posterior semicircular canal treated with the Epley repositioning maneuver. SVV was determined at three different stages: at the time of diagnosis (1st test), after the repositioning maneuver (2nd test), and then 7 days after the resolution of the clinical picture (3rd test). The main study parameter was represented by the mean of 6 consecutive measurements (SVV(0)) for each patient. SVV was also examined in 20 healthy subjects, who represented the control group. The comparison between mean values and standard deviations showed a statistical significance of p<0.05. During the first test, the degree of deviation of SVV was significantly higher in the patient group than in the control group. Tilting towards the affected side was observed in all cases. The 2nd test showed an inversion in the orientation of SVV in 16 patients, and as a result of the Epley maneuver there was a statistically significant variation in SVV(0) values in 20 patients with respect to the previous test (2nd test vs. 1st test). This involved 87% (23 patients) of those who then had a negative Dix-Hallpike test, and none of the ones in whom paroxysmal positional nystagmus persisted. Lastly, no differences emerged in the behavior of the patient group vs. the control group during the third test. SVV is often altered during active BPPV. The degree of otolithic dysfunction is never high and, in all cases, it is brief in duration. Tilting towards the dysfunctional side is essentially a constant in untreated BPPV. This could be due to a substantial loss of otoconia, with a decrease in the density and specific weight of the macula, and thus hypofunction of the receptor. The observation of a significant variation in SVV after therapeutic maneuvers has a favorable predictive value, as it probably reflects the migration of otoliths to the utricle, where saturation mechanisms can often have irritative effects leading to the inversion of SVV.
BibTeX: @article{Faralli2011, author = {Faralli, Mario and Manzari, Leonardo and Panichi, Roberto and Botti, Fabio and Ricci, Giampietro and Longari, Fabrizio and Pettorossi, Vito Enrico}, title = {Subjective visual vertical before and after treatment of a BPPV episode.}, journal = {Auris, nasus, larynx}, year = {2011}, volume = {38}, issue = {3}, pages = {307--311}, doi = {https://doi.org/10.1016/j.anl.2010.10.005}, keywords = {Adult; Female; Functional Laterality, physiology; Humans; Male; Middle Aged; Musculoskeletal Manipulations, methods; Orientation, physiology; Otolithic Membrane, physiopathology; Pattern Recognition, Visual, physiology; Perceptual Distortion, physiology; Postural Balance, physiology; Vertigo, physiopathology, psychology, therapy}, pmid = {21227610} }
Hong, S.M., Park, M.S., Cha, C.I., Park, C.H. and Lee, J.H.	Subjective visual vertical during eccentric rotation in patients with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2008	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 29(8), pp. 1167-1170	article	DOI
Abstract: There have been only a few reports of subjective visual vertical (SVV) in patients with benign paroxysmal positional vertigo (BPPV), and each showed slightly different results. SVV measurement during eccentric rotation that stimulated only 1 labyrinth was known to show a considerable improvement in comparison with conventional SVV as a clinical measure of otolith function. But there has not been a report regarding SVV during eccentric rotation in patients with BPPV. We therefore measured SVV during eccentric rotation and investigated the function of utricles in patients with BPPV. Retrospective study. Tertiary referral center. Twenty-three patients with BPPV. Diagnostic procedure. SVV was measured in 23 patients with BPPV and 20 normal subjects. We compared the SVV values before and during eccentric rotation toward the right and left in both patients with BPPV and the control group. Between BPPV patients and the control group, no difference in the SVV value was observed in pre-eccentric rotation, but significant differences of SVV values were found during eccentric rotation. We identified utricular dysfunction in patients with BPPV during eccentric rotation and suggested that eccentric rotation might be a good method to measure utricular dysfunction.
BibTeX: @article{Hong2008, author = {Hong, Seok Min and Park, Moon Suh and Cha, Chang Il and Park, Chan Hum and Lee, Jun Ho}, title = {Subjective visual vertical during eccentric rotation in patients with benign paroxysmal positional vertigo.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2008}, volume = {29}, issue = {8}, pages = {1167--1170}, doi = {https://doi.org/10.1097/MAO.0b013e31818a0f3c}, keywords = {Adult; Aged; Female; Humans; Male; Middle Aged; Otolithic Membrane, physiopathology; Posture; Reference Values; Retrospective Studies; Rotation; Saccule and Utricle, physiopathology; Vertigo, classification, physiopathology; Visual Perception}, pmid = {18833015} }
Gall, R.M., Ireland, D.J. and Robertson, D.D.	Subjective visual vertical in patients with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	1999	The Journal of otolaryngology Vol. 28(3), pp. 162-165	article
Abstract: The ocular tilt reaction leads to an alteration in the subjective visual vertical (SVV). Nonsurgical peripheral vestibular dysfunction only rarely leads to changes in the SVV. To our knowledge, no studies have examined the effects on the SVV in patients with benign positional paroxysmal vertigo (BPPV) post Hallpike and Semont maneuvers. Sixteen patients with posterior canal BPPV were assessed in the vestibular clinic in Winnipeg, Manitoba. These patients had assessment of their SVV at baseline, post Hallpike and Semont maneuvers, and at follow-up 2 weeks later. These patients were also compared to a control group (n = 9). Ten of 16 patients showed a statistically significant change in SVV post Hallpike maneuver. An even larger number of patients, 14 of 16, showed a significant difference when compared to the control group post Hallpike. These findings suggest that the inferior vestibular nerve may to some degree influence the ocular tilt reaction.
BibTeX: @article{Gall1999, author = {Gall, R M and Ireland, D J and Robertson, D D}, title = {Subjective visual vertical in patients with benign paroxysmal positional vertigo.}, journal = {The Journal of otolaryngology}, year = {1999}, volume = {28}, issue = {3}, pages = {162--165}, keywords = {Adult; Aged; Eye Movements, physiology; Female; Follow-Up Studies; Humans; Male; Middle Aged; Posture; Reflex, Vestibulo-Ocular, physiology; Treatment Outcome; Vertigo, therapy; Vestibular Diseases, physiopathology; Vestibular Nerve, physiopathology; Visual Perception, physiology}, pmid = {10410349} }
Sapountzi, Z., Vital, V. and Psillas, G.	Subjective visual vertical in patients with benign positional paroxysmal vertigo. [BibTeX]	2017	Hippokratia Vol. 21(3), pp. 159	article
BibTeX: @article{Sapountzi2017, author = {Sapountzi, Z and Vital, V and Psillas, G}, title = {Subjective visual vertical in patients with benign positional paroxysmal vertigo.}, journal = {Hippokratia}, year = {2017}, volume = {21}, issue = {3}, pages = {159}, keywords = {BPPV; Benign positional paroxysmal vertigo; subjective visual vertical}, pmid = {30479482} }
Chetana, N. and Jayesh, R.	Subjective Visual Vertical in Various Vestibular Disorders by Using a Simple Bucket Test. [Abstract] [BibTeX]	2015	Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India Vol. 67(2), pp. 180-184	article	DOI
Abstract: Subjective Visual Vertical (S.V.V.) assesses the ability to perceive verticality which depends on visual, vestibular and somatosensory inputs. The judgment of verticality is altered when there is otolith dysfunction. Objective of our study was to present a simple method to assess S.V.V. and to analyze S.V.V. changes in various vestibular disorders. 100 subjects presenting with vestibular disorders in period of 1 year 2 months were subjected to Neurotological history and examination. Patients with non-vestibular causes were excluded. S.V.V was tested with a simple innovative device-a specially designed bucket. The angle of deviation from vertical was noted in degrees. Normal deviation is 0 ± 2°. Out of 23 patients with vestibular neuritis 83 % showed abnormal S.V.V. Amongst 11 patients of Meniere's disease, 55 % and 42 patients of BPPV, 71 % had abnormal S.V.V. Amongst 24 patients with other causes 15 % showed abnormal S.V.V. S.V.V is a reliable screening tool in assessment of vestibular dysfunction along with other clinical tests. It has a prognostic value during recovery following vestibular damage. The modified 'Bucket' is a simple, easy to use and cost-effective device to do the S.V.V. in daily practice.
BibTeX: @article{Chetana2015, author = {Chetana, Naik and Jayesh, Rane}, title = {Subjective Visual Vertical in Various Vestibular Disorders by Using a Simple Bucket Test.}, journal = {Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India}, year = {2015}, volume = {67}, issue = {2}, pages = {180--184}, doi = {https://doi.org/10.1007/s12070-014-0760-0}, keywords = {Bucket test; Otolith dysfunction; Subjective visual vertical; Vestibular vertigo}, pmid = {26075175} }
Cohen, H.S. and Sangi-Haghpeykar, H.	Subjective visual vertical in vestibular disorders measured with the bucket test. [Abstract] [BibTeX]	2012	Acta oto-laryngologica Vol. 132(8), pp. 850-854	article	DOI
Abstract: The 'bucket test' may indicate that patients with known vestibular disorders have spatial orientation deficits but due to the low receiver operating characteristics (ROC) values it is not useful for screening people for vestibular impairments. 1) to verify that patients with unilateral peripheral vestibular weakness (UW) differ from normal subjects on the bucket test, 2) to determine if patients with unilateral benign paroxysmal positional vertigo (BPPV) differ from normal subjects, 3) to determine the sensitivity and specificity of the test. Patients with UW (n = 25) and BPPV (n = 25) were compared to normals (n = 50). Subjects looked into a clean bucket with a vertical line on the bottom, which rested on a table. It was rotated, clockwise or counterclockwise, for three trials per direction until the subject indicated that the line was vertical. The dependent measure was the mean absolute value of the deviations from the true vertical. Some, but not all, patients' responses differed from normal subjects but responses also differed by age and sex. ROC values were all weak, i.e. < 0.8. No good cut-off points differentiated controls from patients. Thus, although the bucket test is useful for describing spatial deficits in patients this test is not useful for screening people for possible vestibular impairments.
BibTeX: @article{Cohen2012a, author = {Cohen, Helen S and Sangi-Haghpeykar, Haleh}, title = {Subjective visual vertical in vestibular disorders measured with the bucket test.}, journal = {Acta oto-laryngologica}, year = {2012}, volume = {132}, issue = {8}, pages = {850--854}, doi = {https://doi.org/10.3109/00016489.2012.668710}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo; Female; Follow-Up Studies; Humans; Male; Middle Aged; Orientation, physiology; ROC Curve; Reproducibility of Results; Space Perception, physiology; Vertigo, diagnosis, physiopathology; Vestibular Function Tests, methods; Vestibule, Labyrinth, physiopathology}, pmid = {22667824} }
Brodsky, J.R., Cusick, B.A., Kenna, M.A. and Zhou, G.	Subjective visual vertical testing in children and adolescents. [Abstract] [BibTeX]	2016	The Laryngoscope Vol. 126(3), pp. 727-731	article	DOI
Abstract: Subjective visual vertical (SVV) is a vestibular test commonly used in adults that has not been well studied in children. In this test, the patient aligns a projected line with the perceived true vertical. Deviation of >2° is usually associated with utricular dysfunction and may also be seen with central vestibular lesions. The goal of this study was to determine the efficacy of SVV in children. Prospective, controlled study. Thirty-three children aged 7 to 18 years with (n = 21) and without (n = 12) dizziness underwent static SVV. History, exam, rotary chair, and caloric testing were used to categorize subjects with dizziness into groups with peripheral vestibular loss (PVL), benign paroxysmal positioning vertigo (BPPV), central vertigo (CV), and nonvestibular dizziness (NVD). Mean SVV deviation was significantly higher in the peripheral vestibular loss group (n = 4; 2.1 ± 1.5) compared to BPPV (n = 5; 0.5 ± 0.3), CV (n = 7; 0.4 ± 0.3), NVD (n = 5; 0.6 ± 0.4), and control (n = 12; 0.7 ± 0.5) groups by one-way analysis of variance (P = .002). SVV deviation >2° demonstrated a sensitivity of 100%, specificity of 75%, positive predictive value of 100%, and negative predictive value of 97% for PVL. SVV is a simple, noninvasive test that provides a valuable contribution to the assessment of peripheral vestibular function in children. 3b Laryngoscope, 126:727-731, 2016.
BibTeX: @article{Brodsky2016, author = {Brodsky, Jacob R and Cusick, Brandon A and Kenna, Margaret A and Zhou, Guangwei}, title = {Subjective visual vertical testing in children and adolescents.}, journal = {The Laryngoscope}, year = {2016}, volume = {126}, issue = {3}, pages = {727--731}, doi = {https://doi.org/10.1002/lary.25389}, keywords = {Adolescent; Age Factors; Case-Control Studies; Child; Dizziness, diagnosis; Female; Humans; Male; Prospective Studies; Reflex, Vestibulo-Ocular, physiology; Risk Assessment; Sensitivity and Specificity; Vertigo, diagnosis; Vestibular Function Tests, methods; Subjective visual vertical; pediatric vestibular testing; utricle; vestibular neuritis}, pmid = {26014221} }
Shaia, W.T., Zappia, J.J., Bojrab, D.I., LaRouere, M.L., Sargent, E.W. and Diaz, R.C.	Success of posterior semicircular canal occlusion and application of the dizziness handicap inventory. [Abstract] [BibTeX]	2006	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 134(3), pp. 424-430	article	DOI
Abstract: To determine the long-term efficacy and patient satisfaction of posterior semicircular canal occlusion (PSCO) as a treatment for intractable benign paroxysmal positional vertigo (BPPV). Retrospective analysis of patients with BPPV who underwent PSCO was conducted in a tertiary referral center. Demographic data, clinical records, and audiometric data were reviewed. Dix-Hallpike maneuver, dizziness handicap inventory (DHI), and a specific PSCO questionnaire (PCOQ) were used to measure outcome. Twenty-eight patients underwent PSCO. The mean follow-up time was 40 months. All patients had normalization of the Hallpike test. DHI scores of 20 patients were recorded. The mean preoperative score was 70 compared with postoperative mean of 13 (P < 0.001). Mild hearing loss was found in 1 patient. PSCO is highly successful. The DHI scores postoperatively show significant improvement. The PCOQ revealed an overall 85% patient satisfaction rate. PSCO is a safe and effective intervention for intractable BPPV with a high patient satisfaction rate. C-4.
BibTeX: @article{Shaia2006, author = {Shaia, Wayne T and Zappia, John J and Bojrab, Dennis I and LaRouere, Michael L and Sargent, Eric W and Diaz, Rodney C}, title = {Success of posterior semicircular canal occlusion and application of the dizziness handicap inventory.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2006}, volume = {134}, issue = {3}, pages = {424--430}, doi = {https://doi.org/10.1016/j.otohns.2005.10.035}, keywords = {Adult; Aged; Audiometry, Pure-Tone; Auditory Threshold, physiology; Dizziness, prevention & control; Female; Follow-Up Studies; Hearing Loss, Sensorineural, etiology; Humans; Longitudinal Studies; Male; Middle Aged; Patient Satisfaction; Postoperative Complications; Quality of Life; Retrospective Studies; Semicircular Canals, surgery; Treatment Outcome; Vertigo, surgery}, pmid = {16500439} }
Wolf, J.S., Boyev, K.P., Manokey, B.J. and Mattox, D.E.	Success of the modified Epley maneuver in treating benign paroxysmal positional vertigo. [Abstract] [BibTeX]	1999	The Laryngoscope Vol. 109(6), pp. 900-903	article
Abstract: Benign paroxysmal positional vertigo (BPPV) is a common condition seen by otolaryngologists. The purpose of this study is to determine the ability of the modified Epley maneuver to treat BPPV. Retrospective review. A retrospective chart review of 107 patients diagnosed with BPPV at our institution between March of 1993 and June of 1995. Each patient was diagnosed with isolated BPPV by history and Hallpike-Dix maneuver. There were no other vestibular symptoms or electronystagmogram abnormalities. Patients diagnosed with BPPV received modified Epley maneuvers, were instructed to remain upright for 48 hours, and wore a soft collar for a week. Patients were followed up with repeat Hallpike-Dix maneuvers at 1 to 2 weeks. If symptoms persisted, the maneuver was repeated for up to a maximum of three times, at which point patients were considered to have failed treatment. The average age of patients was 57.8 years old. Thirty percent were male and the right ear was affected in 54%. The posterior semicircular canal was affected in 105 ears. The average patient received 1.23 Epley maneuvers, with a success rate of 93.4%. No successfully treated patients received mastoid vibration. Seven out of 107 patients failed after three Epley maneuvers. Two failure patients had a history of temporal bone fracture. Two failure patients were treated with posterior semicircular canal block surgery. The modified Epley maneuver is an excellent treatment for BPPV.
BibTeX: @article{Wolf1999, author = {Wolf, J S and Boyev, K P and Manokey, B J and Mattox, D E}, title = {Success of the modified Epley maneuver in treating benign paroxysmal positional vertigo.}, journal = {The Laryngoscope}, year = {1999}, volume = {109}, issue = {6}, pages = {900--903}, keywords = {Female; Humans; Male; Medical Records; Middle Aged; Physical Therapy Modalities, methods; Posture; Recurrence; Retrospective Studies; Treatment Failure; Treatment Outcome; Vertigo, etiology, physiopathology, therapy; Vestibular Function Tests}, pmid = {10369279} }
Burrows, L.	Successful management of benign paroxysmal positional vertigo (BPPV) in a patient who was ventilated with a C3 complete spinal injury on a regional spinal unit intensive care. [Abstract] [BibTeX]	2018	BMJ case reports Vol. 2018	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) occurs in 14.5% of patients with spinal cord injury (SCI) and may require intervention on intensive care unit (ICU). A 61-year-old man was admitted to a spinal injury ICU with a traumatic C3 complete SCI following a mountain bike accident. Ventilated but stable he complained of severe dizziness on rolling, during personal cares, which lasted for 40 s. Clinical examination was limited due to the injury and ventilation. Subjective questioning, visio-ocular control and a modified Dix-Hallpike and roll tests confirmed a right posterior canalithiasis BPPV. A modified right Epley was performed with assistance of four people, medical supervision, monitoring of tracheal ventilation and vital signs. No adverse reaction was observed. Resolution of dizziness on rolling was achieved with no recurrence at 1 year. BPPV can be successfully and safely managed on ICU.
BibTeX: @article{Burrows2018, author = {Burrows, Lisa}, title = {Successful management of benign paroxysmal positional vertigo (BPPV) in a patient who was ventilated with a C3 complete spinal injury on a regional spinal unit intensive care.}, journal = {BMJ case reports}, year = {2018}, volume = {2018}, doi = {https://doi.org/10.1136/bcr-2017-223351}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis, etiology, therapy; Craniocerebral Trauma, complications; Humans; Intensive Care Units; Male; Middle Aged; Patient Positioning, methods; Physical Examination, methods; Respiration, Artificial; Spinal Cord Injuries, complications, therapy; ear, nose and throat/otolaryngology; intensive care; neurological injury; spinal cord}, pmid = {29437815} }
Jose, P., Rupa, V. and Job, A.	Successful management of benign paroxysmal positional vertigo with the epley manoeuvre. [Abstract] [BibTeX]	1999	Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India Vol. 52(1), pp. 49-53	article	DOI
Abstract: Benign paroxysmal positional vertigo is a recurrent, disabling disorder characterized by transient vertigo induced by changes in head position. Several non-surgical and surgical treatment procedures have been recommended as definitive treatment in this condition. Recent reports indicate a favourable response to a variety of non-invasive, easy to perform liberatory manoeuvres, often with a single treatment session. We report our experience with the Epley manoeuvre in which we obtained a 90% overall success rate which is comparable with results of similar recent studies.
BibTeX: @article{Jose1999, author = {Jose, P and Rupa, V and Job, A}, title = {Successful management of benign paroxysmal positional vertigo with the epley manoeuvre.}, journal = {Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India}, year = {1999}, volume = {52}, issue = {1}, pages = {49--53}, doi = {https://doi.org/10.1007/BF02996433}, pmid = {23119621} }
El-Saied, S., Joshua, B.-Z., Segal, N., Kraus, M. and Kaplan, D.M.	Sudden hearing loss with simultaneous posterior semicircular canal BPPV: possible etiology and clinical implications. [Abstract] [BibTeX]	2014	American journal of otolaryngology Vol. 35(2), pp. 180-185	article	DOI
Abstract: The objectives of this study were to describe the clinical course and outcome of patients with sudden sensorineural hearing loss (SSNHL) in conjunction with benign paroxysmal positional vertigo (BPPV), and hypothesize the possible pathophysiology of this entity. Retrospective study of all patients with evidence of SSNHL with any type of BPPV between 2008 and 2012. Tertiary care university hospital. Five patients aged 56 to 71 were diagnosed with unilateral profound SSNHL and BPPV. Neurotologic examination revealed an ipsilateral torsional, up-beating nystagmus on Dix-Hallpike exam. Severe or profound ipsilateral-sensorineural hearing loss was recognized on audiometry. The rest of the exam was normal; this was in keeping with the diagnosis of SSNHL with ipsilateral posterior semicircular canal BPPV. All patients were treated with a modified Epley maneuver; oral steroids were administered for two weeks. In all cases vertigo resolved and the Dix-Hallpike exam became normal within several weeks. However, the hearing loss remained unchanged in two patients. Magnetic resonance imaging of the head was normal and ENG caloric test demonstrated mild ipsilateral canal paresis in two patients. 1. Patients with SSNHL and BPPV can have a variable clinical course and outcome. This entity may be quite common, but the diagnosis of BPPV can be missed if a complete neurological physical examination is not performed. 2. Arterial occlusions or selective multiple vascular or neural involvement may explain the pathophysiology of SSNHL with BPPV of the posterior semicircular canal.
BibTeX: @article{El-Saied2014, author = {El-Saied, Sabri and Joshua, Ben-Zion and Segal, Nili and Kraus, Mordechai and Kaplan, Daniel M}, title = {Sudden hearing loss with simultaneous posterior semicircular canal BPPV: possible etiology and clinical implications.}, journal = {American journal of otolaryngology}, year = {2014}, volume = {35}, issue = {2}, pages = {180--185}, doi = {https://doi.org/10.1016/j.amjoto.2013.08.021}, keywords = {Aged; Audiometry; Benign Paroxysmal Positional Vertigo; Caloric Tests; Female; Follow-Up Studies; Hearing Loss, Sensorineural, complications, diagnosis, physiopathology; Hearing Loss, Sudden, complications, diagnosis, physiopathology; Humans; Male; Middle Aged; Retrospective Studies; Semicircular Canals, physiopathology; Vertigo, complications, diagnosis, physiopathology}, pmid = {24060342} }
Cho, J., Cheon, H., Park, J.H., Lee, H.-J., Kim, H.-J., Choi, H.G., Koo, J.-W. and Hong, S.K.	Sudden sensorineural hearing loss associated with inner ear lesions detected by magnetic resonance imaging. [Abstract] [BibTeX]	2017	PloS one Vol. 12(10), pp. e0186038	article	DOI
Abstract: Although recent advances in magnetic resonance imaging (MRI) techniques have contributed to the detection of tiny lesions in the internal auditory canal (IAC) that may be responsible for sudden sensorineural hearing loss (SSNHL), there have been relatively few studies on the clinical characteristics of intra-labyrinthine hemorrhage (ILH) and labyrinthitis versus those regarding IAC tumors. Our purpose was to investigate the frequency of those IAC lesions on MRI and their clinical characteristics. Initial MRIs of 200 patients with SSNHL (93 men, 107 women; mean age = 48.61 years, range: 18-84 years), as well as detailed clinical histories, audiological examinations, and thyroid function, lipid battery, and serological tests (for viral agents and autoimmune disease), were performed. All patients were hospitalized at the time of diagnosis of SSNHL and were administered the same treatment protocol. Patients were divided into idiopathic and secondary groups according to their MRI results. After discharge, they underwent follow-up audiometry and clinical examination at predetermined intervals (2 weeks, 1, 2, 4, and 6 months, and 1 and 2 years). Propensity score-matching and receiver operating characteristics curves of the initial parameters were used for estimating clinical characteristics. Of the 200 patients, 25 (12.55%) who had abnormal findings suggesting inner ear lesions on MRI were assigned to the secondary SSNHL group; within this group, 10 patients (10/200, 5%) had a tumor invading the IAC, 7 (7/200, 3.5%) had ILH, 6 (6/200, 3%) had labyrinthitis, and 2 (1%) had a structural deformity of the IAC. The secondary group showed significantly poor recovery of hearing function compared with that in the idiopathic group. Patients with ILH or labyrinthitis showed prognoses that were equally poor as those of patients with tumors in the secondary group. Additionally, patients with such lesions showed significant canal paresis on the lesion side at an early stage and a high prevalence of benign paroxysmal positional vertigo (BPPV). In conclusion, the prevalence of non-tumorous lesions on MRI represents common findings and showed a poorer treatment response than that of vestibular Schwannoma in patients with SSNHL. Abnormal canal paresis (cut-off value of 35% on the lesioned side, sensitivity 65.2% and specificity 67%), spontaneous nystagmus directed to the contralesional side, and positional vertigo would be the clinical presentation of SSNHL with IAC lesions, in which the presence of acute prolonged vertigo or positional vertigo compatible with BPPV suggests the possibility of a non-tumorous lesion, such as ILH or a labyrinthitis rather than an IAC tumor.
BibTeX: @article{Cho2017, author = {Cho, Jiwon and Cheon, Hanjae and Park, Jung Hye and Lee, Hyo-Jeong and Kim, Hyung-Jong and Choi, Hyo Geun and Koo, Ja-Won and Hong, Sung Kwang}, title = {Sudden sensorineural hearing loss associated with inner ear lesions detected by magnetic resonance imaging.}, journal = {PloS one}, year = {2017}, volume = {12}, issue = {10}, pages = {e0186038}, doi = {https://doi.org/10.1371/journal.pone.0186038}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Ear, Inner, pathology; Female; Hearing Loss, Sensorineural, diagnostic imaging, etiology; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Young Adult}, pmid = {28977031} }
Karlberg, M., Halmagyi, G.M., Büttner, U. and Yavor, R.A.	Sudden unilateral hearing loss with simultaneous ipsilateral posterior semicircular canal benign paroxysmal positional vertigo: a variant of vestibulo-cochlear neurolabyrinthitis? [Abstract] [BibTeX]	2000	Archives of otolaryngology--head & neck surgery Vol. 126(8), pp. 1024-1029	article
Abstract: We describe 4 patients who all simultaneously developed a sudden total or partial unilateral sensorineural hearing loss and an unusual acute peripheral vestibulopathy in the same ear characterized by posterior semicircular canal benign paroxysmal positional vertigo with intact lateral semicircular canal function. Two patients also had ipsilateral loss of otolith function. The vertigo resolved in all 4 patients after particle-repositioning maneuvers. The findings of audiometry and vestibular tests indicated that the lesion responsible for this syndrome was probably located within the labyrinth itself rather than within the vestibulocochlear nerve and that it was more likely a viral vestibulocochlear neurolabyrinthitis than a labyrinthine infarction.
BibTeX: @article{Karlberg2000, author = {Karlberg, M and Halmagyi, G M and Büttner, U and Yavor, R A}, title = {Sudden unilateral hearing loss with simultaneous ipsilateral posterior semicircular canal benign paroxysmal positional vertigo: a variant of vestibulo-cochlear neurolabyrinthitis?}, journal = {Archives of otolaryngology--head & neck surgery}, year = {2000}, volume = {126}, issue = {8}, pages = {1024--1029}, keywords = {Adult; Aged; Audiometry, Pure-Tone; Female; Hearing Loss, complications, diagnosis; Hearing Loss, Sudden, complications, diagnosis; Humans; Male; Middle Aged; Semicircular Canals, physiopathology; Severity of Illness Index; Tinnitus, complications, physiopathology; Vertigo, complications, diagnosis, physiopathology}, pmid = {10922239} }
Filippone, M.V., Igarashi, M., Miyata, H., Coats, A.C. and Alford, B.R.	Superior vestibular nerve sectioning. Experimental studies in squirrel monkeys. [Abstract] [BibTeX]	1975	Archives of otolaryngology (Chicago, Ill. : 1960) Vol. 101(4), pp. 241-245	article
Abstract: Spontaneous, positional, and paroxysmal positional nystagmus were studied before and after sectioning the superior division of the vestibular nerve and the anterior vestibular artery in squirrel monkeys. Histopathologic study of the temporal bones confirmed the degeneration of the macula utriculi with release of statoconia, but failed to identify the released utricular statoconia within the vestibular endolymphatic space in any animal. Postoperatively the animals consistently demonstrated direction-fixed spontaneous nystagmus until the end of the experiment (five months). Positional tests and Dix-Hallpike maneuver occasionally changed the intensity of the spontaneous nystagmus, but never elicited paroxysmal positional nystagmus. Possible reasons for not demonstrating paroxysmal positional nystagmus in the squirrel monkey are as follows: a resorption of statoconia; slight morphological alteration of the sensory epithelia of the posterior cristae; interference of the posterior crista function due to partial collapse of the membranous ampulla; the existence of interspecies difference; or possibly a faulty hypothesis regarding the etiologic mechanism of benign paroxysmal positional vertigo.
BibTeX: @article{Filippone1975, author = {Filippone, M V and Igarashi, M and Miyata, H and Coats, A C and Alford, B R}, title = {Superior vestibular nerve sectioning. Experimental studies in squirrel monkeys.}, journal = {Archives of otolaryngology (Chicago, Ill. : 1960)}, year = {1975}, volume = {101}, issue = {4}, pages = {241--245}, keywords = {Animals; Arteries, surgery; Ear, Inner, surgery; Electronystagmography; Eye Movements; Female; Haplorhini; Male; Temporal Bone, pathology; Vestibular Function Tests; Vestibular Nerve, surgery; Vestibule, Labyrinth, blood supply}, pmid = {804304} }
Shih, C.-P. and Wang, C.-H.	Supine to prolonged lateral position: a novel therapeutic maneuver for posterior canal benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2013	Journal of neurology Vol. 260(5), pp. 1375-1381	article	DOI
Abstract: The treatment of posterior canal benign paroxysmal positional vertigo often involves repositioning maneuvers and exercises; however, these procedures may not be suitable for patients with limb disabilities or back disorders, or for elder patients. We sought to develop a simple therapeutic maneuver as an alternative procedure, suitable for patients with a wide range of physical ability. A simple therapeutic maneuver, supine to prolonged lateral position, was developed based on the mechanism of canalolithiasis. Its efficacy in treating posterior canal benign paroxysmal positional vertigo was evaluated in a prospective study consisting of 81 objective and 13 subjective posterior canal benign paroxysmal positional vertigo patients. A successful outcome was defined as a negative Dix-Hallpike test within 2 weeks followed by the continued absence of symptoms of vertigo or dizziness for the next 4 weeks. Seventy-two patients with objective posterior canal benign paroxysmal positional vertigo and all 13 patients with subjective posterior canal benign paroxysmal positional vertigo were successfully treated: resolution rates were 88.9 and 100 %, respectively. In the objective group, negative Dix-Hallpike tests were obtained at 1 and 2 weeks in 66.7 and 88.9 % of patients, respectively. In the subjective group, the percentages of patients free of side-dependent vertigo illusions at 1 and 2 weeks were 84.6 and 100 %, respectively. These results suggest that the supine to prolonged lateral position maneuver, which is easy to perform and generally well tolerated, could be recommended as an alternative treatment modality for patients with posterior canal benign paroxysmal positional vertigo.
BibTeX: @article{Shih2013, author = {Shih, Cheng-Ping and Wang, Chih-Hung}, title = {Supine to prolonged lateral position: a novel therapeutic maneuver for posterior canal benign paroxysmal positional vertigo.}, journal = {Journal of neurology}, year = {2013}, volume = {260}, issue = {5}, pages = {1375--1381}, doi = {https://doi.org/10.1007/s00415-012-6807-9}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo; Dizziness, etiology; Female; Follow-Up Studies; Functional Laterality, physiology; Humans; Male; Middle Aged; Physical Therapy Modalities; Prospective Studies; Statistics, Nonparametric; Supine Position, physiology; Treatment Outcome; Vertigo, rehabilitation}, pmid = {23266893} }
Portmann, D. and Guindi, S.	Surgery of the semicircular canals. [Abstract] [BibTeX]	2008	Revue de laryngologie - otologie - rhinologie Vol. 129(1), pp. 3-9	article
Abstract: Surgery of the semicircular canals is seeing a revival as recently we have witnessed the development of specialized surgeries for each canal. The aim of this work is through a review of the literature to describe these different surgeries while stressing on certain surgical aspects, their respective indications, results and their risks. 1: The surgery of the posterior canal relates to the benign paroxysmal positional vertigo resistant to the medical treatments. The results are very good but the indications have become rarer since the introduction of the repositioning maneuvers. 2: The surgery of the lateral canal is the most frequent and the oldest because of chronic otitis and especially cholesteatomas. It is now well codified and is subject to various factors. Plugging of the lateral canal in Menière's disease has just been described and interesting results on vertiginous crises have been reported. Its interest and its place in the treatment of this disease are still to determine. It can be an alternative to surgical management but also to the gentamycin injection. 3: The dehiscence of the superior semicircular canal must be systematically sought after when confronted with a Menière-like disease, a suspicion of perilymphatic fistula or a conductive deafness evoking an otosclerosis with preserved stapedial reflexes. Very often these dehiscences of the superior canal are asymptomatic. High density scans of the petrous bones provide the diagnosis but it is necessary to obtain a 3D view to ascertain the dehiscence. A radiological classification of the dehiscence in 3 types has been proposed. It appears to be of help during surgery. Videonystagmography with and without vibrator and vestibular myogenic evoked potentials allow the determination of the side responsible for the symptoms in case of bilateral dehiscence. The surgery usually through a middle fossa approach will be proposed only to the symptomatic and incapacitated patients. The results are promising. 4: Finally the authors discuss the cochlear risk of this surgery and the types of material used to occlude or cover the canal. The otologists must generally know these indications as this type of surgery entails very good results with a relatively moderate risk on hearing.
BibTeX: @article{Portmann2008, author = {Portmann, D and Guindi, S}, title = {Surgery of the semicircular canals.}, journal = {Revue de laryngologie - otologie - rhinologie}, year = {2008}, volume = {129}, issue = {1}, pages = {3--9}, keywords = {Cholesteatoma, Middle Ear, surgery; Humans; Otologic Surgical Procedures, methods; Semicircular Canals, physiopathology, surgery; Vertigo, physiopathology, surgery}, pmid = {18777763} }
Xie, Y., Sharon, J.D., Pross, S.E., Abt, N.B., Varma, S., Della Santina, C.C., Minor, L.B. and Carey, J.P.	Surgical Complications from Superior Canal Dehiscence Syndrome Repair: Two Decades of Experience. [Abstract] [BibTeX]	2017	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 157(2), pp. 273-280	article	DOI
Abstract: Objective To determine the incidence of surgical complications associated with superior canal dehiscence syndrome (SCDS) repair and identify the demographic, medical, and intraoperative risk factors that are associated with SCDS complications. Study Design Cases series with chart review, including patients who underwent SCDS repair between 1996 and 2015. Setting A tertiary care academic medical center. Subjects and Methods Data were collected from 220 patients, including demographic information, medical comorbidities, prior otologic surgical history, surgical approach, intraoperative findings, and postoperative complications. Relative risk analysis and multivariable logistic regression evaluated the associations between perioperative risk factors and SCDS complications. Results A total of 242 consecutive cases were performed: 95.5% middle fossa and 4.5% transmastoid approach (mean age: 47.8 ± 10.6 years; 54.5% female). Surgical complications were reported in 27 (11.2%) cases; 20 (8.3%) had Clavien-Dindo grade I complications, most commonly benign paroxysmal positional vertigo (n = 11, 4.5%) and profound sensorineural hearing loss (n = 6, 2.5%). Two cases (0.8%) had grade II; 4 cases (1.7%), grade III; and 1 case (0.4%), grade IV complications. In the analysis of comorbidities, only preoperative coagulopathy was significantly associated with increased risk of complications (relative risk = 6.4, P < .01). Following multivariate logistic regression adjusting for demographic covariates, coagulopathy was still associated with increased odds of complications (odds ratio = 15.7, P = .03). There were no significant associations between other risk factors and complications. Conclusion SCDS repair has low rates of adverse events. We observed an incidence of 11.2% complications, most commonly postoperative benign paroxysmal positional vertigo. The risk of nonotologic intracranial complications (1.7%) is low.
BibTeX: @article{Xie2017, author = {Xie, Yanjun and Sharon, Jeffrey D and Pross, Seth E and Abt, Nicholas B and Varma, Sanskriti and Della Santina, Charley C and Minor, Lloyd B and Carey, John P}, title = {Surgical Complications from Superior Canal Dehiscence Syndrome Repair: Two Decades of Experience.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2017}, volume = {157}, issue = {2}, pages = {273--280}, doi = {https://doi.org/10.1177/0194599817706491}, keywords = {Academic Medical Centers; Adult; Benign Paroxysmal Positional Vertigo, etiology; Female; Humans; Incidence; Labyrinth Diseases, surgery; Logistic Models; Male; Middle Aged; Otologic Surgical Procedures, adverse effects, methods; Postoperative Complications, epidemiology; Retrospective Studies; Risk Factors; Semicircular Canals, surgery; complication; middle fossa craniotomy; semicircular canal; superior canal dehiscence syndrome; superior canal dehiscence syndrome repair; transmastoid dehiscence repair}, pmid = {28653553} }
Naples, J.G. and Eisen, M.D.	Surgical management for benign paroxysmal positional vertigo of the superior semicircular canal. [Abstract] [BibTeX]	2015	The Laryngoscope Vol. 125(8), pp. 1965-1967	article	DOI
Abstract: Benign paroxysmal positional vertigo of the superior semicircular canal is a rare form of BPPV. It accounts for 1% to 3% of cases. The characteristic nystagmus is positional, down-beating, with a torsional component elicited by the Dix-Hallpike maneuver. Symptoms of superior semicircular canal BPPV often resolve spontaneously; however, it can be refractory to repositioning maneuvers. Surgical management is described for posterior semicircular canal BPPV. To date, however, there is only one reported case of surgical management for superior semicircular canal BPPV. Here we show video documentation of positional, down-beating nystagmus and describe a case of superior semicircular canal BPPV requiring canal occlusion with successful resolution of symptoms.
BibTeX: @article{Naples2015, author = {Naples, James G and Eisen, Marc D}, title = {Surgical management for benign paroxysmal positional vertigo of the superior semicircular canal.}, journal = {The Laryngoscope}, year = {2015}, volume = {125}, issue = {8}, pages = {1965--1967}, doi = {https://doi.org/10.1002/lary.25123}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis, physiopathology, surgery; Humans; Male; Middle Aged; Nystagmus, Physiologic; Otologic Surgical Procedures, methods; Patient Positioning; Semicircular Canals, physiopathology, surgery; Tomography, X-Ray Computed; BPPV; canal plugging; nystagmus; superior semicircular canal}, pmid = {25583673} }
Sismanis, A.	Surgical management of common peripheral vestibular diseases. [Abstract] [BibTeX]	2010	Current opinion in otolaryngology & head and neck surgery Vol. 18(5), pp. 431-435	article	DOI
Abstract: To review the latest developments in the surgical management of common peripheral vestibular disorders. Although surgery is indicated mainly for patients with Meniere's disease, other less common disorders such as benign paroxysmal positional vertigo, semicircular canal dehiscence, perilymphatic fistulae, fistulae of semicircular canals, VIII nerve vascular compression, chronic vestibular neuronitis, and dizziness following sudden sensorineural hearing loss may require surgical intervention when conservative management has failed. Surgery for vestibular disorders is less often indicated at present. Office-administered intratympanic gentamicin and steroid treatment have been found to be effective for control of vertigo in Meniere's disease. Side-effects of this treatment are overall acceptable. Surgery may be considered for Meniere's disease patients with good hearing who have failed intratympanic steroid treatment. Surgery is indicated for patients with debilitating dizziness associated with benign paroxysmal positional vertigo, semicircular canal dehiscence, vascular loop compression, and perilymphatic fistulae.
BibTeX: @article{Sismanis2010, author = {Sismanis, Aristides}, title = {Surgical management of common peripheral vestibular diseases.}, journal = {Current opinion in otolaryngology & head and neck surgery}, year = {2010}, volume = {18}, issue = {5}, pages = {431--435}, doi = {https://doi.org/10.1097/MOO.0b013e32833de79e}, keywords = {Humans; Vestibular Diseases, surgery}, pmid = {20729736} }
Meyerhoff, W.L.	Surgical section of the posterior ampullary nerve. [Abstract] [BibTeX]	1985	The Laryngoscope Vol. 95(8), pp. 933-935	article
Abstract: Surgical section of the posterior ampullary nerve (PAN) has been used as a form of therapy for persistent benign paroxysmal positional vertigo (BPPV). Eighteen patients were reviewed. The PAN was identified in 16 patients, 15 of whom were completely cured and one of whom had improvement of symptoms. Severe sensorineural hearing loss (SNHL) occurred in three patients. This study suggests that surgical section of the PAN is effective. The procedure is facilitated by a postauricular incision and canalplasty.
BibTeX: @article{Meyerhoff1985, author = {Meyerhoff, W L}, title = {Surgical section of the posterior ampullary nerve.}, journal = {The Laryngoscope}, year = {1985}, volume = {95}, issue = {8}, pages = {933--935}, keywords = {Adult; Aged; Female; Humans; Male; Middle Aged; Neurosurgery; Semicircular Canals, innervation; Vertigo, surgery}, pmid = {4021686} }
Leveque, M., Labrousse, M., Seidermann, L. and Chays, A.	Surgical therapy in intractable benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2007	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 136(5), pp. 693-698	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most frequent vestibular disorder. Although it is easily cured with canal repositioning maneuvers for the majority of patients, it can be disabling in rare cases. For these patients, surgical solutions may be proposed. The aim of this article is to review the techniques used, the reported cases in the literature, and to discuss their indication in intractable BPPV. Literature review. All the articles from 1972 to 2005 that discussed a specific surgical therapy in BPPV were reviewed. Many of them reported cases of operated patients and described original techniques. Some others are anatomic studies that discussed the two techniques used: singular neurectomy and posterior semicircular canal occlusion. Singular neurectomy (posterior ampullary nerve transsection) and posterior semicircular canal occlusion are the 2 specific techniques used in intractable BPPV surgery. The numbers of operated cases are 342 and 97, respectively. These small numbers indicate that the procedures are difficult and risk compromising hearing and that a very small population of patients require surgical treatment of BPPV. The operated cases have been decreasing since the early 1990s because of improved management in BPPV. This article summarizes the techniques and their results and proposes a currently recommended practice of surgical therapy in BPPV as well as new insights into intractable BPPVs' physiopathology.
BibTeX: @article{Leveque2007, author = {Leveque, Marianne and Labrousse, Marc and Seidermann, Laurent and Chays, André}, title = {Surgical therapy in intractable benign paroxysmal positional vertigo.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2007}, volume = {136}, issue = {5}, pages = {693--698}, doi = {https://doi.org/10.1016/j.otohns.2006.04.020}, keywords = {Hearing Loss, Sensorineural, prevention & control; Humans; Otologic Surgical Procedures, methods; Postural Balance, physiology; Semicircular Canals, physiopathology, surgery; Vertigo, physiopathology, surgery; Vestibular Nerve, surgery}, pmid = {17478200} }
Corvera Behar, G. and García de la Cruz, M.A.	Surgical Treatment for Recurrent Benign Paroxysmal Positional Vertigo. [Abstract] [BibTeX]	2017	International archives of otorhinolaryngology Vol. 21(2), pp. 191-194	article	DOI
Abstract: Benign paroxysmal positional vertigo is a generally benign condition that responds to repositioning maneuvers and frequently resolves spontaneously. However, for some patients it can become a disabling condition in which surgery must be considered. Two different surgical techniques exist, singular neurectomy and posterior semicircular canal occlusion. The objective of this study is to review the current status of singular nerve section and posterior semicircular canal occlusion as treatments for intractable benign paroxysmal positional vertigo, and to determine if there are published data available that favors one over the other. MEDLINE and OLDMEDLINE databases of the National Library of Medicine. Four studies regarding singular neurectomy and 14 reports on semicircular canal occlusion were analyzed. Both techniques are reported to provide similar symptomatic benefit, with low risk of hearing loss and balance impairment. However, anatomical and clinical studies of singular neurectomy show it to be a more challenging technique, and considering that it is indicated in a very small number of cases, it may be difficult to master. Both singular neurectomy and semicircular canal occlusion can be safe and effective in those few patients that require surgery for intractable positional vertigo. Although semicircular canal occlusion requires a postauricular transmastoid approach, it is ultimately easier to learn and perform adequately, and thus may be considered the best alternative.
BibTeX: @article{CorveraBehar2017, author = {Corvera Behar, Gonzalo and García de la Cruz, Miguel Alfredo}, title = {Surgical Treatment for Recurrent Benign Paroxysmal Positional Vertigo.}, journal = {International archives of otorhinolaryngology}, year = {2017}, volume = {21}, issue = {2}, pages = {191--194}, doi = {https://doi.org/10.1055/s-0037-1599784}, keywords = {benign paroxysmal positional vertigo; otologic surgical procedures; semicircular canals; vertigo/surgery}, pmid = {28382130} }
Brandt, T., Grill, E., Strupp, M. and Huppert, D.	Susceptibility to Fear of Heights in Bilateral Vestibulopathy and Other Disorders of Vertigo and Balance. [Abstract] [BibTeX]	2018	Frontiers in neurology Vol. 9, pp. 406	article	DOI
Abstract: To determine the susceptibility to visual height intolerance (vHI) in patients with acquired bilateral vestibulopathy (BVP). The question was whether postural instability in BVP, which is partially compensated for by visual substitution of the impaired vestibular control of balance, leads to an increased susceptibility. This is of particular importance since fear of heights is dependent on body posture, and visual control of balance at heights can no longer substitute vestibular input. For comparison susceptibility to vHI was determined in patients with other vestibular or functional disorders. A total of 150 patients aged 18 or above who had been referred to the German Center for Vertigo and Balance Disorders and diagnosed to have BVP were surveyed with a standardized questionnaire by specifically trained neurological professionals. Further, 481 patients with other vestibular or functional disorders were included. Susceptibility to vHI was reported by 29% (32 % in females, 25% in males) of the patients with BVP. Patients with vHI were slightly younger (67 vs. 71 years). Seventy percent of those with vHI reported avoidance of climbing, hiking, stairs, darkness, cycling or swimming (84% of those without vHI). Mean age for onset of vHI was 40 years. Susceptibility to vHI was higher in patients with other vertigo disorders than in those with BVP: 64% in those with phobic postural vertigo, 61% in vestibular migraine, 56% in vestibular paroxysmia, 54% in benign paroxysmal positional vertigo, 49% in unilateral vestibulopathy and 48% in Menière's disease. The susceptibility to vHI in BVP was not higher than that of the general population (28%).This allows two explanations that need not be alternatives but contribute to each other: (1) Patients with a bilateral peripheral vestibular deficit largely avoid exposure to heights because of their postural instability. (2) The irrational anxiety to fall from heights triggers increased susceptibility to vHI, not the objective postural instability. However, patients with BVP do not exhibit increased comorbid anxiety disorders. This view is supported by the significantly increased susceptibility to vHI in other vestibular syndromes, which are characterized by an increased comorbidity of anxiety disorders.
BibTeX: @article{Brandt2018, author = {Brandt, Thomas and Grill, Eva and Strupp, Michael and Huppert, Doreen}, title = {Susceptibility to Fear of Heights in Bilateral Vestibulopathy and Other Disorders of Vertigo and Balance.}, journal = {Frontiers in neurology}, year = {2018}, volume = {9}, pages = {406}, doi = {https://doi.org/10.3389/fneur.2018.00406}, keywords = {Menière's disease; benign paroxysmal positional vertigo; bilateral vestibulopathy; phobic postural vertigo; vestibular migraine; visual height intolerance}, pmid = {29928252} }
Oh, S.-Y., Kim, J.-S., Choi, K.-D., Park, J.-Y., Jeong, S.-H., Lee, S.-H., Lee, H.-S., Yang, T.-H. and Kim, H.-J.	Switch to Semont maneuver is no better than repetition of Epley maneuver in treating refractory BPPV. [Abstract] [BibTeX]	2017	Journal of neurology Vol. 264(9), pp. 1892-1898	article	DOI
Abstract: The objectives of this study is to compare the efficacy between repetition of Epley maneuver and switch to alternate Semont maneuver in treating posterior canal benign paroxysmal positional vertigo (PC-BPPV) that does not respond to the initial Epley maneuver. In the nationwide, seven dizziness clinics of Korea, 506 consecutive patients (303 women, age range 22-87, mean age ± SD = 64 ± 12, median = 61) with idiopathic PC-BPPV were initially treated with a single Epley maneuver. Of those, 144 (28.5%) patients, who did not respond to the therapy, were randomized to the repetition of Epley maneuver (n = 70) or switch to Semont maneuver (n = 74). The therapeutic efficacy was determined within 1 h by a blinded examiner after the trial of each second maneuver. The efficacy did not differ between the repetition of Epley maneuver and switch to Semont maneuver groups (38.6 vs. 27.0%, p = 0.14, Chi-square test). However, the patients with a long duration (p < 0.001, linear regression) and latency (p = 0.01) of the positional nystagmus during Dix-Hallpike maneuver showed a higher rate of the initial and second treatment failures. Either Epley or Semont maneuver may be applied as a second treatment to the patients with PC-BPPV refractory to the initial Epley maneuver. This study provides Class I evidence that repeated Epley and switch to Semont maneuver shows a similar efficacy in treating PC-BPPV that does not respond to the initial Epley maneuver. NCT01822002.
BibTeX: @article{Oh2017, author = {Oh, Sun-Young and Kim, Ji-Soo and Choi, Kwang-Dong and Park, Ji-Yun and Jeong, S-H and Lee, Seung-Han and Lee, Hak-Seung and Yang, Tae-Ho and Kim, H-J}, title = {Switch to Semont maneuver is no better than repetition of Epley maneuver in treating refractory BPPV.}, journal = {Journal of neurology}, year = {2017}, volume = {264}, issue = {9}, pages = {1892--1898}, doi = {https://doi.org/10.1007/s00415-017-8580-2}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, rehabilitation; Double-Blind Method; Female; Humans; Male; Middle Aged; Patient Positioning; Physical Therapy Modalities; Posture; Retrospective Studies; Statistics, Nonparametric; Treatment Outcome; Vestibular Function Tests; Young Adult; BPPV, benign paroxysmal positional vertigo; Double-blind randomized trial; Epley maneuver; Nystagmus; PC-BPPV, BPPV involving the posterior semicircular canal; Semont maneuver; Treatment outcome; Vertigo; Vestibular}, pmid = {28755307} }
Aron, M., Lea, J., Nakku, D. and Westerberg, B.D.	Symptom Resolution Rates of Posttraumatic versus Nontraumatic Benign Paroxysmal Positional Vertigo: A Systematic Review. [Abstract] [BibTeX]	2015	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 153(5), pp. 721-730	article	DOI
Abstract: To determine the rate of symptom resolution in patients with posttraumatic benign paroxysmal positional vertigo (BPPV) and to determine if it differs from resolution rates in patients with BPPV and without a history of head trauma. Systematic review of the literature was performed using Medline, EMBASE, and Cochrane databases. English and French articles meeting inclusion criteria and published between 1946 and October 2014 were included. Data were independently extracted from the articles by 2 reviewers using data collection forms developed a priori. Inclusion and exclusion criteria were decided a priori. Studies were included if they reported on at least 1 case of posttraumatic BPPV (t-BPPV), reported on outcomes of all patients with t-BPPV, had a clearly defined inception point, and provided a clear diagnosis of BPPV (defined a priori by reviewers). A total of 3017 titles, 362 abstracts, and 67 articles were reviewed, from which 16 articles met inclusion criteria and underwent data extraction. There were a total of 207 patients with posttraumatic BPPV identified. Among the 207 patients, 151 (73%) had resolution of symptoms. The T-BPPV patients may have more multi-canal involvement and may require more repositioning maneuvers for resolution compared to patients with nontraumatic BPPV. Available evidence does not support the notion that symptom resolution rates in patients with posttraumatic BPPV are worse than those with nontraumatic BPPV. However, well-designed studies with adequate cohorts are lacking. Additional well-executed studies are needed to confirm this lack of difference in resolution rates.
BibTeX: @article{Aron2015, author = {Aron, Margaret and Lea, Jane and Nakku, Doreen and Westerberg, Brian D}, title = {Symptom Resolution Rates of Posttraumatic versus Nontraumatic Benign Paroxysmal Positional Vertigo: A Systematic Review.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2015}, volume = {153}, issue = {5}, pages = {721--730}, doi = {https://doi.org/10.1177/0194599815594384}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis, etiology, physiopathology; Craniocerebral Trauma, complications; Humans; Patient Positioning; Posture, physiology; Recovery of Function; Semicircular Canals, physiopathology; BPPV; benign paroxysmal positional vertigo; craniocerebral trauma; posttraumatic BPPV; wounds and injuries}, pmid = {26183524} }
Angeli, S.I., Hawley, R. and Gomez, O.	Systematic approach to benign paroxysmal positional vertigo in the elderly. [Abstract] [BibTeX]	2003	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 128(5), pp. 719-725	article	DOI
Abstract: We evaluated the effectiveness of a management approach that combines the canalith repositioning maneuver (CRM) and vestibular rehabilitation (VR) in the treatment of benign positional paroxysmal vertigo (BPPV) in elderly persons. Forty-seven patients (>/=70 years old) with the diagnosis of unilateral posterior semicircular canal BPPV formed the study population. This study has 2 parts. In the first part, patients were randomly assigned to 1 of 2 groups: the CRM and avoidance (no treatment). Patients were evaluated 1 month after the first visit. Those patients not responding to treatment were enrolled in the second part of the study, treated with an individualized combination of CRM and VR, and then reevaluated 3 months later. Statistically significant improvement of vertigo and provoked nystagmus in 64% of patients in the CRM group compared with the no-treatment group. After the addition of VR, 77% of all patients improved. A combination of CRM and VR improves BPPV in the elderly. These findings suggest that although CRM is more effective than no treatment, VR can be added to improve the results in the treatment of BPPV.
BibTeX: @article{Angeli2003, author = {Angeli, Simon I and Hawley, Rose and Gomez, Orlando}, title = {Systematic approach to benign paroxysmal positional vertigo in the elderly.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2003}, volume = {128}, issue = {5}, pages = {719--725}, doi = {https://doi.org/10.1016/S0194-59980300256-0}, keywords = {Aged; Aged, 80 and over; Diagnostic Techniques, Otological; Female; Humans; Male; Prospective Studies; Treatment Outcome; Vertigo, diagnosis, rehabilitation, therapy}, pmid = {12748567} }
van den Broek, E.M.J.M., van der Zaag-Loonen, H.J. and Bruintjes, T.D.	Systematic Review: Efficacy of Gufoni Maneuver for Treatment of Lateral Canal Benign Paroxysmal Positional Vertigo with Geotropic Nystagmus. [Abstract] [BibTeX]	2014	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 150(6), pp. 933-938	article	DOI
Abstract: In this rapid systematic review, we studied the efficacy of the Gufoni maneuver for the treatment of lateral canal benign paroxysmal positional vertigo (BPPV) with geotropic nystagmus. A comprehensive search, including PubMed, Embase, Web of Science, and Cochrane as data sources, resulted in 44 original papers for randomized trials that compared the Gufoni maneuver with other maneuvers (date of search: April 23, 2013). Three studies (389 patients) remained after screening of title, abstract, and full text. After method assessment, 2 of these 3 studies were considered to have a low risk of bias and a high level of validity. The third study did not properly report the treatment allocation and blinding; moreover, outcome data were incomplete. The first 2 studies compared the Gufoni maneuver with a sham maneuver (and the barbecue roll in one study). The third study compared the Gufoni maneuver with a treatment with vestibular suppressants and with the barbecue roll (plus forced prolonged positioning). All 3 studies reported short-term results. Midterm results (1 month) were reported in 2 studies. Given the variety in the comparative treatments and follow-up duration, all 3 studies showed that the Gufoni maneuver was more effective than the sham maneuver or treatment with vestibular suppressants. All agreed that the maneuver was easy to perform, which made it suitable for older, immobile, and obese patients. However, there were insufficient data to establish the relative efficacy of the Gufoni maneuver compared with other maneuvers.
BibTeX: @article{Broek2014, author = {van den Broek, Emke Mechelina Josephina Margo and van der Zaag-Loonen, Hester Josephine and Bruintjes, Tjasse Doewe}, title = {Systematic Review: Efficacy of Gufoni Maneuver for Treatment of Lateral Canal Benign Paroxysmal Positional Vertigo with Geotropic Nystagmus.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2014}, volume = {150}, issue = {6}, pages = {933--938}, doi = {https://doi.org/10.1177/0194599814525919}, keywords = {Benign Paroxysmal Positional Vertigo, complications, therapy; Humans; Musculoskeletal Manipulations; Nystagmus, Pathologic, complications, therapy; Gufoni (liberatory) maneuver; benign paroxysmal positional vertigo; lateral canal}, pmid = {24627409} }
Karatayli-Ozgursoy, S., Lundy, L.B., Zapala, D.A. and Oken, K.R.	Takotsubo cardiomyopathy and canalith repositioning procedure for benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2010	Journal of the American Academy of Audiology Vol. 21(2), pp. 73-7; quiz 139-40	article
Abstract: Takotsubo cardiomyopathy, also known as left ventricular apical ballooning syndrome, ampulla cardiomyopathy, or transient left ventricular dysfunction is characterized by chest pain, electrocardiographic changes, transient left ventricular apical aneurysm, and normal coronary arteries. Takotsubo is a round-bottomed, narrow-necked Japanese octopus trap and lends its name to takotsubo cardiomyopathy because of its resemblance to echocardiographic and ventricular angiographic images of the left ventricle in this condition. This appearance takes its source from peculiar, transient regional systolic dysfunction involving the left ventricular apex and mid-ventricle with hyperkinesis of the basal left ventricular segments. Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo caused by peripheral vestibular dysfunction. The symptoms of BPPV are attributed to intralabyrinthine particles, presumed displaced otoconia. Thus, the treatment recommended for BPPV is head repositioning maneuvers. To present the first takotsubo cardiomyopathy case in the English literature related to BPPV undergoing canalith repositioning procedure. This report will provide additional information for physicians encountering acute-onset chest pain and vertigo. It will also expand the spectrum of clinical correlates of the increasingly well recognized but poorly understood syndrome, takotsubo cardiomyopathy.
BibTeX: @article{Karatayli-Ozgursoy2010, author = {Karatayli-Ozgursoy, Selmin and Lundy, Larry B and Zapala, David A and Oken, Keith R}, title = {Takotsubo cardiomyopathy and canalith repositioning procedure for benign paroxysmal positional vertigo.}, journal = {Journal of the American Academy of Audiology}, year = {2010}, volume = {21}, issue = {2}, pages = {73--7; quiz 139-40}, keywords = {Aged; Diagnosis, Differential; Echocardiography; Electrocardiography; Female; Follow-Up Studies; Humans; Long QT Syndrome, diagnostic imaging, physiopathology; Otolithic Membrane, physiopathology; Risk Factors; Takotsubo Cardiomyopathy, diagnostic imaging, physiopathology; Ventricular Dysfunction, Left, diagnostic imaging, physiopathology; Vertigo, complications, physiopathology, therapy; Vestibular Function Tests}, pmid = {20166309} }
Kaski, D., Buttell, J. and Greenwood, R.	Targeted rehabilitation reduces visual dependency and improves balance in severe traumatic brain injury: a case study. [Abstract] [BibTeX]	2018	Disability and rehabilitation Vol. 40(7), pp. 856-858	article	DOI
Abstract: To further understand the mechanisms underlying gait impairment following traumatic brain injury. A 58-year-old man presented with marked unsteadiness and motion sensitivity following a severe traumatic brain injury. He underwent a 6-week inpatient rehabilitation program focused on re-weighting and subsequently re-integrating ascending interoceptive information, by gradual reduction of maladaptive visual fixation techniques. We report clinical neurological outcomes and measures of functional outcome, as well as an objective assessment of visual dependency (the rod and disk test) at baseline and after the rehabilitation. Clinically, the patient had gait unsteadiness exacerbated by visual motion. A significant reduction in visual dependency occurred with tailored multi-disciplinary rehabilitation via gradual removal of visual fixation strategies that the patient had developed to maintain balance (t-test; p < 0.01), as well as clinical improvements in gait, balance, and functional outcome. We highlight the importance of visual dependency in the generation of maladaptive gait strategies following brain injury. Our data suggest assessing and treating visual dependency to be an important component of gait rehabilitation after traumatic brain injury. Implications for rehabilitation Whilst gait disturbance in TBI is multifactorial, abnormal visual dependency may be important but under-recognised component of the disorder. Visual dependency can be easily and objectively assessed by the bedside in patients using a dynamic rod and disc test. Tailored rehabilitation with gradual reduction of maladaptive visual fixation can reduce visual dependency and contribute to improved gait and balance following TBI.
BibTeX: @article{Kaski2018, author = {Kaski, Diego and Buttell, Joseph and Greenwood, Richard}, title = {Targeted rehabilitation reduces visual dependency and improves balance in severe traumatic brain injury: a case study.}, journal = {Disability and rehabilitation}, year = {2018}, volume = {40}, issue = {7}, pages = {856--858}, doi = {https://doi.org/10.1080/09638288.2016.1276976}, keywords = {Adaptation, Physiological, physiology; Brain Injuries, Traumatic, physiopathology, rehabilitation; Gait Disorders, Neurologic, physiopathology, rehabilitation; Humans; Male; Middle Aged; Physical Therapy Modalities; Postural Balance, physiology; BPPV; Visual dependency; balance; gait; rehabilitation; traumatic brain injury}, pmid = {28112541} }
Jilla, A.M., Roberts, R.A. and Johnson, C.E.	Teaching Patient-Centered Counseling Skills for Assessment, Diagnosis, and Management of Benign Paroxysmal Positional Vertigo. [Abstract] [BibTeX]	2018	Seminars in hearing Vol. 39(1), pp. 52-66	article	DOI
Abstract: Audiologists are an integral part of the management of those with dizziness and vestibular disorders. However, little research has been performed on counseling approaches for patients who present with dizziness as a primary concern. Accordingly, it is important that audiology students are provided with didactic and experiential learning opportunities for the assessment, diagnosis, and management of this population. Benign paroxysmal positional vertigo is the most common vestibular disorder among adults. Doctor of Audiology students, at a minimum, should be provided with learning opportunities for counseling patients with this particular disorder. Implementation of patient-centered counseling is applied across various parts of the patient encounter from initial intake to treatment and patient education. The purpose of this article is to present the available evidence and to apply widely accepted theories and techniques to counseling those with benign paroxysmal positional vertigo. Didactic resources and experiential learning activities are provided for use in coursework or as a supplement to clinical education.
BibTeX: @article{Jilla2018, author = {Jilla, Anna Marie and Roberts, Richard A and Johnson, Carole E}, title = {Teaching Patient-Centered Counseling Skills for Assessment, Diagnosis, and Management of Benign Paroxysmal Positional Vertigo.}, journal = {Seminars in hearing}, year = {2018}, volume = {39}, issue = {1}, pages = {52--66}, doi = {https://doi.org/10.1055/s-0037-1613705}, keywords = {Audiology; benign paroxysmal positional vertigo; counseling; education; teaching}, pmid = {29422713} }
Gacek, R.R.	Technique and results of singular neurectomy for the management of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	1995	Acta oto-laryngologica Vol. 115(2), pp. 154-157	article
Abstract: One hundred thirty-seven patients with chronic disabling paroxysmal positional vertigo were treated surgically with singular neurectomy (SN) during the years 1972-1994. One hundred forty-six SN were performed on these patients. One hundred twenty-eight patients underwent unilateral SN while 9 patients underwent bilateral sequential SN. The patients ranged in age from 25 to 86 years with a mean of 57 years and a female to male ratio of 92: 45. One hundred thirty-eight patients (94%) experienced complete relief of vertigo following SN. Three patients (2%) experienced partial relief of positional vertigo following SN and 5 patients failed to have any improvement of symptoms following SN (4%). A partial sensorineural occurred following SN in 4 patients (3%) in this series. The results indicate that SN is a safe and effective surgical treatment for chronic disabling BPV caused by the posterior semicircular canal.
BibTeX: @article{Gacek1995a, author = {Gacek, R R}, title = {Technique and results of singular neurectomy for the management of benign paroxysmal positional vertigo.}, journal = {Acta oto-laryngologica}, year = {1995}, volume = {115}, issue = {2}, pages = {154--157}, keywords = {Adult; Aged; Cranial Nerves, physiopathology, surgery; Ear, Inner, physiopathology, surgery; Female; Hearing Loss, Sensorineural, etiology; Humans; Male; Middle Aged; Postoperative Complications; Treatment Outcome; Vertigo, physiopathology, surgery}, pmid = {7610793} }
Barratt, H., Bronstein, A.M. and Gresty, M.A.	Testing the vestibular-ocular reflexes: abnormalities of the otolith contribution in patients with neuro-otological disease. [Abstract] [BibTeX]	1987	Journal of neurology, neurosurgery, and psychiatry Vol. 50(8), pp. 1029-1035	article
Abstract: Conventional vestibular rotation testing with the head centered on the axis stimulates the semicircular canals evoking compensatory eye movements. If the head is placed forwards of the axis in an eccentric position the otoliths are also stimulated by a tangential linear acceleration acting laterally to the skull. In normal subjects the additional otolithic stimulus evokes compensatory eye movements with a higher gain than with head centred, particularly for high frequency (greater than 0.1 Hz) stimuli. The responses with head centred and eccentric in various patients with known/suspected neuro-otological abnormalities have been compared. Patients with vestibular neurinectomies who have asymmetrical head centred responses showed greater asymmetry with head eccentric at higher stimulus frequencies. Some patients with cerebellar lesions showed abnormally enhanced or depressed and asymmetrical responses with head eccentric in comparison with head centred responses, which could be normal. The enhancing effects could be specific to low frequency stimuli. All patients who showed abnormal responses with head eccentric also had positional nystagmus provoked by the gravity acceleration vector when the head was tilted laterally. The direction of the positional nystagmus with respect to the gravity vector was not necessarily the same as the direction of the effect on eye movements of lateral acceleration during eccentric oscillation. Patients with benign paroxysmal vertigo or chronic linear vertigo in whom otolithic abnormalities are suspected were not found to have abnormal responses with head eccentric. We conclude that this method of testing may be useful in elucidating pathophysiology but is not a decisive clinical test for the presence of disordered otolith function.
BibTeX: @article{Barratt1987, author = {Barratt, H and Bronstein, A M and Gresty, M A}, title = {Testing the vestibular-ocular reflexes: abnormalities of the otolith contribution in patients with neuro-otological disease.}, journal = {Journal of neurology, neurosurgery, and psychiatry}, year = {1987}, volume = {50}, issue = {8}, pages = {1029--1035}, keywords = {Acceleration; Acoustic Stimulation; Brain Diseases, complications, physiopathology; Electronystagmography, methods; Female; Head, physiology; Humans; Male; Middle Aged; Nystagmus, Physiologic; Otolithic Membrane, physiology; Posture; Reflex, Vestibulo-Ocular; Saccule and Utricle, physiology}, pmid = {3655807} }
Cohen, H.S., Mulavara, A.P., Peters, B.T., Sangi-Haghpeykar, H. and Bloomberg, J.J.	Tests of walking balance for screening vestibular disorders. [Abstract] [BibTeX]	2012	Journal of vestibular research : equilibrium & orientation Vol. 22(2), pp. 95-104	article	DOI
Abstract: Few reliable tests are available for screening people rapidly for vestibular disorders although such tests would be useful for a variety of testing situations. Balance testing is widely performed but of unknown value for screening. The goal of this study was to determine the value of tests of walking balance for screening people with vestibular impairments. We tested three groups of patients with known vestibular impairments: benign paroxysmal positional vertigo, unilateral vestibular weakness, and post-acoustic neuroma resection. We compared them to normal subjects. All subjects were independently ambulatory without gait aids. Subjects were tested on tandem walking (TW) with eyes open and eyes closed for 10 steps, walking with no additional head motions and with augmented head rotations in yaw for 7 m (WwHT), and an obstacle avoidance task, the Functional Mobility Test (FMT). Subjects wore a 3-D motion sensor centered at mid-torso to capture kinematic measures. Patients and normals differed significantly on some behavioral measures, such as the number of steps to perform TW, and on some but not all kinematic measures. ROC analyses, however, were at best only moderate, and failed to find strong differences and cut-points that would differentiate the groups. These findings suggest that although patients and normals differ in performance of these tests in some interesting ways the groups are not sufficiently different on these tests for easy use as screening tests to differentiate the populations.
BibTeX: @article{Cohen2012, author = {Cohen, Helen S and Mulavara, Ajitkumar P and Peters, Brian T and Sangi-Haghpeykar, Haleh and Bloomberg, Jacob J}, title = {Tests of walking balance for screening vestibular disorders.}, journal = {Journal of vestibular research : equilibrium & orientation}, year = {2012}, volume = {22}, issue = {2}, pages = {95--104}, doi = {https://doi.org/10.3233/VES-2012-0443}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo; Diagnostic Techniques, Neurological; Female; Gait; Humans; Male; Middle Aged; Neuroma, Acoustic, diagnosis, physiopathology; Postural Balance; ROC Curve; Vertigo, diagnosis; Vestibular Diseases, diagnosis; Walking}, pmid = {23000609} }
Li, J.C. and Epley, J.	The 360-degree maneuver for treatment of benign positional vertigo. [Abstract] [BibTeX]	2006	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 27(1), pp. 71-77	article
Abstract: The purpose of this study was to determine whether rotating a patient 360 degrees in the plane of the posterior semicircular canal is effective in treating classic benign paroxysmal positional vertigo. The study also compares the features of the Epley maneuver and the Semont maneuver and correlates them to the 360-degree maneuver. A prospective analysis of 31 patients presenting with benign paroxysmal positional vertigo who were treated using the multiaxial positioning device. A questionnaire was administered immediately after each treatment. The study was carried out in a private practice referral clinic for benign paroxysmal positional vertigo. Subjects consisted of 31 adults who ranged in age from 44 to 95 years. Thirty-one patients were treated using the 360-degree maneuver. A multiaxial positioning device was used to rotate patients completely upside down and back into the starting position in the proper plane. Subjective improvement scores, tolerability, objective nystagmus observations, and complications were recorded. Subjective improvement rates were 90% after one treatment; 97% were symptom-free and nystagmus-free after a maximum of three treatment sessions. Eighty-seven percent found the procedure quite tolerable from an ergonomic standpoint. The 360-degree maneuver can be effective in treating benign paroxysmal positional vertigo. Its rate of success is comparable to the rate of success of the standard Epley maneuver. On analysis, it is strikingly similar to the Epley and Semont maneuvers.
BibTeX: @article{Li2006, author = {Li, John C and Epley, John}, title = {The 360-degree maneuver for treatment of benign positional vertigo.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2006}, volume = {27}, issue = {1}, pages = {71--77}, keywords = {Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Posture; Prospective Studies; Surveys and Questionnaires; Treatment Outcome; Vertigo, therapy}, pmid = {16371850} }
Ojala, M. and Palo, J.	The aetiology of dizziness and how to examine a dizzy patient. [Abstract] [BibTeX]	1991	Annals of medicine Vol. 23(3), pp. 225-230	article
Abstract: Dizziness embraces various sensations of spatial disorientation. A common symptom, it has been experienced by at least one third of the population by the age of 65. Peripheral causes include disorders of the labyrinth and vestibular nerve such as Ménière's disease, benign paroxysmal positional vertigo, acute vestibulopathy (vestibular neuronitis) and acoustic neuroma. The most common lesions of the central nervous system that cause dizziness are infratentorial ischaemia, mechanical trauma, multiple sclerosis and cerebellar atrophy. Other aetiological factors include intoxications, psychogenic causes, cervical problems and cardiovascular diseases. The history and physical examination are the cornerstones of the search for the cause of dizziness. The most valuable otological methods are electronystagmography and audiometry. Of the clinical neurophysiological methods, brainstem auditory evoked potentials are more useful than electroencephalography. Computed tomography and magnetic resonance imaging should be used when a CNS disorder is suspected.
BibTeX: @article{Ojala1991, author = {Ojala, M and Palo, J}, title = {The aetiology of dizziness and how to examine a dizzy patient.}, journal = {Annals of medicine}, year = {1991}, volume = {23}, issue = {3}, pages = {225--230}, keywords = {Dizziness, diagnosis, etiology, physiopathology; Humans}, pmid = {1930912} }
Papi, G., Guidetti, G., Corsello, S.M., Di Donato, C. and Pontecorvi, A.	The association between benign paroxysmal positional vertigo and autoimmune chronic thyroiditis is not related to thyroid status. [BibTeX]	2010	Thyroid : official journal of the American Thyroid Association Vol. 20(2), pp. 237-238	article	DOI
BibTeX: @article{Papi2010, author = {Papi, Giampaolo and Guidetti, Giorgio and Corsello, Salvatore Maria and Di Donato, Carlo and Pontecorvi, Alfredo}, title = {The association between benign paroxysmal positional vertigo and autoimmune chronic thyroiditis is not related to thyroid status.}, journal = {Thyroid : official journal of the American Thyroid Association}, year = {2010}, volume = {20}, issue = {2}, pages = {237--238}, doi = {https://doi.org/10.1089/thy.2009.0319}, keywords = {Antigen-Antibody Complex, adverse effects; Ear, Inner, metabolism; Hashimoto Disease, blood; Humans; Labyrinth Diseases, immunology; Thyroid Gland, immunology; Thyroiditis, Autoimmune, complications; Vasculitis, immunology; Vertigo, etiology}, pmid = {20151837} }
Gofrit, S.G., Mayler, Y., Eliashar, R., Bdolah-Abram, T., Ilan, O. and Gross, M.	The Association Between Vestibular Physical Examination, Vertigo Questionnaires, and the Electronystagmography in Patients With Vestibular Symptoms. [Abstract] [BibTeX]	2017	The Annals of otology, rhinology, and laryngology Vol. 126(4), pp. 315-321	article	DOI
Abstract: Dizziness makes up a diagnostic and treatment challenge. The diagnostic accuracy of the medical history and vestibular physical examination in cases of vestibular symptoms is not clear. The aim of this study is to determine the association between vestibular physical examination, vestibular questionnaires, and electronystagmography (ENG) test in patients with vestibular symptoms. This is a prospective study of 135 adults with vestibular symptoms. The subjects underwent targeted physical examination and filled vestibular questionnaires, including the Dizziness Handicap Inventory (DHI), before ENG testing. The results of the physical examination and questionnaires were compared with the final ENG findings. Of patients who had normal ENG results, 32.1% (17/52) showed abnormal physical examination, and 48.8% (40/82) of the patient who had normal physical examination showed abnormal ENG results ( P = .46). Among patients with severe disability by DHI, 46.4% (13/28) had an abnormal ENG, and 42.9% (12/28) had a normal ENG ( P = .39). This study did not demonstrate association between vestibular physical examination, vestibular questionnaires, and ENG results. Although history (augmented by questionnaires) and physical examination are the initial steps in the evaluation of vertigo, the current study suggests that they should be complemented by objective testing for evaluation of inner ear origin of vertigo.
BibTeX: @article{Gofrit2017, author = {Gofrit, Shany G and Mayler, Yulia and Eliashar, Ron and Bdolah-Abram, Tali and Ilan, Ophir and Gross, Menachem}, title = {The Association Between Vestibular Physical Examination, Vertigo Questionnaires, and the Electronystagmography in Patients With Vestibular Symptoms.}, journal = {The Annals of otology, rhinology, and laryngology}, year = {2017}, volume = {126}, issue = {4}, pages = {315--321}, doi = {https://doi.org/10.1177/0003489417691298}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, diagnosis, physiopathology; Caloric Tests; Electronystagmography; Female; Humans; Male; Middle Aged; Physical Examination; Prospective Studies; Surveys and Questionnaires; Vertigo, diagnosis, physiopathology; Vestibular Diseases, diagnosis, physiopathology; Vestibular Function Tests; Young Adult; dizziness handicap inventory; questionnaires; vertigo; vestibular function tests}, pmid = {28290231} }
Dlugaiczyk, J., Thiemer, M., Neubert, C., Schorn, B.A. and Schick, B.	The aVOR App Increases Medical Students' Competence in Treating Benign Paroxysmal Positional Vertigo (BPPV). [Abstract] [BibTeX]	2018	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 39(5), pp. e401-e406	article	DOI
Abstract: Implementation of the "aVOR app" into teaching courses at medical school enhances students' satisfaction with the course and increases their competence in treating benign paroxysmal positional vertigo (BPPV). BPPV is often underdiagnosed and left untreated. One problem in teaching the management of BPPV to health care professionals is the lack of simulation-based training tools. The aVOR app (aVOR = angular vestibulo-ocular reflex) works as a bionic labyrinth that simulates the activation of the semicircular canals by rotational acceleration and the resulting vestibular evoked eye movements. In this prospective, randomized, controlled study, medical students at a university hospital were randomly assigned to two kinds of small instructional groups. Students of the control group (n = 67) practiced diagnostic and therapeutic maneuvers for BPPV on each other, while the participants of the study group (n = 46) used the aVOR app as a virtual patient in addition. At the end of the term, students were asked to arrange the steps of the canalith repositioning procedure in the correct order in a written test. Quality of the teaching media was rated significantly better in the aVOR group (two-sided Mann-Whitney test: P < 0.00001). Significantly more students of the aVOR group than the control group arranged the steps of the canalith repositioning procedure correctly in the final exam (56.3% versus 25.9%, Fisher's exact test: P = 0.006). Implementation of the aVOR app as a virtual patient into small instructional courses is well adopted by medical students and increases their competence in treating BPPV.
BibTeX: @article{Dlugaiczyk2018, author = {Dlugaiczyk, Julia and Thiemer, Michael and Neubert, Christian and Schorn, Bianca Anna and Schick, Bernhard}, title = {The aVOR App Increases Medical Students' Competence in Treating Benign Paroxysmal Positional Vertigo (BPPV).}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2018}, volume = {39}, issue = {5}, pages = {e401--e406}, doi = {https://doi.org/10.1097/MAO.0000000000001778}, pmid = {29579015} }
Benecke, H., Agus, S., Kuessner, D., Goodall, G. and Strupp, M.	The Burden and Impact of Vertigo: Findings from the REVERT Patient Registry. [Abstract] [BibTeX]	2013	Frontiers in neurology Vol. 4, pp. 136	article	DOI
Abstract: Despite the high prevalence of vertigo globally and an acknowledged, but under-reported, effect on an individual's wellbeing, few studies have evaluated the burden on healthcare systems and society. This study was aimed to quantitatively determine the impact of vertigo on healthcare resource use and work productivity. The economic burden of vertigo was assessed through a multi-country, non-interventional, observational registry of vertigo patients: the Registry to Evaluate the Burden of Disease in Vertigo. Patients included were those with a new diagnosis of Meniere's disease, benign paroxysmal positional vertigo, other vertigo of peripheral vestibular origin, or peripheral vestibular vertigo of unknown origin. A total of 4,294 patients at 618 centers in 13 countries were included during the registry. Of the 4,105 patients analyzed, only half were in employment. Among this working patient population, 69.8% had reduced their workload, 63.3% had lost working days, and 4.6% had changed and 5.7% had quit their jobs, due to vertigo symptoms. Use of healthcare services among patients was high. In the 3 months preceding Visit 1, patients used emergency services 0.4 ± 0.9 times, primary care consultations 1.6 ± 1.8 times, and specialist consultations 1.4 ± 2.0 times (all mean ± SD). A mean of 2.0 ± 5.4 days/patient was also spent in hospital due to vertigo. In addition to the negative impact on the patient from a humanistic perspective, vertigo has considerable impact on work productivity and healthcare resource use.
BibTeX: @article{Benecke2013, author = {Benecke, Heike and Agus, Sam and Kuessner, Daniel and Goodall, Gordon and Strupp, Michael}, title = {The Burden and Impact of Vertigo: Findings from the REVERT Patient Registry.}, journal = {Frontiers in neurology}, year = {2013}, volume = {4}, pages = {136}, doi = {https://doi.org/10.3389/fneur.2013.00136}, keywords = {Meniere’s disease; economic burden; healthcare resource; registry; vertigo}, pmid = {24106487} }
Dal, T., Ozlüoğlu, L.N. and Ergin, N.T.	The canalith repositioning maneuver in patients with benign positional vertigo. [Abstract] [BibTeX]	2000	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 257(3), pp. 133-136	article
Abstract: The canalith repositioning maneuver (CRM), as defined by Epley, can be an effective treatment for benign paroxysmal positional vertigo (BPPV). The staff at Başkent University's Ear Nose and Throat Clinic performed CRM on 68 cases of canalithiasis in 64 BPPV patients from June 1996 to August 1997. Symptoms resolved after the first session in 49 patients (72%) and after the second session in 11 cases (16.2%). It was necessary to repeat the maneuver three times in two cases (2.9%) and four times in one patient (1.5%). Discounting three patients who were lost to follow-up, only two patients in our study did not respond to CRM treatment. There was no co-existing pathology found in all but two of the patients studied. Our experience indicates that unless there is no response to CRM or there is suspicion of an incorrect diagnosis, it is not necessary to perform diagnostic studies routinely for differentiating other neuro-otologic disorders prior to using CRM in BPPV patients diagnosed by the Dix-Hallpike test.
BibTeX: @article{Dal2000, author = {Dal, T and Ozlüoğlu, L N and Ergin, N T}, title = {The canalith repositioning maneuver in patients with benign positional vertigo.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2000}, volume = {257}, issue = {3}, pages = {133--136}, keywords = {Adult; Aged; Aged, 80 and over; Female; Follow-Up Studies; Head Movements, physiology; Humans; Male; Meniere Disease, physiopathology, therapy; Middle Aged; Otolithic Membrane, physiopathology; Posture, physiology; Treatment Outcome}, pmid = {10839485} }
Woodworth, B.A., Gillespie, M.B. and Lambert, P.R.	The canalith repositioning procedure for benign positional vertigo: a meta-analysis. [Abstract] [BibTeX]	2004	The Laryngoscope Vol. 114(7), pp. 1143-1146	article	DOI
Abstract: To review the effectiveness of the canalith repositioning procedure (CRP) in the treatment of benign paroxysmal positional vertigo (BPPV) with a critical review of the literature and meta-analysis. Meta-analysis. Studies eligible for inclusion were randomized, controlled trials of the CRP performed on clearly defined cases of BPPV. A total of nine studies meeting inclusion criteria were identified by two independent literature searches of Medline. Treatment and control groups were compared for symptom resolution and elimination of a positive Dix-Hallpike test. Patients treated with CRP were more likely to demonstrate symptom resolution (odds ratio [OR] 4.6; 95% confidence interval [CI] 2.8-7.6) and negative Dix-Hallpike (OR 5.2; 95% CI 3.0-8.8) at the time of first follow-up. The effect of CRP for symptom improvement was strongest within the first month after treatment (OR 4.1; 95% CI 3.1-5.2) with some decline thereafter (OR 2.8; 95% CI 1.7-3.9). Conversely, the ability of CRP to produce a negative Dix-Hallpike strengthened between the first month after treatment (OR 3.0; 95% CI 1.8-4.0) and later follow-up times (OR 5.0; 95% CI 3.9-6.1). The CRP is more effective than control in resolving vertigo and positive Dix-Hallpike associated with BPPV. This finding was consistent among a variety of studies using different study designs. Untreated patients may demonstrate symptom improvement with time; however, many will continue to have a positive Dix-Hallpike when examined. Resolution of vertigo in untreated patients is therefore most likely because of avoidance of provocative positions.
BibTeX: @article{Woodworth2004, author = {Woodworth, Bradford Alan and Gillespie, M Boyd and Lambert, Paul R}, title = {The canalith repositioning procedure for benign positional vertigo: a meta-analysis.}, journal = {The Laryngoscope}, year = {2004}, volume = {114}, issue = {7}, pages = {1143--1146}, doi = {https://doi.org/10.1097/00005537-200407000-00002}, keywords = {Humans; Posture; Randomized Controlled Trials as Topic; Semicircular Canals, physiopathology; Vertigo, physiopathology, therapy}, pmid = {15235337} }
Froehling, D.A., Bowen, J.M., Mohr, D.N., Brey, R.H., Beatty, C.W., Wollan, P.C. and Silverstein, M.D.	The canalith repositioning procedure for the treatment of benign paroxysmal positional vertigo: a randomized controlled trial. [Abstract] [BibTeX]	2000	Mayo Clinic proceedings Vol. 75(7), pp. 695-700	article	DOI
Abstract: To compare the canalith repositioning procedure (CRP) with a sham maneuver for the treatment of benign paroxysmal positional vertigo. We recruited 50 patients with a history of positional vertigo and unilateral positional nystagmus on physical examination (Dix-Hallpike maneuver). Patients were randomized to either the CRP (n = 24) or a sham maneuver (n = 26). Measured outcomes included resolution of vertigo and positional nystagmus at follow-up examination. The mean duration of follow-up was 10 days for both groups. Resolution of symptoms was reported by 12 (50%) of the 24 patients in the CRP group and by 5 (19%) of the 26 patients in the sham group (P = .02). The results of the Dix-Hallpike maneuver were negative for positional nystagmus in 16 (67%) of 24 patients in the CRP group and in 10 (38%) of 26 patients in the sham group (P = .046). The CRP is effective treatment of benign paroxysmal positional vertigo, and this procedure can be performed by general internists on outpatients with this disorder.
BibTeX: @article{Froehling2000, author = {Froehling, D A and Bowen, J M and Mohr, D N and Brey, R H and Beatty, C W and Wollan, P C and Silverstein, M D}, title = {The canalith repositioning procedure for the treatment of benign paroxysmal positional vertigo: a randomized controlled trial.}, journal = {Mayo Clinic proceedings}, year = {2000}, volume = {75}, issue = {7}, pages = {695--700}, doi = {https://doi.org/10.4065/75.7.695}, keywords = {Chi-Square Distribution; Female; Follow-Up Studies; Head Movements; Humans; Logistic Models; Male; Middle Aged; Nystagmus, Pathologic, therapy; Otolithic Membrane, pathology; Posture; Saccule and Utricle, pathology; Semicircular Canals, pathology; Treatment Outcome; Vertigo, therapy}, pmid = {10907384} }
Ruckenstein, M.J. and Shepard, N.T.	The canalith repositioning procedure with and without mastoid oscillation for the treatment of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2007	ORL; journal for oto-rhino-laryngology and its related specialties Vol. 69(5), pp. 295-298	article	DOI
Abstract: To evaluate the efficacy of mastoid oscillation performed with a canalith repositioning procedure (CRP) for the treatment of benign paroxysmal positional vertigo (BPPV). A total of 137 patients with posterior canal BPPV were treated with an Epley CRP with or without mastoid oscillation at a tertiary care, university-based balance center. Data were collected prospectively from all patients via a preprinted diary which they maintained for 14 days after the maneuver. Patients underwent office evaluation at 2 weeks after the maneuver. A total of 137 patients were divided equally between the treatment groups. At 48 h post-treatment, 61% (with vibration) and 64% (without vibration) of patients were free of vertigo. At 2 weeks' post-treatment, 74% (with vibration) and 85% (without vibration) were vertigo-free. Residual symptoms of lightheadedness/imbalance were experienced by 32% of patients with vibration and 40% of patients without vibration. None of these differences between groups were statistically significant. The addition of mastoid oscillation to the positioning maneuver does not add any therapeutic benefit.
BibTeX: @article{Ruckenstein2007, author = {Ruckenstein, Michael J and Shepard, Neil T}, title = {The canalith repositioning procedure with and without mastoid oscillation for the treatment of benign paroxysmal positional vertigo.}, journal = {ORL; journal for oto-rhino-laryngology and its related specialties}, year = {2007}, volume = {69}, issue = {5}, pages = {295--298}, doi = {https://doi.org/10.1159/000105265}, keywords = {Ear Canal, pathology; Ear Diseases, complications, pathology; Female; Humans; Lithiasis, complications, pathology; Male; Mastoid, physiopathology; Posture; Prospective Studies; Vertigo, etiology, therapy; Vibration}, pmid = {17622794} }
Epley, J.M.	The canalith repositioning procedure: for treatment of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	1992	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 107(3), pp. 399-404	article	DOI
Abstract: The Canalith Repositioning Procedure (CRP) is designed to treat benign paroxysmal positional vertigo (BPPV) through induced out-migration of free-moving pathological densities in the endolymph of a semicircular canal, using timed head maneuvers and applied vibration. This article describes the procedure and its rationale, and reports the results in 30 patients who exhibited the classic nystagmus of BPPV with Hallpike maneuvers. CRP obtained timely resolution of the nystagmus and positional vertigo in 100%. Of these, 10% continued to have atypical symptoms, suggesting concomitant pathology; 30% experienced one or more recurrences, but responded well to retreatment with CRP. These results also support an alternative theory that the densities that impart gravity-sensitivity to a semicircular canal in BPPV are free in the canal, rather than attached to the cupula. CRP offers significant advantages over invasive and other noninvasive treatment modalities in current use.
BibTeX: @article{Epley1992, author = {Epley, J M}, title = {The canalith repositioning procedure: for treatment of benign paroxysmal positional vertigo.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {1992}, volume = {107}, issue = {3}, pages = {399--404}, doi = {https://doi.org/10.1177/019459989210700310}, keywords = {Adult; Aged; Aged, 80 and over; Calculi, complications, therapy; Endolymph; Female; Follow-Up Studies; Humans; Labyrinth Diseases, complications, therapy; Male; Middle Aged; Nystagmus, Pathologic, etiology, therapy; Posture; Recurrence; Semicircular Canals, pathology; Vertigo, etiology, therapy; Vibration}, pmid = {1408225} }
Sargent, E.W.	The challenge of vestibular migraine. [Abstract] [BibTeX]	2013	Current opinion in otolaryngology & head and neck surgery Vol. 21(5), pp. 473-479	article	DOI
Abstract: Migraine is a common illness and migraine-related dizziness occurs in up to 3% of the population. Because the diagnosis is controversial and may be difficult, many patients go undiagnosed and untreated. This review summarizes current understanding of the taxonomy and diagnosis of vestibular migraine, the relation of vestibular migraine to labyrinthine disease, and the treatment of the condition in adults and children. The categories of migraine accepted by the International Headache Society do not reflect the complex presentations of patients suspected of having vestibular migraine. In clinical practice and research, criteria are increasingly accepted that divide patients suspected of vestibular migraine into 'definite vestibular migraine' and 'probable vestibular migraine.' Because vertigo itself may trigger migraine, patients with vestibular migraine should be suspected of having vestibular end-organ disease until proven otherwise. Treatment remains controversial because of a notable lack of randomized controlled studies of vestibular migraine treatment. For now, the best strategy for the treatment of suspected vestibular migraine patients is dietary/lifestyle modification, antinausea/antiemetics for acute vertigo, and preventive medication for patients who have continued disruptive symptoms. Patients with vestibular migraine should be monitored regularly for the development of latent audiovestibular end-organ disease.
BibTeX: @article{Sargent2013, author = {Sargent, Eric W}, title = {The challenge of vestibular migraine.}, journal = {Current opinion in otolaryngology & head and neck surgery}, year = {2013}, volume = {21}, issue = {5}, pages = {473--479}, doi = {https://doi.org/10.1097/MOO.0b013e3283648682}, keywords = {Anticonvulsants, therapeutic use; Benign Paroxysmal Positional Vertigo; Diagnosis, Differential; Diet; Fructose, analogs & derivatives, therapeutic use; Humans; Life Style; Meniere Disease, diagnosis, physiopathology; Migraine Disorders, diagnosis, physiopathology; Topiramate; Vertigo, diagnosis}, pmid = {23892794} }
Plodpai, Y., Atchariyasathian, V. and Khaimook, W.	The characteristic differences of benign paroxysmal positional vertigo among the elderly and the younger patients: A 10-year retrospective review. [Abstract] [BibTeX]	2014	Journal of the Medical Association of Thailand = Chotmaihet thangphaet Vol. 97(8), pp. 850-855	article
Abstract: To compare the clinical characteristics of benign paroxysmal positional vertigo (BPPV) between the elderly and the younger patients. The medical records of BPPV patients with positive testing result on the Dix-Hallpike or supine roll test between January 2002 and December 2012 at Songklanagarind hospital, Thailand were retrospectively reviewed. Of the 951 BPPV patients, 595 patients were in the younger group (age < or =60-year-old, mean age = 46.9+/-8.9 years) and 356 patients were in the elderly group (age >60-year-old, mean age = 69.3+/-6. 7years). The most common etiology of BPPV was idiopathic. No significant difference was found regarding gender and semicircular canals that were involved in both groups. The most involved semicircular canal was the posterior canal. The most common described symptom of BPPV was vertigo. Patients in the elderly group were less likely to describe vertigo as the presenting symptom of BPPV compared to those in the younger group (OR = 0.22; 95% CI, 0. 12-0.41; p< 0. 001). The elderly group usually complained of imbalance and dizziness (OR = 15.83; 95% CI, 8.7-28.8; p<0. 001 and OR = 10.12; 95% CI, 5.23-19.59; p<0. 001, respectively). The duration of the symptom before diagnosis was longer in the elderly, when compared to the younger group (30 days, median; IQR = 7, 61 versus 5 days, median; IQR = 2, 7), respectively (p<0. 001). The ability to describe the trigger event precisely was less in the elderly group (63.8% versus 82.2%, p<0.001). The elderly group significantly underwent brain imaging studies more than the younger group (8.4% versus 3.5%, p = 0.02). Outcome of the treatment after the repositioning procedure was comparable in both groups (p = 0.58). Approximately 80% of patients in both groups had complete recovery from BPPV during their last visit. Dizziness and imbalance were the common presenting symptoms of BPPV in the elderly. The younger patients tended to describe the classic symptom of vertigo that was specific to BPPV more precisely than the elderly. These may contribute to underestimate BPPV, do unnecessary brain imaging study, and take more time to get the correct diagnosis of BPP V among elderly patients.
BibTeX: @article{Plodpai2014, author = {Plodpai, Yuvatiya and Atchariyasathian, Viraporn and Khaimook, Wandee}, title = {The characteristic differences of benign paroxysmal positional vertigo among the elderly and the younger patients: A 10-year retrospective review.}, journal = {Journal of the Medical Association of Thailand = Chotmaihet thangphaet}, year = {2014}, volume = {97}, issue = {8}, pages = {850--855}, keywords = {Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, physiopathology; Child; Female; Humans; Male; Middle Aged; Retrospective Studies; Semicircular Canals, physiopathology; Thailand; Vertigo, etiology; Young Adult}, pmid = {25345261} }
Nelson, J.A. and Viirre, E.	The clinical differentiation of cerebellar infarction from common vertigo syndromes. [Abstract] [BibTeX]	2009	The western journal of emergency medicine Vol. 10(4), pp. 273-277	article
Abstract: This article summarizes the emergency department approach to diagnosing cerebellar infarction in the patient presenting with vertigo. Vertigo is defined and identification of a vertigo syndrome is discussed. The differentiation of common vertigo syndromes such as benign paroxysmal positional vertigo, Meniere's disease, migrainous vertigo, and vestibular neuritis is summarized. Confirmation of a peripheral vertigo syndrome substantially lowers the likelihood of cerebellar infarction, as do indicators of a peripheral disorder such as an abnormal head impulse test. Approximately 10% of patients with cerebellar infarction present with vertigo and no localizing neurologic deficits. The majority of these may have other signs of central vertigo, specifically direction-changing nystagmus and severe ataxia.
BibTeX: @article{Nelson2009, author = {Nelson, James A and Viirre, Erik}, title = {The clinical differentiation of cerebellar infarction from common vertigo syndromes.}, journal = {The western journal of emergency medicine}, year = {2009}, volume = {10}, issue = {4}, pages = {273--277}, pmid = {20046249} }
Sreenivasan, A., Sivaraman, G., Parida, P.K., Alexander, A., Saxena, S.K. and Suria, G.	The Clinical Utility of Vestibular Evoked Myogenic Potentials in Patients of Benign Paroxysmal Positional Vertigo. [Abstract] [BibTeX]	2015	Journal of clinical and diagnostic research : JCDR Vol. 9(6), pp. MC01-MC03	article	DOI
Abstract: Vestibular Evoked Myogenic Potentials (VEMP) is an emerging tool to diagnose Benign Paroxysmal Positional Vertigo (BPPV). The clinical utility of VEMP has been reported only in small accord in Indian literature. To study the latency and amplitude of VEMP in patients with BPPV and compare it with that of normal subjects. The study included two groups. Group one (control group) were 18 normal subjects. Group two (test group) were 15 subjects with unilateral BPPV. Those subjects who fulfilled the selection criteria based on case history and audiological assessment were taken for the VEMP recording. The VEMP response consist of positive and negative successive waves (pI-nI), with latency values in adults about 13 and 23 milliseconds respectively. Data was analysed using Statistical Package for Social Sciences (SPSS) version 12 (Chicago, IL, USA). Unpaired t-test was employed to measure the statistical difference between control group and test group. The difference in n23 and the peak to peak amplitude between the ipsilateral and contralateral ears of the test group were statistically significant, whereas such a difference in the p13 latency turned out to be statistically insignificant. It should be noted that, out of 15 patients in the test group, five patients showed only artifact tracer recordings in both the ears which is considered as no response. The heterogeneity of the results extended from absence of VEMP to prolongation of both p13, n23; prolongation of p13 alone; and even side to side variations. Absent response from the ipsilateral ear, prolonged latency of n23 and decreased peak to peak amplitude (p13, n23), indicates the disease pathology. However, large sample size is required to draw further conclusions and to consolidate the usage of VEMP in the diagnosis of BPPV.
BibTeX: @article{Sreenivasan2015, author = {Sreenivasan, Anuprasad and Sivaraman, Ganesan and Parida, Pradiptata Kumar and Alexander, Arun and Saxena, Sunil Kumar and Suria, Gopalakrishnan}, title = {The Clinical Utility of Vestibular Evoked Myogenic Potentials in Patients of Benign Paroxysmal Positional Vertigo.}, journal = {Journal of clinical and diagnostic research : JCDR}, year = {2015}, volume = {9}, issue = {6}, pages = {MC01--MC03}, doi = {https://doi.org/10.7860/JCDR/2015/9953.6058}, keywords = {Amplitude; Latency; n23 p13}, pmid = {26266140} }
Kutz, J.W.	The dizzy patient. [Abstract] [BibTeX]	2010	The Medical clinics of North America Vol. 94(5), pp. 989-1002	article	DOI
Abstract: The dizzy patient often presents a challenge to the physician. The history is the most important component of the evaluation of the dizzy patient and often allows the cause of the dizziness to be categorized as peripheral or central. Peripheral causes include benign paroxysmal positional vertigo, Meniere's disease, and vestibular neuritis. Central causes include migraine-associated dizziness, postconcussion syndromes, cerebrovascular disease, and multiple sclerosis. Treatment depends on the cause of the dizziness and may include dietary modifications, diuretics, vestibular suppressants, vestibular rehabilitation, or surgical intervention.
BibTeX: @article{Kutz2010, author = {Kutz, Joe Walter}, title = {The dizzy patient.}, journal = {The Medical clinics of North America}, year = {2010}, volume = {94}, issue = {5}, pages = {989--1002}, doi = {https://doi.org/10.1016/j.mcna.2010.05.011}, keywords = {Dizziness, diagnosis, physiopathology; Humans; Magnetic Resonance Imaging; Physical Examination, methods; Tomography, X-Ray Computed; Vertigo, diagnosis, physiopathology}, pmid = {20736108} }
Bromwich, M.A. and Parnes, L.S.	The DizzyFix: initial results of a new dynamic visual device for the home treatment of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2008	Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale Vol. 37(3), pp. 380-387	article
Abstract: To develop and test a completely new dynamic visual device for the home treatment of benign paroxysmal positional vertigo (BPPV). Randomized, controlled, prospective trial. Tertiary care hospital. We designed and manufactured a new device (the DizzyFix) to assist in the performance of the particle repositioning manoeuvre (PRM). Fifty healthy volunteers were taught the PRM, half using the new device. At 1 week, we compared the PRM performance between the device and nondevice user groups. Performance of the PRM as graded on an 11-point scale. DizzyFix users in phase I scored significantly higher on their PRM performance compared with controls (p = .0001). The use of this new device enables volunteers to conduct a correct PRM on their own. This is a significant improvement from written instructions or in-office training.
BibTeX: @article{Bromwich2008, author = {Bromwich, Matthew A and Parnes, Lorne S}, title = {The DizzyFix: initial results of a new dynamic visual device for the home treatment of benign paroxysmal positional vertigo.}, journal = {Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale}, year = {2008}, volume = {37}, issue = {3}, pages = {380--387}, keywords = {Adult; Cross-Over Studies; Double-Blind Method; Equipment Design; Female; Home Care Services, Hospital-Based; Humans; Male; Middle Aged; Outpatients; Photic Stimulation, instrumentation; Postural Balance, physiology; Prospective Studies; Semicircular Canals, physiopathology; Treatment Outcome; Vertigo, physiopathology, therapy; Young Adult}, pmid = {19128643} }
Kim, Y.K., Shin, J.E. and Chung, J.W.	The effect of canalith repositioning for anterior semicircular canal canalithiasis. [Abstract] [BibTeX]	2005	ORL; journal for oto-rhino-laryngology and its related specialties Vol. 67(1), pp. 56-60	article	DOI
Abstract: The purpose of this study was to evaluate the efficacy of our canalith repositioning procedure (CRP) for benign paroxysmal positional vertigo (BPPV) of the anterior semicircular canal (ASC). We conducted a prospective study of 30 ASC BPPV patients to analyze the efficacy of a modified CRP. When the patient was diagnosed as having ASC BPPV by a specific provocative positioning test, a CRP was performed. The response to the treatment was categorized as grade I-IV. Of the 30 study patients, 6 were male and 24 were female with the highest incidence when the patients were in their 50s. The vertigo and nystagmus in 29 patients fully resolved (grade I). Using this maneuver, 96.7% of patients became symptom free. Overall, the maneuver needed to be performed 1.97 times to control the symptoms. Based on these findings, CRP could be one of the most effective treatment methods for ASC BPPV.
BibTeX: @article{Kim2005, author = {Kim, Yoon Kyung and Shin, Jeong Eun and Chung, Jong Woo}, title = {The effect of canalith repositioning for anterior semicircular canal canalithiasis.}, journal = {ORL; journal for oto-rhino-laryngology and its related specialties}, year = {2005}, volume = {67}, issue = {1}, pages = {56--60}, doi = {https://doi.org/10.1159/000084336}, keywords = {Adult; Calcinosis, complications, pathology, surgery; Female; Humans; Male; Middle Aged; Nystagmus, Physiologic, physiology; Otologic Surgical Procedures, methods; Prospective Studies; Semicircular Canals, pathology, surgery; Vertigo, etiology}, pmid = {15761244} }
Do, Y.-K., Kim, J., Park, C.Y., Chung, M.-H., Moon, I.S. and Yang, H.-S.	The effect of early canalith repositioning on benign paroxysmal positional vertigo on recurrence. [Abstract] [BibTeX]	2011	Clinical and experimental otorhinolaryngology Vol. 4(3), pp. 113-117	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) can be treated using a simple repositioning maneuver. This study demonstrates the effects of early repositioning therapy in patients with BPPV, especially with regard to recurrence. We enrolled 138 consecutive patients who had been diagnosed with BPPV in the emergency rooms and ENT out-patient clinics of Chung-Ang University Hospital and Samyook Medical Center from January to June 2009. All patients immediately underwent appropriate canalith repositioning procedures (CRPs) depending on canalith type and location. The CRPs were performed daily until the patient's symptoms were resolved. The patients were classified into two groups according to the duration between symptom onset and initial treatment: less than 24 hours (early repositioning group, n=66) and greater 24 hours (delayed repositioning group, n=72). We prospectively compared the numbers of treatments received and the recurrence rates between the two groups. Follow-up periods ranged from 8 to 14 months, 77 cases involved posterior canal BPPV, 48 cases were lateral canal BPPV (of which 20 cases were cupulolithiasis), and 13 cases were multiple canal BPPV. BPPV recurrence was found in a total of 46 patients (33.3%). The necessary numbers of CRPs were 2.3 for the early repositioning group and 2.5 for the late repositioning group, a difference that was not statistically significant (P=0.582). The early repositioning group showed a recurrence rate of 19.7%, and the delayed repositioning group showed a recurrence rate of 45.8% (P=0.002). Performing repositioning treatments as soon as possible after symptom onset may be an important factor in the prevention of BPVV recurrence.
BibTeX: @article{Do2011, author = {Do, Youn-Kyoung and Kim, Jin and Park, Chong Yoon and Chung, Myung-Hyun and Moon, In Seok and Yang, Hoon-Shik}, title = {The effect of early canalith repositioning on benign paroxysmal positional vertigo on recurrence.}, journal = {Clinical and experimental otorhinolaryngology}, year = {2011}, volume = {4}, issue = {3}, pages = {113--117}, doi = {https://doi.org/10.3342/ceo.2011.4.3.113}, keywords = {Positional vertigo; Prognosis; Recurrence}, pmid = {21949575} }
Moon, S.J., Bae, S.H., Kim, H.D., Kim, J.H. and Cho, Y.B.	The effect of postural restrictions in the treatment of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2005	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 262(5), pp. 408-411	article	DOI
Abstract: The treatment of benign paroxysmal positional vertigo (BPPV) consists of a repositioning maneuver in order to remove otoliths from the posterior semicircular canal and subsequent postural restrictions to prevent debris from reentering the canal. However, the extent to which postural restrictions affect the final outcomes of BPPV is still uncertain. The purpose of this study is to determine the effects of postural restrictions in the treatment of BPPV, which is caused by otoliths in the posterior semicircular canal, and to evaluate its usefulness as a therapy. Seventy cases diagnosed as BPPV of the posterior semicircular canal were studied. All patients were treated utilizing the modified Epley maneuver. They were divided into two groups. The first group (group A, 35 patients) was instructed to sleep in a semi-sitting position and to avoid moving their heads forward or backward, whereas no instructions were given to the second group (group B, 35 patients). The information gathered from the patients was analyzed by age of onset, gender, duration of the disease and cure rates or recurrence rates. In group A, the average age was 54.5 years and the mean duration of symptoms was 116.5 days, whereas in group B, these measurements were 54.8 years and 86.7 days. The cure rates were 91.4 and 94.3%, respectively. Symptoms recurred in 12.5% of group A patients, while in group B, there was a 9.1% recurrence rate. Our study did not show any significant difference between the two groups. Postural restriction therapy, practiced after the modified Epley repositioning maneuver, did not have a significant effect on the final outcomes of BPPV. Based on our results, we do not recommend this therapy since there was no significant benefit for the patients who utilized postural restrictions.
BibTeX: @article{Moon2005, author = {Moon, Seok Jin and Bae, Soon Ho and Kim, Hee Dae and Kim, Jung Hyun and Cho, Yong Bum}, title = {The effect of postural restrictions in the treatment of benign paroxysmal positional vertigo.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2005}, volume = {262}, issue = {5}, pages = {408--411}, doi = {https://doi.org/10.1007/s00405-004-0836-7}, keywords = {Adult; Age Factors; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Physical Therapy Modalities; Posture; Recurrence; Retrospective Studies; Sex Factors; Treatment Outcome; Vertigo, therapy}, pmid = {15378315} }
Sheikhzadeh, M., Lotfi, Y., Mousavi, A., Heidari, B. and Bakhshi, E.	The effect of serum vitamin D normalization in preventing recurrences of benign paroxysmal positional vertigo: A case-control study. [Abstract] [BibTeX]	2016	Caspian journal of internal medicine Vol. 7(3), pp. 173-177	article
Abstract: Benign paroxysmal positional vertigo (BPPV) is a condition with recurrent attacks in a significant proportion of patients. The present case- control study was conducted to assess the influence of serum vitamin D normalization on recurrent attacks of vitamin D deficient patients. Diagnosis of BPPV was made based on history and clinical examination and exclusion of other conditions. Serum 25-hydroxy vitamin D (25-OHD) was measured using ELISA method and a levels of < 20 ng/ml was considered a deficiency of vitamin D. Inclusion criteria were as follows: history of recurrent attacks and serum 25-OHD<20.ng/ml. While the patients with history of trauma, surgery and chronic systemic diseases were excluded. The patients were classified into two groups: treatment and control, intermittently. Both groups received Epley rehabilitation therapy one session per week for 4 weeks but the treatment group received an additional supplement of 50.000 IU of vitamin D (cholecalciferol) weekly for two months to achieve serum 25-OHD ≥ 30 ng/ml and the study patients were followed-up for 6 months. Twenty-seven patients were allocated to each group. At baseline, serum 25-OHD was similar (10.7±2.3 vs 11.41±1.9, P=0.23). At month 2, serum 25-OHD in the treatment group increased significantly to ≥ 30 ng/ ml, whereas serum 25-OHD in the control group remained unchanged (34.2±3.3 vs 10.6 10.6±2.2 ng/ml, P=0.001). During the follow-up period, attacks of BPPV in the treatment group decreased significantly compared with the control group (14.8% vs 96.3% OR= 0.18, P=0.001). The findings of this study indicate that the normalization of serum vitamin D significantly reduces BPPV recurrences.
BibTeX: @article{Sheikhzadeh2016, author = {Sheikhzadeh, Mahboobeh and Lotfi, Yones and Mousavi, Abdollah and Heidari, Behzad and Bakhshi, Enyatollah}, title = {The effect of serum vitamin D normalization in preventing recurrences of benign paroxysmal positional vertigo: A case-control study.}, journal = {Caspian journal of internal medicine}, year = {2016}, volume = {7}, issue = {3}, pages = {173--177}, keywords = {25-hydroxy vitamin D; BPPV; Epley Therapy; Recurrent vertigo}, pmid = {27757201} }
Blatt, P.J., Georgakakis, G.A., Herdman, S.J., Clendaniel, R.A. and Tusa, R.J.	The effect of the canalith repositioning maneuver on resolving postural instability in patients with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2000	The American journal of otology Vol. 21(3), pp. 356-363	article
Abstract: Patients with benign paroxysmal positional vertigo (BPPV) often experience postural instability as well as brief episodes of vertigo. The purpose of this study was to determine whether successful resolution of the episodic vertigo, through use of the canalith repositioning treatment, would be accompanied by improvement in postural stability. Prospective clinical study. Outpatient tertiary care facility in a university. Thirty-three patients with a diagnosis of the canalithiasis form of BPPV affecting the posterior canal unilaterally. All patients had complete remission of the positional vertigo after treatment. Patients with abnormal caloric or rotary chair test results were excluded from the study. The posterior canal BPPV was treated by the canalith repositioning treatment. Postural stability was assessed by computerized dynamic posturography before and 1 to 2 weeks after treatment. Six different subtests were used. A significant number of patients had abnormal stability, as measured with computerized dynamic posturography, before treatment. After treatment there was a significant increase in the number of subjects with normal results on the different subtests; however, not all patients had normal postural stability. Younger subjects were more likely to show improved stability. Treatment of BPPV using the canalith repositioning treatment results in improved postural stability in patients with BPPV. Not all patients have normal stability after treatment, however, and assessment and treatment of the balance problems may be necessary.
BibTeX: @article{Blatt2000, author = {Blatt, P J and Georgakakis, G A and Herdman, S J and Clendaniel, R A and Tusa, R J}, title = {The effect of the canalith repositioning maneuver on resolving postural instability in patients with benign paroxysmal positional vertigo.}, journal = {The American journal of otology}, year = {2000}, volume = {21}, issue = {3}, pages = {356--363}, keywords = {Adult; Aged; Aged, 80 and over; Feedback; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, diagnosis; Posture; Prospective Studies; Treatment Outcome; Vertigo, complications, therapy; Vestibular Diseases, complications, diagnosis}, pmid = {10821549} }
Shi, T., Yu, L., Yang, Y., Wang, Y., Shao, Y., Wang, M., Geng, Y., Shi, Z. and Yin, X.	The effective clinical outcomes of the Gufoni maneuver used to treat 91 vertigo patients with apogeotropic direction-changing positional nystagmus (apo-DCPN). [Abstract] [BibTeX]	2018	Medicine Vol. 97(39), pp. e12363	article	DOI
Abstract: This study aimed to observe and analyze the effects and outcomes of patients with apogeotropic direction-changing positional nystagmus (apo-DCPN) who received Gufoni maneuver.A total of 91 patients with positional vertigo admitted to the specialized dizziness clinic in Zhejiang Provincial People's Hospital from February 2014 to August 2017 were included. The immediate treatment responses to the Gufoni maneuver were observed and recorded. The patients in whom the treatment was ineffective were followed up for 4 weeks to observe the outcome of apo-DCPN.In 21 patients, the apo-DCPN was transformed after Gufoni maneuver, and 7 patients developed transformation within 4 weeks of follow-up. Spontaneous remission of apo-DCPN within the follow-up period was observed in 55 patients who were unresponsive to the Gufoni maneuver. The prevalence of migraine was significantly higher in the early remission group (P < .05) and the period between the initial visit and nystagmus remission was significantly shorter in the group of patients with migraine history (P < .05).This study demonstrates that the immediate treatment efficacy of the Gufoni maneuver is poor in positional vertigo patients with apo-DCPN. We believe that the reason for the low efficacy is that the Gufoni maneuver is only effective for some patients with apo-DCPN type HSC-BPPV. In patients with early spontaneous remission and a history of migraine, central positional nystagmus of probable vestibular migraine (VM) or benign recurrent vertigo should be considered for the mechanisms of apo-DCPN generation.
BibTeX: @article{Shi2018, author = {Shi, Tianming and Yu, Lihua and Yang, Yi and Wang, Yiqi and Shao, Yanqi and Wang, Meiping and Geng, Yu and Shi, Zongjie and Yin, Xiaojun}, title = {The effective clinical outcomes of the Gufoni maneuver used to treat 91 vertigo patients with apogeotropic direction-changing positional nystagmus (apo-DCPN).}, journal = {Medicine}, year = {2018}, volume = {97}, issue = {39}, pages = {e12363}, doi = {https://doi.org/10.1097/MD.0000000000012363}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, therapy; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nystagmus, Physiologic; Patient Positioning, methods; Physical Therapy Modalities; Semicircular Canals, physiopathology; Treatment Outcome; Vestibular Function Tests, methods}, pmid = {30278514} }
Arnold, S.A., Stewart, A.M., Moor, H.M., Karl, R.C. and Reneker, J.C.	The Effectiveness of Vestibular Rehabilitation Interventions in Treating Unilateral Peripheral Vestibular Disorders: A Systematic Review. [Abstract] [BibTeX]	2017	Physiotherapy research international : the journal for researchers and clinicians in physical therapy Vol. 22(3)	article	DOI
Abstract: Various types of vestibular rehabilitation therapy are routinely used in clinical practice to treat unilateral peripheral vestibular hypofunction. The purpose of this systematic review was to compare the effectiveness of vestibular rehabilitation interventions (adaptation, substitution and habituation) in people with unilateral peripheral vestibular hypofunction, exclusionary of benign paroxysmal positional vertigo and Meniere's disease. A search of the literature was conducted using PubMed, CINAHL and Scopus. Studies were eligible for inclusion if they were 1) a randomized controlled trial or randomized clinical trial; 2) written in English; 3) of participants with a unilateral, peripheral vestibular hypofunction; 4) of a conservative treatment approach only; and 5) with human subjects. Quality was assessed by two authors using the Physiotherapy Evidence Database scale. Effect size was calculated to determine the effect of treatment within each study group. Seven papers were selected for inclusion. Physiotherapy Evidence Database scores ranged from 2/10 to 7/10. Interventions within the selected studies included combinations of adaptation, habituation, substitution or substitution by itself. Calculated effect sizes, or significance values, revealed that all interventions demonstrated effectiveness. Two studies reported improvements on the dynamic gait index, and a large difference was seen between intervention groups of the two studies. Results suggest that vestibular therapy for unilateral peripheral vestibular hypofunction is effective. When considering all seven studies included in the review, it is difficult to determine the superiority of one intervention over another in treating unilateral peripheral vestibular hypofunction except when patient outcomes are captured by the dynamic gait index or dizziness handicap inventory. Many studies in this review demonstrate notable biases, suggesting that results should be used with caution. Future research should aim to use a common set of measures to capture outcomes. Copyright © 2015 John Wiley & Sons, Ltd.
BibTeX: @article{Arnold2017, author = {Arnold, Scott A and Stewart, Aaron M and Moor, Heather M and Karl, Rita C and Reneker, Jennifer C}, title = {The Effectiveness of Vestibular Rehabilitation Interventions in Treating Unilateral Peripheral Vestibular Disorders: A Systematic Review.}, journal = {Physiotherapy research international : the journal for researchers and clinicians in physical therapy}, year = {2017}, volume = {22}, issue = {3}, doi = {https://doi.org/10.1002/pri.1635}, keywords = {Comparative Effectiveness Research; Dizziness, physiopathology; Randomized Controlled Trials as Topic; Vestibular Diseases, rehabilitation; Vestibule, Labyrinth, physiopathology; dizziness/rehabilitation; exercise therapy; head movements; vestibular diseases/rehabilitation}, pmid = {26111348} }
Hoseinabadi, R., Pourbakht, A., Yazdani, N., Kouhi, A. and Kamali, M.	The effects of abnormality of cVEMP and oVEMP on rehabilitation outcomes in patients with idiopathic benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2016	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 273(3), pp. 643-648	article	DOI
Abstract: The presence of utricular and saccular dysfunction impairs quality of life (QoL) in patients. The aims of the present study were to examine the effect of repositioning maneuvers on QoL of patients with idiopathic benign paroxysmal positional vertigo (BPPV) and to describe the effect of cervical vestibular-evoked myogenic potential (cVEMP) or ocular VEMP (oVEMP) abnormalities on patient recovery after rehabilitation. Thirty idiopathic BPPV patients with/without otolith dysfunctions (n = 15, each group) were included in this clinical trial study. Otolith dysfunction was determined using oVEMP and cVEMP abnormalities. EcochG and caloric tests were performed to rule out other causes of secondary BPPV. The QoL in groups of patients with idiopathic BPPV was assessed using a Persian version of the dizziness handicap inventory (DHI-P) before and after treatment with Epley's maneuver. Pre-treatment results showed significant handicaps in both groups. DHI-P scores were higher in BPPV patients with otolith dysfunction (total, functional, emotional, physical score: 34.13, 11.20, 7.06, 15.86, respectively) than those in patients without otolith dysfunction (total, functional, emotional, physical score: 25.46, 7.86, 6.13, 11.46, respectively, P < 0.05). After treatment, DHI-P scores decreased in both groups. However, in the otolith dysfunction group, DHI-P scores (total, functional, emotional, physical score: 9.20, 3.33, 1.33, 4.53, respectively) were higher than those in patients without otolith dysfunction (total, functional, emotional, physical score: 4.13, 0.93, 1.06, 2.00, respectively). In BPPV patients with cVEMP or oVEMP abnormalities, QoL is more compromised in comparison with that in BPPV patients without these dysfunctions. Otolith dysfunction enhances the negative effects of BPPV on QoL.
BibTeX: @article{Hoseinabadi2016, author = {Hoseinabadi, Reza and Pourbakht, Akram and Yazdani, Nasrin and Kouhi, Ali and Kamali, Mohammad}, title = {The effects of abnormality of cVEMP and oVEMP on rehabilitation outcomes in patients with idiopathic benign paroxysmal positional vertigo.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2016}, volume = {273}, issue = {3}, pages = {643--648}, doi = {https://doi.org/10.1007/s00405-015-3612-y}, keywords = {Adult; Benign Paroxysmal Positional Vertigo, diagnosis, physiopathology, psychology, rehabilitation; Caloric Tests, methods; Dizziness, physiopathology, psychology; Female; Humans; Male; Middle Aged; Otolithic Membrane, physiopathology; Patient Positioning, methods; Psychological Techniques; Quality of Life; Treatment Outcome; Vestibular Evoked Myogenic Potentials, physiology; Epley’s maneuver; Handicap; Idiopathic BPPV; Otolith dysfunction}, pmid = {25825004} }
Guneri, E.A. and Kustutan, O.	The effects of betahistine in addition to epley maneuver in posterior canal benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2012	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 146(1), pp. 104-108	article	DOI
Abstract: The purpose of this study is to evaluate the effects of betahistine in addition to Epley maneuver on the quality of life of patients with posterior semicircular canal benign paroxysmal positional vertigo (BPPV) of the canalithiasis type. Double-blind, randomized, controlled clinical trial. Academic university hospital. Seventy-two patients were enrolled in the study. The first group was treated with Epley maneuver only. The second group received placebo drug 2 times daily for 1 week in addition to Epley maneuver, and the third group received 24 mg betahistine 2 times daily for 1 week in addition to Epley maneuver. The effectiveness of the treatments was assessed in each group as well as between them by analyzing and comparing data of 4 different vertigo symptom scales. Epley maneuver, alone or combined with betahistine or placebo, was found to be very effective with a primary success rate of 86.2%. The symptoms were significantly reduced in group 3 patients overall, and those patients younger or older than 50 years of age who had hypertension, with symptom onset <1 month, and with attack duration of less than a minute did significantly better with the combination of betahistine 48 mg daily. Betahistine in addition to Epley maneuver is more effective than Epley maneuver alone or combined with placebo with regard to improvement of symptoms in certain patients. However, future clinical studies covering more patients to investigate the benefit of medical treatments in addition to Epley maneuver are needed.
BibTeX: @article{Guneri2012, author = {Guneri, Enis Alpin and Kustutan, Ozge}, title = {The effects of betahistine in addition to epley maneuver in posterior canal benign paroxysmal positional vertigo.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2012}, volume = {146}, issue = {1}, pages = {104--108}, doi = {https://doi.org/10.1177/0194599811419093}, keywords = {Administration, Oral; Adolescent; Adult; Aged; Benign Paroxysmal Positional Vertigo; Betahistine, administration & dosage; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Female; Humans; Male; Middle Aged; Physical Therapy Modalities; Posture, physiology; Semicircular Canals, physiopathology; Treatment Outcome; Vasodilator Agents, administration & dosage; Vertigo, physiopathology, therapy; Young Adult}, pmid = {21852389} }
Hoseinabadi, R., Pourbakht, A., Yazdani, N., Kouhi, A., Kamali, M., Abdollahi, F.Z. and Jafarzadeh, S.	The Effects of the Vestibular Rehabilitation on the Benign Paroxysmal Positional Vertigo Recurrence Rate in Patients with Otolith Dysfunction. [Abstract] [BibTeX]	2018	Journal of audiology & otology Vol. 22(4), pp. 204-208	article	DOI
Abstract: Although repositioning maneuvers have shown remarkable success rate in treatments of benign paroxysmal positional vertigo (BPPV), the high recurrence rate of BPPV has been an important issue. The aims of present study were to examine the effects of otolith dysfunction on BPPV recurrence rate and to describe the effect of vestibular rehabilitation exercises on BPPV recurrence in BPPV patients with concomitant otolith dysfunction. Subjects and. Forty-five BPPV patients included in this study (three groups). Patients in group 1 had no otolith dysfunction and patients in groups 2 and 3 had concomitant otolith dysfunction. Otolith dysfunction was determined with ocular/cervical vestibular evoked myogenic potential (oVEMP and cVEMP) abnormalities. Epley's maneuver was performed for the patients in all groups but patients in group 3 also received a 2-month vestibular rehabilitation program (habituation and otolith exercises). This study showed that BPPV recurrent rate was significantly higher in patients with otolith dysfunction in comparison to the group 1 (p<0.05). Vestibular rehabilitation resulted in BPPV recurrence rate reduction. Utricular dysfunction showed significant correlation with BPPV recurrence rate. Otolith dysfunction can increase BPPV recurrence rate. Utricular dysfunction in comparison to saccular dysfunction leads to more BPPV recurrence rate. Vestibular rehabilitation program including habituation and otolith exercises may reduce the chance of BPPV recurrence.
BibTeX: @article{Hoseinabadi2018, author = {Hoseinabadi, Reza and Pourbakht, Akram and Yazdani, Nasrin and Kouhi, Ali and Kamali, Mohammad and Abdollahi, Farzaneh Zamiri and Jafarzadeh, Sadegh}, title = {The Effects of the Vestibular Rehabilitation on the Benign Paroxysmal Positional Vertigo Recurrence Rate in Patients with Otolith Dysfunction.}, journal = {Journal of audiology & otology}, year = {2018}, volume = {22}, issue = {4}, pages = {204--208}, doi = {https://doi.org/10.7874/jao.2018.00087}, keywords = {Benign paroxysmal positional vertigo; Otolith dysfunction; Vestibular rehabilitation}, pmid = {30016856} }
van der Scheer-Horst, E.S., van Benthem, P.P.G., Bruintjes, T.D., van Leeuwen, R.B. and van der Zaag-Loonen, H.J.	The efficacy of vestibular rehabilitation in patients with benign paroxysmal positional vertigo: a rapid review. [Abstract] [BibTeX]	2014	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 151(5), pp. 740-745	article	DOI
Abstract: To systematically review the evidence on the effectiveness of vestibular rehabilitation in addition to a canalith repositioning maneuver in patients with benign paroxysmal positional vertigo. A literature search was performed in the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, and EMBASE databases. A comprehensive search was performed up to July 2013. Two authors independently scanned the search results to identify randomized controlled trials of vestibular rehabilitation in addition to a canalith repositioning maneuver in patients with benign paroxysmal positional vertigo. We included trials that were available in the English language and did not apply publication year or publication status restrictions. Studies were methodologically assessed using the Cochrane risk of bias tool. Primary outcome was the effect on vertigo attacks and balance. Of 76 identified trials, only 2 trials fulfilled our inclusion criteria and were included in this review, involving 106 patients. One study was methodologically weak, the other strong. The studies differed in type of intervention, type of outcome, and follow-up time. Both studies reported no significant difference in the vertigo intensity between groups. A small effect was found on balance. Two level II studies in benign paroxysmal positional vertigo showed no effect of vestibular rehabilitation in addition to a canalith repositioning maneuver on vertigo intensity and a small, beneficial effect on balance. We therefore conclude that there is no evidence for an effect of vestibular rehabilitation in addition to a canalith repositioning maneuver in patients with benign paroxysmal positional vertigo.
BibTeX: @article{Scheer-Horst2014, author = {van der Scheer-Horst, Ellis S and van Benthem, Peter Paul G and Bruintjes, Tjasse D and van Leeuwen, Roeland B and van der Zaag-Loonen, Hester J}, title = {The efficacy of vestibular rehabilitation in patients with benign paroxysmal positional vertigo: a rapid review.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2014}, volume = {151}, issue = {5}, pages = {740--745}, doi = {https://doi.org/10.1177/0194599814546479}, keywords = {Benign Paroxysmal Positional Vertigo, rehabilitation; Humans; benign paroxysmal positional vertigo; physiotherapy; vertigo; vestibular rehabilitation}, pmid = {25155900} }
Neuhauser, H.K.	The epidemiology of dizziness and vertigo. [Abstract] [BibTeX]	2016	Handbook of clinical neurology Vol. 137, pp. 67-82	article	DOI
Abstract: This chapter gives an overview of the epidemiology of dizziness, vertigo, and imbalance, and of specific vestibular disorders. In the last decade, population-based epidemiologic studies have complemented previous publications from specialized settings and provided evidence for the high burden of dizziness and vertigo in the community. Dizziness (including vertigo) affects about 15% to over 20% of adults yearly in large population-based studies. Vestibular vertigo accounts for about a quarter of dizziness complaints and has a 12-month prevalence of 5% and an annual incidence of 1.4%. Its prevalence rises with age and is about two to three times higher in women than in men. Imbalance has been increasingly studied as a highly prevalent complaint particularly affecting healthy aging. Studies have documented the high prevalence of benign paroxysmal positional vertigo (BPPV) and vestibular migraine (VM), as well as of comorbid anxiety at the population level. BPPV and VM are largely underdiagnosed, while Menière's disease, which is about 10 times less frequent than BPPV, appears to be overdiagnosed. Risk factor research is only at its beginning, but has provided some interesting observations, such as the consistent association of vertigo and migraine, which has greatly contributed to the recognition of VM as a distinct vestibular syndrome.
BibTeX: @article{Neuhauser2016, author = {Neuhauser, H K}, title = {The epidemiology of dizziness and vertigo.}, journal = {Handbook of clinical neurology}, year = {2016}, volume = {137}, pages = {67--82}, doi = {https://doi.org/10.1016/B978-0-444-63437-5.00005-4}, keywords = {Dizziness, epidemiology; Humans; Vertigo, epidemiology; Menière's disease; benign paroxysmal positional vertigo; dizziness; epidemiology; vertigo; vestibular migraine; vestibular neuritis}, pmid = {27638063} }
Hilton, M. and Pinder, D.	The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2002	The Cochrane database of systematic reviews(1), pp. CD003162	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is a syndrome characterised by short-lived episodes of vertigo in association with rapid changes in head position. It is a common cause of vertigo presenting to primary care and specialist otolaryngology clinics. Current treatment approaches include rehabilitative exercises and physical manoeuvres including the Epley manoeuvre. To assess the effectiveness of the Epley manoeuvre compared to other treatments available for posterior canal benign paroxysmal positional vertigo, or no treatment. The Cochrane Controlled Trials Register (Cochrane Library, Issue 2 2001), MEDLINE (1966 onwards), EMBASE (1974 onwards), and reference lists of identified publications. Date of the most recent search was June 2001. Randomised trials of adults diagnosed with posterior canal BPPV (including a positive Dix-Hallpike test). Comparisons sought: - Epley manoeuvre versus placebo. - Epley manoeuvre versus untreated controls. Epley manoeuvre versus other active treatment. Outcome measures that were considered include: frequency and severity of attacks of vertigo; proportion of patients improved by each intervention; and conversion of a "positive" Dix-Hallpike test to a "negative" Dix-Hallpike test Both reviewers independently extracted data and assessed trials for quality. Eleven trials were identified but nine studies were excluded because of a high risk of bias, leaving two trials in the review. Trials were mainly excluded because of inadequate concealment during randomisation, or failure to blind outcome assessors. Both studies included in the review (Lynn 1995, Froehling 2000) addressed the efficacy of the Epley manoeuvre against a sham manoeuvre by comparing the proportion of subjects in each group who had complete resolution of their symptoms, and who converted from a positive to negative Dix-Hallpike test. Individual and pooled data showed a statistically significant effect in favour of the Epley manoeuvre over controls. There were no serious adverse effects of treatment. bullet There is some evidence that the Epley manoeuvre is a safe effective treatment for posterior canal BPPV, although this is based on the results of only two small randomised controlled trials with relatively short follow up. bullet There is no good evidence that the Epley manoeuvre provides a long term resolution of symptoms. bullet There is no good evidence comparing the Epley manoeuvre with other physical, medical or surgical therapy for posterior canal BPPV.
BibTeX: @article{Hilton2002a, author = {Hilton, M and Pinder, D}, title = {The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo.}, journal = {The Cochrane database of systematic reviews}, year = {2002}, issue = {1}, pages = {CD003162}, doi = {https://doi.org/10.1002/14651858.CD003162}, keywords = {Humans; Randomized Controlled Trials as Topic; Vertigo, rehabilitation}, pmid = {11869655} }
Hilton, M. and Pinder, D.	The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2004	The Cochrane database of systematic reviews(2), pp. CD003162	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is a syndrome characterised by short-lived episodes of vertigo in association with rapid changes in head position. It is a common cause of vertigo presenting to primary care and specialist otolaryngology clinics. Current treatment approaches include rehabilitative exercises and physical manoeuvres including the Epley manoeuvre. To assess the effectiveness of the Epley manoeuvre compared to other treatments available for posterior canal benign paroxysmal positional vertigo, or no treatment. The Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library Issue 1, 2004), MEDLINE (1966 to 2004), EMBASE (1974 to 2004) and reference lists of identified publications. Date of the most recent search was January 2004. Randomised trials of adults diagnosed with posterior canal BPPV (including a positive Dix-Hallpike test). Comparisons sought: Epley manoeuvre versus placebo Epley manoeuvre versus untreated controls Epley manoeuvre versus other active treatment Outcome measures that were considered include: frequency and severity of attacks of vertigo; proportion of patients improved by each intervention; and conversion of a "positive" Dix-Hallpike test to a "negative" Dix-Hallpike test Both reviewers independently extracted data and assessed trials for quality. Fifteen trials were identified but twelve studies were excluded because of a high risk of bias, leaving three trials in the review. Trials were mainly excluded because of inadequate concealment during randomisation, or failure to blind outcome assessors. The studies included in the review (Lynn 1995; Froehling 2000; Yimtae 2003) addressed the efficacy of the Epley manoeuvre against a sham manoeuvre or control group by comparing the proportion of subjects in each group who had complete resolution of their symptoms, and who converted from a positive to negative Dix-Hallpike test. Individual and pooled data showed a statistically significant effect in favour of the Epley manoeuvre over controls. There were no serious adverse effects of treatment. There is some evidence that the Epley manoeuvre is a safe effective treatment for posterior canal BPPV, although this is based on the results of only three small randomised controlled trials with relatively short follow up. There is no good evidence that the Epley manoeuvre provides a long term resolution of symptoms. There is no good evidence comparing the Epley manoeuvre with other physical, medical or surgical therapy for posterior canal BPPV.
BibTeX: @article{Hilton2004, author = {Hilton, M and Pinder, D}, title = {The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo.}, journal = {The Cochrane database of systematic reviews}, year = {2004}, issue = {2}, pages = {CD003162}, doi = {https://doi.org/10.1002/14651858.CD003162.pub2}, keywords = {Humans; Randomized Controlled Trials as Topic; Semicircular Canals; Vertigo, rehabilitation}, pmid = {15106194} }
Hilton, M.P. and Pinder, D.K.	The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2014	The Cochrane database of systematic reviews(12), pp. CD003162	article	DOI
Abstract: This is an update of a Cochrane Review first published in The Cochrane Library in Issue 1, 2002 and previously updated in 2004 and 2007.Benign paroxysmal positional vertigo (BPPV) is a syndrome characterised by short-lived episodes of vertigo in association with rapid changes in head position. It is a common cause of vertigo presenting to primary care and specialist otolaryngology clinics. Current treatment approaches include rehabilitative exercises and physical manoeuvres, including the Epley manoeuvre. To assess the effectiveness of the Epley manoeuvre for posterior canal BPPV. We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; CENTRAL; PubMed; EMBASE; CINAHL; Web of Science; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 23 January 2014. Randomised controlled trials of the Epley manoeuvre versus placebo, no treatment or other active treatment for adults diagnosed with posterior canal BPPV (including a positive Dix-Hallpike test). The primary outcome of interest was complete resolution of vertigo symptoms. Secondary outcomes were conversion of a 'positive' Dix-Hallpike test to a 'negative' Dix-Hallpike test and adverse effects of treatment. We used the standard methodological procedures expected by The Cochrane Collaboration. We included 11 trials in the review with a total of 745 patients.Five studies compared the efficacy of the Epley manoeuvre against a sham manoeuvre, three against other particle repositioning manoeuvres (Semont, Brandt-Daroff and Gans) and three against a control (no treatment, medication only, postural restriction). Patients were treated in hospital otolaryngology departments in eight studies and family practices in two studies. All patients were adults aged 18 to 90 years old, with a sex ratio of 1:1.5 male to female.There was a low risk of overall bias in the studies included. All studies were randomised with six applying sealed envelope or external allocation techniques. Eight of the trials blinded the assessors to the participants' treatment group and data on all outcomes for all participants were reported in eight of the 11 studies. Complete resolution of vertigo Complete resolution of vertigo occurred significantly more often in the Epley treatment group when compared to a sham manoeuvre or control (odds ratio (OR) 4.42, 95% confidence interval (CI) 2.62 to 7.44; five studies, 273 participants); the proportion of patients resolving increased from 21% to 56%. None of the trials comparing Epley versus other particle repositioning manoeuvres reported vertigo resolution as an outcome. Conversion of Dix-Hallpike positional test result from positive to negative Conversion from a positive to a negative Dix-Hallpike test significantly favoured the Epley treatment group when compared to a sham manoeuvre or control (OR 9.62, 95% CI 6.0 to 15.42; eight studies, 507 participants). There was no difference when comparing the Epley with the Semont manoeuvre (two studies, 117 participants) or the Epley with the Gans manoeuvre (one study, 58 participants). In one study a single Epley treatment was more effective than a week of three times daily Brandt-Daroff exercises (OR 12.38, 95% CI 4.32 to 35.47; 81 participants). Adverse effects Adverse effects were infrequently reported. There were no serious adverse effects of treatment. Rates of nausea during the repositioning manoeuvre varied from 16.7% to 32%. Some patients were unable to tolerate the manoeuvres because of cervical spine problems. There is evidence that the Epley manoeuvre is a safe, effective treatment for posterior canal BPPV, based on the results of 11, mostly small, randomised controlled trials with relatively short follow-up. There is a high recurrence rate of BPPV after treatment (36%). Outcomes for Epley manoeuvre treatment are comparable to treatment with Semont and Gans manoeuvres, but superior to Brandt-Daroff exercises.
BibTeX: @article{Hilton2014, author = {Hilton, Malcolm P and Pinder, Darren K}, title = {The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo.}, journal = {The Cochrane database of systematic reviews}, year = {2014}, issue = {12}, pages = {CD003162}, doi = {https://doi.org/10.1002/14651858.CD003162.pub3}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, rehabilitation; Exercise Movement Techniques, adverse effects, methods; Female; Humans; Male; Middle Aged; Randomized Controlled Trials as Topic; Semicircular Canals}, pmid = {25485940} }
Ciniglio Appiani, G., Gagliardi, M., Urbani, L. and Lucertini, M.	The Epley maneuver for the treatment of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	1996	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 253(1-2), pp. 31-34	article
Abstract: In recent years, different forms of physical therapy have been proposed for the treatment of benign paroxysmal positional vertigo (BPPV). These mainly consist of maneuvers aiming to reposition and disperse free-floating endolymph particles in the posterior semicircular canal. We report our experience with one of these procedures, the Epley maneuver (EM), in treating 30 cases of BPPV. Twenty-six patients (87%) were cured, while four (13%) did not respond to treatment. These results are similar to those reported in the literature for the EM and the Semont maneuver.
BibTeX: @article{CiniglioAppiani1996, author = {Ciniglio Appiani, G and Gagliardi, M and Urbani, L and Lucertini, M}, title = {The Epley maneuver for the treatment of benign paroxysmal positional vertigo.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {1996}, volume = {253}, issue = {1-2}, pages = {31--34}, keywords = {Adult; Aged; Endolymph, physiology; Female; Humans; Male; Meniere Disease, physiopathology, rehabilitation; Middle Aged; Orientation, physiology; Posture, physiology; Semicircular Canals, physiology; Treatment Outcome; Vestibular Function Tests}, pmid = {8932426} }
Glasziou, P., Bennett, J., Greenberg, P., Green, S., Gunn, J., Hoffman, T., Pirotta, M. and of Non Drug Intervention (HANDI) Project Team, H.	The Epley manoeuvre - for benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2013	Australian family physician Vol. 42(1-2), pp. 36-37	article
Abstract: The Epley manoeuvre (canalith repositioning) can be used to treat posterior canal benign paroxysmal positional vertigo (BPPV). BPPV is characterised by brief episodes of vertigo related to rapid changes in head position. BPPV can be confirmed by the Dix-Hallpike positional test. The Epley manoeuvre is easily performed in the clinic, or by the patient, and is described in detail in this article. It has NHMRC Level I evidence of efficacy and no serious adverse effects have been reported.
BibTeX: @article{Glasziou2013, author = {Glasziou, Paul and Bennett, John and Greenberg, Peter and Green, Sally and Gunn, Jane and Hoffman, Tammy and Pirotta, Marie and Handbook of Non Drug Intervention (HANDI) Project Team}, title = {The Epley manoeuvre - for benign paroxysmal positional vertigo.}, journal = {Australian family physician}, year = {2013}, volume = {42}, issue = {1-2}, pages = {36--37}, keywords = {Benign Paroxysmal Positional Vertigo; Humans; Patient Positioning, methods; Vertigo, therapy}, pmid = {23529458} }
Hilton, M. and Pinder, D.	The Epley manoeuvre for benign paroxysmal positional vertigo--a systematic review. [Abstract] [BibTeX]	2002	Clinical otolaryngology and allied sciences Vol. 27(6), pp. 440-445	article
Abstract: Benign paroxysmal positional vertigo (BPPV) is a syndrome characterized by short-lived episodes of vertigo in association with rapid changes in head position. Current treatment approaches include rehabilitative exercises and physical manoeuvres including the Epley manouevre. Randomized clinical trials of the Epley manoeuvre were identified. Outcome measures that were considered include: frequency and severity of attacks of vertigo; proportion of patients improved by each intervention; and conversion of a 'positive' Dix-Hallpike test to a 'negative' Dix-Hallpike test. Patients who received the Epley manoeuvre were more likely to have complete resolution of their symptoms [odds ratio 4.92 (95% C.I. 1.84-13.16)], and more likely to convert from a positive to negative Dix-Hallpike test [odds ratio 5.67 (95% C.I. 2.21-14.56)]. There were no serious adverse effects of treatment. There is some evidence that the Epley manouevre is a safe effective treatment for posterior canal BPPV.
BibTeX: @article{Hilton2002, author = {Hilton, M and Pinder, D}, title = {The Epley manoeuvre for benign paroxysmal positional vertigo--a systematic review.}, journal = {Clinical otolaryngology and allied sciences}, year = {2002}, volume = {27}, issue = {6}, pages = {440--445}, keywords = {Humans; Posture; Vertigo, therapy}, pmid = {12472509} }
Kahraman, S.S., Arli, C., Copoglu, U.S., Kokacya, M.H. and Colak, S.	The evaluation of anxiety and panic agarophobia scores in patients with benign paroxysmal positional vertigo on initial presentation and at the follow-up visit. [Abstract] [BibTeX]	2017	Acta oto-laryngologica Vol. 137(5), pp. 485-489	article	DOI
Abstract: Patients with BPPV experienced short but intense anxiety and/or panic disorder, especially at the initial visit, but most patients recovered without medication with successful treatment. Recent studies have shown that people with dizziness report some psychological problems such as panic and agoraphobia and anxiety. The aim of this study was to evaluate anxiety and panic agorophobia levels in patients with benign paroxysmal positional vertigo on initial presentation and at the follow-up visit and compare the scores with the control group. All the 32 patients in the study had a diagnosis of BPPV confirmed by their history, typical subjective symptom reports, and characteristic positional nystagmus during the Dix-Hallpike test and/or Roll test. The patients were instructed to complete the standard forms of Beck anxiety inventory and panic agoraphobia scale questionnaire before and at 7 and 14 days after the canalith repositioning treatment. The validity scores of panic agoraphobia were statistically significantly higher in patients with BPPV than in the control group in each period (p < .001) and the validity scores of the Beck anxiety inventory were statistically significantly higher in patients with BPPV than in the control group at the first and second evaluation (p < .001).
BibTeX: @article{Kahraman2017a, author = {Kahraman, Serif Samil and Arli, Cengiz and Copoglu, Umit Sertan and Kokacya, Mehmet Hanifi and Colak, Sait}, title = {The evaluation of anxiety and panic agarophobia scores in patients with benign paroxysmal positional vertigo on initial presentation and at the follow-up visit.}, journal = {Acta oto-laryngologica}, year = {2017}, volume = {137}, issue = {5}, pages = {485--489}, doi = {https://doi.org/10.1080/00016489.2016.1247986}, keywords = {Adult; Aged; Agoraphobia, etiology; Anxiety, etiology; Benign Paroxysmal Positional Vertigo, complications, psychology; Female; Follow-Up Studies; Humans; Male; Middle Aged; Panic; Young Adult; Benign paroxysmal positional vertigo; anxiety; panic agarophobia}, pmid = {27809643} }
Kerber, K.A. and Fendrick, A.M.	The evidence base for the evaluation and management of dizziness. [Abstract] [BibTeX]	2010	Journal of evaluation in clinical practice Vol. 16(1), pp. 186-191	article	DOI
Abstract: Dizziness presentations pose many clinical challenges. The objective of this study is to broadly summarize the evidence base that supports clinical decisions in dizziness presentations. MEDLINE (1966 to September 2007), Web of Science and The Cochrane Library were searched for articles with clinical relevance on topics concerning dizziness. Additional sources were also searched for clinical practice guidelines. The following information was abstracted from each article: year of publication, journal type, type of article and the topics of the article. Of nearly 3000 articles identified, 1244 articles met the inclusion criteria. The most common article type was a case report or case series, followed by expert opinion or review articles, studies of medical tests and clinical trials. Meta-analyses and systematic reviews were found on benign paroxysmal positional vertigo and Meniere's disease, but only a few other topics. No clinical practice guidelines were found that focus specifically on dizziness. The evidence base for the evaluation and management of dizziness seems to be weak. Future work to establish or summarize evidence in clinically meaningful ways could contribute to efforts to optimize patient care and health care utilization for one of the most common presenting symptoms.
BibTeX: @article{Kerber2010, author = {Kerber, Kevin A and Fendrick, A Mark}, title = {The evidence base for the evaluation and management of dizziness.}, journal = {Journal of evaluation in clinical practice}, year = {2010}, volume = {16}, issue = {1}, pages = {186--191}, doi = {https://doi.org/10.1111/j.1365-2753.2009.01133.x}, keywords = {Bibliometrics; Dizziness, diagnosis, therapy; Evidence-Based Medicine; Humans; Meta-Analysis as Topic; Practice Guidelines as Topic; Review Literature as Topic}, pmid = {20367831} }
Gizzi, M., Ayyagari, S. and Khattar, V.	The familial incidence of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	1998	Acta oto-laryngologica Vol. 118(6), pp. 774-777	article
Abstract: The goal of this investigation was to determine whether there is a familial tendency in the development of benign paroxysmal positional vertigo (BPPV). We hypothesized an increased frequency of BPPV among relatives of patients with the same diagnosis. BPPV is caused by dislodged otoconia from the utricular macula floating in the semicircular canals. At least half of BPPV cases are idiopathic and most pathological associations provide no clue as to the reason otoconia become dislodged. We have noted a number of BPPV patients with family histories of BPPV, suggesting a genetic predisposition to the condition. We surveyed 120 successive BPPV patients and 120 successive dizzy patients without BPPV regarding the frequency of dizziness and BPPV (diagnosed by a physician) among family members. Patients in our group with BPPV were 5 times as likely to have relatives with BPPV compared to the dizzy control group (chi2=5.95, DF=1, p=0.015). We have demonstrated that there is a familial tendency for the occurrence of BPPV. There is nothing in our data that would distinguish between a hereditary or environmental influence in the development of the disease, however.
BibTeX: @article{Gizzi1998, author = {Gizzi, M and Ayyagari, S and Khattar, V}, title = {The familial incidence of benign paroxysmal positional vertigo.}, journal = {Acta oto-laryngologica}, year = {1998}, volume = {118}, issue = {6}, pages = {774--777}, keywords = {Age Factors; Chi-Square Distribution; Dizziness, genetics; Environment; Female; Genetic Predisposition to Disease; Humans; Incidence; Male; Middle Aged; Nystagmus, Physiologic; Otolithic Membrane, pathology; Posture; Saccule and Utricle, pathology; Semicircular Canals, pathology; Vertigo, diagnosis, genetics}, pmid = {9870618} }
Naples, J.G. and Eisen, M.D.	The History and Evolution of Surgery on the Vestibular Labyrinth. [Abstract] [BibTeX]	2016	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 155(5), pp. 816-819	article	DOI
Abstract: The history of surgery on the vestibular labyrinth is rich but sparsely documented in the literature. The story begins over a century ago with the labyrinthectomy in an era that consisted exclusively of ablative surgery for infection or vertigo. Improved understanding of vestibular physiology and pathology produced an era of selective ablation and hearing preservation that includes semicircular canal occlusion for benign paroxysmal positional vertigo. An era of restoration began with a discovery of superior semicircular canal dehiscence and its repair. The final era of vestibular replacement is upon us as the possibility of successful prosthetic vestibular implantation becomes reality.
BibTeX: @article{Naples2016, author = {Naples, James G and Eisen, Marc D}, title = {The History and Evolution of Surgery on the Vestibular Labyrinth.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2016}, volume = {155}, issue = {5}, pages = {816--819}, doi = {https://doi.org/10.1177/0194599816665807}, keywords = {History, 19th Century; History, 20th Century; History, 21st Century; Humans; Otologic Surgical Procedures, history; Vestibular Diseases, history, surgery; Vestibule, Labyrinth, surgery; BPPV; history; labyrinth; vertigo; vestibular}, pmid = {27554515} }
Baloh, R.W., Halmagyi, G.M. and Zee, D.S.	The history and future of neuro-otology. [Abstract] [BibTeX]	2012	Continuum (Minneapolis, Minn.) Vol. 18(5 Neuro-otology), pp. 1001-1015	article	DOI
Abstract: The field of neuro-otology has advanced substantially over the past 150 years. The function of the vestibular system was presumed to be audiologic prior to the groundbreaking work of Prosper Ménière in the late 1800s. Since that time, scientific discovery has advanced our knowledge of the physiology and the pathophysiology of the vestibular system. This article describes where we have been, where we are now, and where we need to go from here. Some of the important recent advances include: (1) improved imaging of the brain and inner ear, (2) development of new eye movement recording and analysis techniques, (3) development of new tests of otolith function, (4) particle repositioning maneuvers for all types of benign paroxysmal positional vertigo, and (5) improved bedside diagnosis and treatment of vestibular neuritis. The cause and treatment for some common neuro-otologic disorders is now well delineated. The diagnosis and management of less common disorders has improved as well. Future work is still required to advance the science of vestibular physiology and pathophysiology and ultimately to discover new ways to improve the health of patients with these disorders.
BibTeX: @article{Baloh2012, author = {Baloh, Robert W and Halmagyi, G Michael and Zee, David S}, title = {The history and future of neuro-otology.}, journal = {Continuum (Minneapolis, Minn.)}, year = {2012}, volume = {18}, issue = {5 Neuro-otology}, pages = {1001--1015}, doi = {https://doi.org/10.1212/01.CON.0000418371.49605.19}, keywords = {Forecasting; History, 19th Century; History, 20th Century; Humans; Meniere Disease, etiology, therapy; Neurologic Examination, history, methods; Neurotology, history, trends; Vertigo, etiology; Vestibular Diseases, diagnosis, etiology, therapy; Vestibular Evoked Myogenic Potentials, physiology; Vestibular Neuronitis, diagnosis, etiology; Vestibule, Labyrinth, physiology}, pmid = {23042057} }
D'Silva, L.J., Whitney, S.L., Santos, M., Dai, H. and Kluding, P.M.	The impact of diabetes on mobility, balance, and recovery after repositioning maneuvers in individuals with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2017	Journal of diabetes and its complications Vol. 31(6), pp. 976-982	article	DOI
Abstract: The prevalence of benign paroxysmal positional vertigo (BPPV) is higher in people with type 2 diabetes (DM). The impact of DM on mobility, balance, and management of BPPV is unknown. This prospective study compared symptom severity, mobility and balance before and after the canalith repositioning maneuver (CRM) in people with posterior canal BPPV canalithiasis, with and without DM. Fifty participants, BPPV (n=34) and BPPV+DM (n=16) were examined for symptom severity (dizziness handicap inventory, DHI), mobility (functional gait assessment, FGA), and postural sway (using an accelerometer in five conditions) before and after the CRM. The number of maneuvers required for symptom resolution was recorded. At baseline, no differences in DHI or FGA scores were seen between groups, however, people with BPPV+DM had higher sway velocity in the medio-lateral direction in tandem stance (p<0.01). After treatment, both groups improved in DHI and FGA scores (p<0.01), with no differences between groups. Decrease in sway velocity in the mediolateral direction (p=0.003) were seen in tandem stance in persons with BPPV+DM. There were no differences between the groups in the number of CRMs provided. This pilot study showed no differences in symptom severity, mobility deficits or efficacy of CRM treatments in people with posterior canal BPPV canalithiasis with and without DM. Future studies examining the impact of the severity and duration of diabetes, as well as the influence of diabetic peripheral neuropathy on functional performance are essential.
BibTeX: @article{DSilva2017, author = {D'Silva, Linda J and Whitney, Susan L and Santos, Marcio and Dai, Hongying and Kluding, Patricia M}, title = {The impact of diabetes on mobility, balance, and recovery after repositioning maneuvers in individuals with benign paroxysmal positional vertigo.}, journal = {Journal of diabetes and its complications}, year = {2017}, volume = {31}, issue = {6}, pages = {976--982}, doi = {https://doi.org/10.1016/j.jdiacomp.2017.03.006}, keywords = {Accelerometry; Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, complications, physiopathology, rehabilitation; Diabetes Mellitus, Type 2, complications, physiopathology; Dizziness, complications, pathology, physiopathology, rehabilitation; Exercise, physiology; Female; Gait, physiology; Humans; Male; Middle Aged; Moving and Lifting Patients, methods; Pilot Projects; Postural Balance, physiology; Severity of Illness Index; Canalith repositioning maneuvers; Functional mobility; Positional vertigo; Postural sway; Type 2 diabetes}, pmid = {28392043} }
Pollak, L.	The importance of repeated clinical examination in patients with suspected benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2009	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 30(3), pp. 356-358	article	DOI
Abstract: We enable patients with recurrent vertigo, who were examined during an asymptomatic period, to be reexamined on an urgent basis when the symptoms reappear. In this study, we tried to establish the usefulness of this arrangement. Retrospective case review. Outpatient clinic. We reviewed the medical records of patients treated at our dizziness clinic for benign paroxysmal positional vertigo (BPPV) during 1999-2008. The rate and characteristics of patients with BPPV where the diagnosis was established on reexamination. : Among 464 patients treated for BPPV, 364 were seen during asymptomatic period, whereas in 100 patients (21.5%), the diagnosis was established during reexamination. In 86 of them, BPPV was suspected during the first visit, and in the remaining patients, another diagnosis was initially assumed.The mean period between the first visit to final diagnosis was 14.9 months. Seven percent of patients had to be examined repeatedly until signs of BPPV could be elicited. Seventy-nine percent of patients had a laboratory examination before the diagnosis was established. At a specialized clinic, the method of reexamination in patients with recurrent vertigo and a normal neurotologic examination between attacks are useful for clarifying the diagnosis. A high confidence is justified when suspecting the diagnosis of BPPV between the attacks. Auxiliary examinations can be reserved for cases with an atypical history or abnormal findings on neurotologic testing.
BibTeX: @article{Pollak2009a, author = {Pollak, Lea}, title = {The importance of repeated clinical examination in patients with suspected benign paroxysmal positional vertigo.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2009}, volume = {30}, issue = {3}, pages = {356--358}, doi = {https://doi.org/10.1097/MAO.0b013e3181967b9c}, keywords = {Adult; Aged; Aged, 80 and over; Ambulatory Care Facilities; Dizziness, drug therapy; Electrocardiography; Female; Humans; Male; Meniere Disease, diagnosis, therapy; Middle Aged; Nystagmus, Physiologic, physiology; Recurrence; Retrospective Studies; Vertigo, diagnosis, therapy; Young Adult}, pmid = {19174708} }
Bachor, E., Wright, C.G. and Karmody, C.S.	The incidence and distribution of cupular deposits in the pediatric vestibular labyrinth. [Abstract] [BibTeX]	2002	The Laryngoscope Vol. 112(1), pp. 147-151	article	DOI
Abstract: Deposits of basophilic material on the cupulae of the semicircular ducts have been described in adult human temporal bones, and such deposits have been implicated in the clinical phenomenon of benign paroxysmal positional vertigo (BPPV). Although relatively rare, BPPV has been reported to occur in children. The goal of this study was to evaluate the occurrence of cupular deposits in pediatric material. Basic science, two-center histopathologic temporal bone study. We examined 186 temporal bones from 121 individuals between the ages of newborn and 10 years. The average age was 14.7 months. All temporal bones were acquired at autopsy, embedded in celloidin, and sectioned for light microscopic study. The cupulae of the semicircular ducts were identified and any deposits found were graded according to their size and position on the cupula. A total of 276 cupulae were identified, and in 35 (12.7%) of these a basophilic deposit was found. In many cases the deposits contained recognizable otoconial crystals. Most deposits were small and they were almost equally distributed between the three semicircular ducts. However, the lateral and posterior cupulae were somewhat more involved than the superior cupula. Our data showed that cupular deposits are less frequently found in the pediatric labyrinth, compared with adults as reported in previous studies. The lower occurrence in children versus adults suggests that the deposits may be a phenomenon of the aging vestibular labyrinth.
BibTeX: @article{Bachor2002, author = {Bachor, Edgar and Wright, Charles G and Karmody, Collin S}, title = {The incidence and distribution of cupular deposits in the pediatric vestibular labyrinth.}, journal = {The Laryngoscope}, year = {2002}, volume = {112}, issue = {1}, pages = {147--151}, doi = {https://doi.org/10.1097/00005537-200201000-00026}, keywords = {Child; Child, Preschool; Crystallization; Female; Humans; Infant; Infant, Newborn; Male; Otolithic Membrane, pathology; Pilot Projects; Semicircular Canals, pathology; Temporal Bone, pathology; Vertigo, pathology}, pmid = {11802054} }
Ford-Smith, C.D.	The individualized treatment of a patient with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	1997	Physical therapy Vol. 77(8), pp. 848-855	article
Abstract: The purpose of this case report is to describe the evaluation and treatment of a patient with vertigo. The patient was a 32-year-old male carpenter with a 17-year history of episodic vertigo that occurred when his neck was in the extended position while positioned supine and during walking. His medical and physical therapy evaluative findings were consistent with a diagnosis of benign paroxysmal positional vertigo (BPPV). He was treated with an individualized home exercise program of eye movement exercises, Brandt/Daroff exercises, and general conditioning exercises. Twenty-four days from the start of physical therapy, the patient was free of symptoms even when his neck was in the extended position.
BibTeX: @article{Ford-Smith1997, author = {Ford-Smith, C D}, title = {The individualized treatment of a patient with benign paroxysmal positional vertigo.}, journal = {Physical therapy}, year = {1997}, volume = {77}, issue = {8}, pages = {848--855}, keywords = {Adult; Exercise Therapy, methods; Eye Movements; Humans; Male; Neck, physiopathology; Patient Care Planning; Posture; Supine Position; Vertigo, diagnosis, etiology, physiopathology, rehabilitation; Vestibular Function Tests; Walking}, pmid = {9256873} }
Kotaka, S., Okubo, J. and Watanabe, I.	The influence of eye movements and tactile information on postural sway in patients with peripheral vestibular lesions. [Abstract] [BibTeX]	1986	Auris, nasus, larynx Vol. 13 Suppl 2, pp. S153-S159	article
Abstract: The statokinesigram of the 16 benign paroxysmal positional vertigo (BPPV) patients and the 28 vestibular deficits (VDS) patients were analyzed in comparison with the 20 normal subjects (NS). Velocity of the track (LNG/T), root mean square (RMS), and standard deviation area (SD-Area) were used as parameters. Fourteen different tests were done. When the result for each subject group were analyzed there were interesting differences between the compensated VDS and BPPV patients and between the untreated period and the compensated stage in each patient group. Comparing the data between NS and BPPV at the compensated stage, the latter group was unstable while watching LED with OKN on the tactile information plate (S-G plate). The significant differences were for RMS and SD-Area. The data of the NS and the untreated VDS show that the latter group was more unstable while watching LED with OKN than in the dark on the S-G plate. According to the data of the NS and the VDS at the compensated stage, the latter group was more unstable during OKN or watching LED which was almost the same as in the dark on both plate conditions. And it was more unstable while watching LED than during OKN on the S-G plate. The significant differences were for velocity of body sway (LNG/T). The neural region for compensation in BPPV patients might be on the visuo-oculomotor pathway through the peripheral retina. One of the most important regions for compensation in VDS patients might be in the rombencephalic reticular formation.
BibTeX: @article{Kotaka1986, author = {Kotaka, S and Okubo, J and Watanabe, I}, title = {The influence of eye movements and tactile information on postural sway in patients with peripheral vestibular lesions.}, journal = {Auris, nasus, larynx}, year = {1986}, volume = {13 Suppl 2}, pages = {S153--S159}, keywords = {Eye Movements; Hearing Loss, Sudden, diagnosis; Humans; Ischemic Attack, Transient, diagnosis; Labyrinth Diseases, diagnosis, physiopathology; Meniere Disease, diagnosis; Neuritis, diagnosis; Nystagmus, Physiologic; Postural Balance; Posture; Touch, physiology; Vestibular Function Tests; Vestibule, Labyrinth, blood supply, physiopathology}, pmid = {3493763} }
Walther, L.E., Blödow, A., Bloching, M.B., Buder, J., Carrillo-Cabrera, W., Roseeva, E., Borrmann, H., Simon, P. and Kniep, R.	The inner structure of human otoconia. [Abstract] [BibTeX]	2014	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 35(4), pp. 686-694	article	DOI
Abstract: The architecture of human otoconia has been only poorly understood up to now. Currently, it is assumed that otoconia contain a central core surrounded by a shell. To investigate the inner structure of human otoconia. Human otoconia were investigated by environmental scanning electron microscopy (ESEM). The diffraction behavior was analyzed using X-ray techniques (XRD). Focused ion beam (FIB) slices of otoconia were investigated by transmission electron microscopy (TEM). The results were correlated with observations on degenerate human otoconia and decalcification experiments using ethylenediaminetetraacetic acid (EDTA). Artificial otoconia (calcite-gelatine and calcite-gelatine/agarose composites) were investigated in the same way and compared with human otoconia. Human otoconia represent highly mosaic-controlled calcite-based nanocomposites. The inner structure is composed of 3 + 3 branches with an ordered arrangement of nanocomposite particles and parallel orientation of fibrils. The surrounding belly is less ordered and appears more porous. Degenerate otoconia show a successive dissolution of the belly region exposing to the inner structure (branches) in later stages of degeneration. Artificial otoconia reveal identical chemical, crystallographic and morphologic patterns. They are, however, larger in size. Human otoconia show an inner architecture consisting of a less dense belly region and 3 + 3 more dense branches meeting at a central point (center of symmetry). The differences in volume densities and the resulting solubility may play a role in BPPV. Artificial otoconia may serve as a model for further investigations.
BibTeX: @article{Walther2014a, author = {Walther, Leif Erik and Blödow, Alexander and Bloching, Marc Boris and Buder, Jana and Carrillo-Cabrera, Wilder and Roseeva, Elena and Borrmann, Horst and Simon, Paul and Kniep, Rüdiger}, title = {The inner structure of human otoconia.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2014}, volume = {35}, issue = {4}, pages = {686--694}, doi = {https://doi.org/10.1097/MAO.0000000000000206}, keywords = {Crystallography, X-Ray; Decalcification Technique; Ear, Inner, surgery; Humans; Imaging, Three-Dimensional; Microscopy, Electron, Scanning; Microscopy, Electron, Transmission; Microtomy; Models, Anatomic; Nanocomposites; Otolithic Membrane, anatomy & histology, chemistry, pathology; Tissue Embedding}, pmid = {24622023} }
Jeffery, H., Hopkins, M., Anderson, R., Patel, V. and Rogers, J.	The interpretation of static positional nystagmus in a balance clinic. [Abstract] [BibTeX]	2017	International journal of audiology Vol. 56(12), pp. 958-966	article	DOI
Abstract: To review the current criteria for the interpretation of positional nystagmus (PN). Videonystagmography data on PN was collected for 90 patients presenting for balance testing with a history of vertigo or imbalance (excluding those diagnosed with benign paroxysmal positional vertigo). These were compared to normative data from 90 asymptomatic subjects. A literature review was carried out regarding threshold criteria for clinically significant PN. These were evaluated using the data collected. Clinic group: 90 patients; 37 male, 53 female. Age range 15-82 years. Normative group: Ninety subjects; 31 male, 59 female. Age range 21-79 years. PN was seen in 75.6% of the clinic group and in 50% of the normative group. The prevalence of nystagmus of slow phase velocity (SPV) > 3°/s was significantly higher in the clinic group than the normative group. The maximum SPV recorded in each position was greater from the clinic group than the normative group. This study supports the use of normative thresholds for SPV for both horizontal and vertical PN. A normative threshold of >3°/s for horizontal and >7°/s for vertical nystagmus is proposed.
BibTeX: @article{Jeffery2017, author = {Jeffery, Hanna and Hopkins, Matthew and Anderson, Rebecca and Patel, Vignapti and Rogers, Jennifer}, title = {The interpretation of static positional nystagmus in a balance clinic.}, journal = {International journal of audiology}, year = {2017}, volume = {56}, issue = {12}, pages = {958--966}, doi = {https://doi.org/10.1080/14992027.2017.1357841}, keywords = {Adult; Aged; Case-Control Studies; Female; Humans; Male; Middle Aged; Nystagmus, Physiologic; Outpatient Clinics, Hospital; Postural Balance; Predictive Value of Tests; Prevalence; Vestibular Diseases, diagnosis, epidemiology, physiopathology; Vestibular Function Tests, methods; Vestibule, Labyrinth, physiopathology; Wales, epidemiology; Young Adult; Static; VNG; balance; nystagmus; positional; vestibular}, pmid = {28859528} }
Kim, M.-B., Hong, S.M., Choi, H., Choi, S., Pham, N.C., Shin, J.E. and Kim, C.-H.	The Light Cupula: An Emerging New Concept for Positional Vertigo. [Abstract] [BibTeX]	2018	Journal of audiology & otology Vol. 22(1), pp. 1-5	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most common type of positional vertigo. A canalolithiasis-type of BPPV involving the lateral semicircular canal (LSCC) shows a characteristic direction-changing positional nystagmus (DCPN) which beats towards the lower ear (geotropic) on turning the head to either side in a supine position. Because geotropic DCPN in LSCC canalolithiasis is transient with a latency of a few seconds, the diagnosis can be challenging if geotropic DCPN is persistent without latency. The concept of "light cupula" has been introduced to explain persistent geotropic DCPN, although the mechanism behind it requires further elucidation. In this review, we describe the characteristics of the nystagmic pattern in light cupula and discuss the current evidence for possible mechanisms explaining the phenomenon.
BibTeX: @article{Kim2018e, author = {Kim, Min-Beom and Hong, Seok Min and Choi, Hyerang and Choi, Seongjun and Pham, Ngoc Chien and Shin, Jung Eun and Kim, Chang-Hee}, title = {The Light Cupula: An Emerging New Concept for Positional Vertigo.}, journal = {Journal of audiology & otology}, year = {2018}, volume = {22}, issue = {1}, pages = {1--5}, doi = {https://doi.org/10.7874/jao.2017.00234}, keywords = {Direction-changing positional nystagmus; Head-roll test; Light cupula; Null plane; Positional vertigo}, pmid = {29061034} }
Cromwell, C., Tyler, J., Nobbs, R., Hockaday, A., Donnelly, S. and Clendaniel, R.	The Necessity for Post-Maneuver Restrictions in the Treatment of Benign Paroxysmal Positional Vertigo: An Updated Meta-Analysis of the Literature. [Abstract] [BibTeX]	2018	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 39(6), pp. 671-679	article	DOI
Abstract: Many studies have published conflicting results regarding the necessity of post-maneuver postural restrictions following treatment of benign paroxysmal positional vertigo (BPPV). The purpose of this meta-analysis is to complete an updated, comprehensive review to determine best practice following a repositioning maneuver (RM). PubMed, CINAHL, and Embase were searched through July 2016. The reference lists of the selected studies were searched for studies that were not identified in the electronic database searches. Studies investigating the effect of post-maneuver postural restrictions on RM treatment efficacy were included. The methodology, number of participants, type of RM administered, post-maneuver restrictions implemented, outcome measures, and results for each study were recorded. Following data extraction, heterogeneity and homogeneity values of included studies were determined. Risk ratios and random effects values were obtained to determine effect size. Eleven studies were included in the meta-analysis. The results of 739 total subjects were analyzed, 362 of which received post-maneuver postural restrictions and 377 of which did not. Meta-analysis revealed that there was not a statistically significant difference in treatment success rates between patients who received post-maneuver postural restrictions (90.3%) and those who did not (81.7%) (p = 0.095). There was no statistically significant difference found in treatment efficacy between subjects who received post-maneuver postural restrictions and those who did not. Based on the results of this meta-analysis, if there is any benefit from prescribing the postural restrictions, it is likely to be a small marginal improvement in outcomes.
BibTeX: @article{Cromwell2018, author = {Cromwell, Christina and Tyler, Jordan and Nobbs, Rachael and Hockaday, Adam and Donnelly, Sean and Clendaniel, Richard}, title = {The Necessity for Post-Maneuver Restrictions in the Treatment of Benign Paroxysmal Positional Vertigo: An Updated Meta-Analysis of the Literature.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2018}, volume = {39}, issue = {6}, pages = {671--679}, doi = {https://doi.org/10.1097/MAO.0000000000001798}, pmid = {29697583} }
Mostafa, B.E., Youssef, T.A. and Hamad, A.S.	The necessity of post-maneuver postural restriction in treating benign paroxysmal positional vertigo: a meta-analytic study. [Abstract] [BibTeX]	2013	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 270(3), pp. 849-852	article	DOI
Abstract: The objective of this article is to verify the role of postural restrictions after repositioning maneuvers in treating patients with benign paroxysmal positional vertigo (BPPV). The study included published articles yielded by a Pubmed search concerning post-maneuver postural restriction in treating BPPV. The search was limited to articles published in English language in the last three decades. The search was done on 1/11/2011. For the 18 relevant articles, we applied our inclusion and exclusion criteria and only 9 articles were included. The data collected from each article were statistically analyzed utilizing meta-analytic Review Manager (RevMan 5.1) software. (Version: 5.1.0.0). There were no significant differences between patients instructed with postural restriction after undergoing repositioning maneuver and patients left free to move after undergoing repositioning maneuver with regard to the presence or absence of post-maneuver symptoms. In conclusion, post-maneuver restrictions do not add to the success of the treatment of BPPV and there is no reason to submit patients to these impractical instructions.
BibTeX: @article{Mostafa2013, author = {Mostafa, Badr E and Youssef, Tamer Ali and Hamad, Ahmed S}, title = {The necessity of post-maneuver postural restriction in treating benign paroxysmal positional vertigo: a meta-analytic study.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2013}, volume = {270}, issue = {3}, pages = {849--852}, doi = {https://doi.org/10.1007/s00405-012-2046-z}, keywords = {Benign Paroxysmal Positional Vertigo; Humans; Patient Positioning, methods; Posture; Treatment Outcome; Vertigo, therapy}, pmid = {22588196} }
Dorigueto, R.S., Ganança, M.M. and Ganança, F.F.	The number of procedures required to eliminate positioning nystagmus in benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2005	Brazilian journal of otorhinolaryngology Vol. 71(6), pp. 769-775	article
Abstract: To evaluate the number of weekly canalith repositioning procedures needed to eliminate positioning nystagmus in patients with benign paroxysmal positional vertigo and to verify influences of canalithiasis or cupulolithiasis and/or semicircular canal involvement. clinical prospective with transversal cohort. Sixty patients with benign paroxysmal positional vertigo were consecutively selected according to each combination of canalithiasis or cupulolithiasis with semicircular canal involvement. Patients were treated by means of canalith repositioning procedures repeated weekly until the elimination of the positioning nystagmus. Analysis of Variance was used to verify differences between the variables. An average of 2.13 procedures (from 1 to 8) was needed to eliminate the positioning nystagmus. Canalithiasis required an average of 1.53 procedures, while cupulolithiasis needed 2.92 procedures (p=0.0002). An average of two procedures was needed to eliminate the positioning nystagmus in cases with posterior canal involvement, 2.39 procedures in cases with anterior canal involvement and 2.07 procedures in cases with lateral canal involvement (p=0.5213). From one to eight weekly canalith repositioning procedures were needed, with an average of two, to eliminate positioning nystagmus in benign paroxysmal positional vertigo. Cupulolithiasis requires a greater number of procedures than canalithiasis to eliminate positioning nystagmus. Semicircular canal involvement didn't influence the number of therapeutic maneuvers.
BibTeX: @article{Dorigueto2005, author = {Dorigueto, Ricardo Schaffeln and Ganança, Maurício Malavasi and Ganança, Fernando Freitas}, title = {The number of procedures required to eliminate positioning nystagmus in benign paroxysmal positional vertigo.}, journal = {Brazilian journal of otorhinolaryngology}, year = {2005}, volume = {71}, issue = {6}, pages = {769--775}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Analysis of Variance; Cohort Studies; Cross-Sectional Studies; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, etiology, physiopathology, therapy; Otolithic Membrane, physiopathology; Physical Therapy Modalities; Prospective Studies; Semicircular Canals, physiopathology; Vertigo, complications, physiopathology, therapy}, pmid = {16878247} }
Witsell, D.L., Rauch, S.D., Tucci, D.L., Telian, S.A., Roland, P.S., Nguyen-Huynh, A.T. and Schulz, K.	The Otology Data Collection project: report from the CHEER network. [Abstract] [BibTeX]	2011	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 145(4), pp. 572-580	article	DOI
Abstract: To describe and communicate data collected in the CHEER (Creating Healthcare Excellence through Education and Research) infrastructure proof-of-concept study to facilitate understanding of the potential capabilities of practice-based research networks and to present pilot data for development of future research initiatives. Prospective observational study of CHEER infrastructure operational capacity using a convenience sample of all patients presenting to the practices with tinnitus, dizziness, or a combination of these symptoms. The CHEER network of community and academic practice sites. The data collection exercise collected demographic, clinical, treatment, and health-related quality-of-life surveys on tinnitus, dizziness, and migraine disorders. Descriptive analysis of the data is presented. Of the sites in the CHEER network, 73% (16/22) successfully enrolled subjects; a total of 1532 patients were enrolled in 8 months. Tinnitus alone, dizziness alone, and both occurred in 28%, 34%, and 29%, respectively. Patients complaining of tinnitus and dizziness had lower quality of life than those sufferers with 1 disorder. Migraine was associated with 27% of patients. The most frequent diagnoses for patients with tinnitus and dizziness were Ménière disease (34%), vertiginous migraine (18%), and benign paroxysmal positional vertigo (16%). Descriptive data on patients with common disorders can be rapidly collected within the framework of a practice-based research network. The data in this study provide valuable pilot information on the targeted disorders, providing a baseline for development of future epidemiological data and clinical trials.
BibTeX: @article{Witsell2011, author = {Witsell, David L and Rauch, Steven D and Tucci, Debara L and Telian, Steven A and Roland, Peter S and Nguyen-Huynh, Anh T and Schulz, Kristine}, title = {The Otology Data Collection project: report from the CHEER network.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2011}, volume = {145}, issue = {4}, pages = {572--580}, doi = {https://doi.org/10.1177/0194599811416063}, keywords = {Biomedical Research, organization & administration; Community-Based Participatory Research, organization & administration; Data Collection; Dizziness, epidemiology; Female; Health Services Research, organization & administration; Humans; Male; Middle Aged; Models, Organizational; Otolaryngology, organization & administration; Program Development; Tinnitus, epidemiology}, pmid = {21771950} }
Monobe, H., Sugasawa, K. and Murofushi, T.	The outcome of the canalith repositioning procedure for benign paroxysmal positional vertigo: are there any characteristic features of treatment failure cases? [Abstract] [BibTeX]	2001	Acta oto-laryngologica. Supplementum Vol. 545, pp. 38-40	article
Abstract: To demonstrate the success rate of the canalith repositioning procedure (CRP) in our clinic and to establish any characteristic features of cases of treatment failure, we reviewed clinical records of 62 patients who were diagnosed with posterior semicircular canal-benign paroxysmal positional vertigo (BPPV) and treated with the CRP. The basic strategy of the CRP was to rotate the involved canal slowly in the plane of gravity so that free-floating materials could migrate into the utricle only once. After the procedure we instructed patients to keep their heads upright for 10 h and not to sleep on the affected ear for 2 weeks. After the initial treatment, successful results were obtained in 51 of the 62 patients (82.2%). After the second treatment, 56 patients (90.3%) experienced success. Six patients (9.7%) did not obtain resolution even after the second treatment. While 46 patients were diagnosed with idiopathic BPPV, in 16 patients a different diagnosis was determined (head injury in 7 patients, Ménière's disease in 2, vestibular neuritis in 2 and unilateral sensorineural hearing loss in 5). We categorized these 16 patients as having secondary BPPV. Patients with idiopathic BPPV showed a significantly higher success rate with CRP than those with secondary BPPV. Patients with secondary BPPV may have quantitatively or qualitatively different lesions than those with idiopathic BPPV.
BibTeX: @article{Monobe2001, author = {Monobe, H and Sugasawa, K and Murofushi, T}, title = {The outcome of the canalith repositioning procedure for benign paroxysmal positional vertigo: are there any characteristic features of treatment failure cases?}, journal = {Acta oto-laryngologica. Supplementum}, year = {2001}, volume = {545}, pages = {38--40}, keywords = {Adult; Aged; Craniocerebral Trauma, complications, epidemiology; Female; Hearing Loss, Sensorineural, complications, epidemiology; Humans; Male; Meniere Disease, complications, epidemiology; Middle Aged; Posture; Recurrence; Semicircular Canals, physiopathology; Treatment Failure; Vertigo, complications, physiopathology, therapy; Vestibular Neuronitis, complications, epidemiology}, pmid = {11677739} }
Thakar, A. and Deka, R.C.	The particle repositioning maneouvre for benign paroxysmal positioning vertigo. [Abstract] [BibTeX]	2000	Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India Vol. 52(2), pp. 128-132	article	DOI
Abstract: Thirteen consecutive cases wherein Benign Paroxysmal Positional Vertigo was diagnosed are retrospectively reviewed. The Dix-Hallpike positioning test was classically positive with a typical torsional, down beating, transient nystagmus in four of these thirteen cases. The diagnosis in the other nine was based on a suggestive history with or without subjective vertigo on the positioning test. Ten cases improved with labyrinthine suppressants and habituation exercises alone. This included all the patients wherein the Dix-Hallpike maneouvre did not elicit any nystagmus. However, in the group wherein the Dix-Hallpike maneouvre resulted in nystagmus, only one of the four improved and the particle repositioning maneouvre (PRM) was employed in the three cases with persistent symptoms. Two had immediate relief of symptoms. The particle repositioning maneouvre was repeated after three days in the one other patient and proved successful on this second occasion. Surgical treatment was not necessitated in any case, It is proposed that the particle repositioning maneouvre should be the preferred first-line treatment for any patient who on Dix-Hallpike testing demonstrates nystagmus typical of BPPV.
BibTeX: @article{Thakar2000, author = {Thakar, A and Deka, R C}, title = {The particle repositioning maneouvre for benign paroxysmal positioning vertigo.}, journal = {Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India}, year = {2000}, volume = {52}, issue = {2}, pages = {128--132}, doi = {https://doi.org/10.1007/BF03000329}, pmid = {23119650} }
Gacek, R.R. and Gacek, M.R.	The pathology of benign paroxysmal positional vertigo. [BibTeX]	2002	Advances in oto-rhino-laryngology Vol. 60, pp. 80-87	article
BibTeX: @article{Gacek2002a, author = {Gacek, Richard R and Gacek, Mark R}, title = {The pathology of benign paroxysmal positional vertigo.}, journal = {Advances in oto-rhino-laryngology}, year = {2002}, volume = {60}, pages = {80--87}, keywords = {Female; Humans; Middle Aged; Vertigo, pathology; Vestibular Nerve, pathology}, pmid = {12077901} }
Kim, H.-J. and Kim, J.-S.	The Patterns of Recurrences in Idiopathic Benign Paroxysmal Positional Vertigo and Self-treatment Evaluation. [Abstract] [BibTeX]	2017	Frontiers in neurology Vol. 8, pp. 690	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) recurs frequently. This study aims to determine that each patient with BPPV has a predilection for a specific canal and the type of recurred BPPV can be predicted from that observed during the previous attack. The involved side (right, left, and bilateral) and affected canal (posterior, geotropic horizontal, apogeotropic horizontal, anterior, and mixed) were analyzed in 224 pairs of consecutive attacks of BPPV confirmed in 167 patients at the Dizziness Clinic of Seoul National Bundang Hospital from 2003 to 2017. We defined the recurrence when patients had the redevelopment of BPPV at least 1 week after resolution of the previous one. During the initial attack, the involved canals were posterior in 134 (59.8%), geotropic horizontal in 53 (23.7%), apogeotropic horizontal in 27 (12.1%), anterior in 5 (2.2%), and mixed in 5 (2.2%). The right ear was more commonly affected than the left ear [132 (58.9%) vs. 90 (40.2%)]. Two patients (0.9%) showed bilateral involvements. During the recurrences, the proportions of involved canals and affected side were similar irrespective of those during the former event. Only 24% of the patients showed the recurrence in the same canal on the same side. The patterns of recurrences are usually discordant in patients with BPPV. Instruction for self-administration of a specific canalith repositioning procedure based on the previous type of BPPV may have a limited efficacy in this frequently recurrent disorder.
BibTeX: @article{Kim2017, author = {Kim, Hyo-Jung and Kim, Ji-Soo}, title = {The Patterns of Recurrences in Idiopathic Benign Paroxysmal Positional Vertigo and Self-treatment Evaluation.}, journal = {Frontiers in neurology}, year = {2017}, volume = {8}, pages = {690}, doi = {https://doi.org/10.3389/fneur.2017.00690}, keywords = {benign paroxysmal positional vertigo; recurrence; self-administration; treatment; vertigo}, pmid = {29326650} }
Bisdorff, A.R., Wolsley, C.J., Anastasopoulos, D., Bronstein, A.M. and Gresty, M.A.	The perception of body verticality (subjective postural vertical) in peripheral and central vestibular disorders. [Abstract] [BibTeX]	1996	Brain : a journal of neurology Vol. 119 ( Pt 5), pp. 1523-1534	article
Abstract: The perception of body verticality (subjective postural vertical, SPV) was assessed in normal subjects and in patients with peripheral and central vestibular lesions and the data were compared with conventional neuro-otological assessments. Subjects were seated with eyes closed in a motorized gimbal which executed cycles of tilt at low constant speed (1.5 degrees s-1), both in the frontal (roll) and sagittal (pitch) planes. Subjects indicated with a joystick when they entered and left verticality, thus defining a sector of subjective uprightness in each plane. The mean angle of tilt (identifying a bias of the SPV) and the width of the sector (defining sensitivity of the SPV) were then determined. In normal subjects, the angle of the "verticality' sector was 5.9 degrees for pitch and roll. Patients with bilateral absence of vestibular function, patients with vertigo, i.e. acute unilateral lesions, benign paroxysmal positional vertigo (BPPV) and Ménière's disease, and patients with positionally modulated up-/downbeat nystagmus all had enlarged sectors (i.e. loss in sensitivity). Mean sector angle in these groups ranged from 7.8 to 11 degrees and the abnormality was present both in pitch and roll, regardless of the direction of nystagmus or body sway. Patients with chronic unilateral peripheral vestibular lesions and those with position-independent vertical nystagmus had normal sensitivities. No significant bias of the SPV was found in any patient group, not even those with acute unilateral vestibular lesions who had marked tilts of the subjective visual vertical (SVV). Complementary experiments in normal subjects tested under galvanic vestibular or roll-plane optokinetic stimulation also failed to show biases of the SPV. In contrast, a significant bias in the SPV could be induced in normal subjects by asymmetric cycles of gimbals tilt, presumably by proprioceptive adaptation. The following conclusions can be drawn. (i) The perception of body verticality whilst seated is mainly dependent on proprioceptive/contact cues but these are susceptible to tilt-mediated adaptation. (ii) Vestibular input improves the sensitivity of the SPV, even in vestibular disorders, as long as the abnormality is stable. (iii) There can be marked dissociation between vestibulo-motor (ocular and postural) phenomena and the perception of body verticality, and between the SPV and SVV. (iv) The postural sway asymmetries in patients with peripheral and central vestibular lesions, like those induced by galvanic or optokinetic stimulation in normal subjects, are not consequences of changes of the SPV.
BibTeX: @article{Bisdorff1996, author = {Bisdorff, A R and Wolsley, C J and Anastasopoulos, D and Bronstein, A M and Gresty, M A}, title = {The perception of body verticality (subjective postural vertical) in peripheral and central vestibular disorders.}, journal = {Brain : a journal of neurology}, year = {1996}, volume = {119 ( Pt 5)}, pages = {1523--1534}, keywords = {Adolescent; Adult; Aged; Female; Humans; Male; Middle Aged; Perception, physiology; Posture, physiology; Vestibular Diseases, physiopathology; Vestibular Function Tests; Visual Perception, physiology}, pmid = {8931577} }
Goto, F., Hayashi, K., Kunihiro, T. and Ogawa, K.	The possible contribution of angiitis to the onset of benign paroxysmal positional vertigo (BPPV). [Abstract] [BibTeX]	2010	The international tinnitus journal Vol. 16(1), pp. 25-28	article
Abstract: The aim was to evaluate the oxidative stress and the angiitis in patients with BPPV. Patients with benign paroxysmal positional vertigo (BPPV) within 14 days of onset were analyzed. The level of diacron reactive oxygen metabolites (d-ROM) and circulating soluble vascular cell adhesion molecule 1 (VCAM-1), were evaluated. As a treatment the patients were taught to perform the Brandt-Daroff exercise at home by themselves. The prognosis of BPPV, which is measured as the time until the disappearance of positional nystagmus by a physician during the outpatient visit each week, the relation among the level of oxygen metabolites, vascular molecule and the duration until remission were analyzed. The patients who required longer time for the disappearance of positional nystagmus showed high d-ROM and VCAM levels, whereas those who required shorter time for remission showed lower d-ROM and VCAM levels. There is an increased expression of VCAM-1 and d-ROM confirming the existence of an angiitis and supporting the vascular involvement in BPPV. The identification of the high levels of d-ROM and VCAM-1 can open the way to selective pharmacological treatments able to correct the oxidative stress and activation of endothelial cells.
BibTeX: @article{Goto2010, author = {Goto, Fumiyuki and Hayashi, Ken and Kunihiro, Takanobu and Ogawa, Kaoru}, title = {The possible contribution of angiitis to the onset of benign paroxysmal positional vertigo (BPPV).}, journal = {The international tinnitus journal}, year = {2010}, volume = {16}, issue = {1}, pages = {25--28}, keywords = {Adult; Aged; Audiometry, Pure-Tone; Brain Ischemia, complications, metabolism, physiopathology; Female; Humans; Male; Middle Aged; Nystagmus, Physiologic, physiology; Oxidative Stress, physiology; Prospective Studies; Vascular Cell Adhesion Molecule-1, metabolism; Vasculitis, Central Nervous System, complications, metabolism, physiopathology; Vertigo, etiology, metabolism, physiopathology; Vestibule, Labyrinth, metabolism, physiopathology}, pmid = {21609909} }
Tsai, K.-L., Wang, C.-T., Kuo, C.-H., Cheng, Y.-Y., Ma, H.-I., Hung, C.-H., Tsai, Y.-J. and Kao, C.-L.	The potential role of epigenetic modulations in BPPV maneuver exercises. [Abstract] [BibTeX]	2016	Oncotarget Vol. 7(24), pp. 35522-35534	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is one of the most common complaints encountered in clinics and is strongly correlated with advanced age or, possibly, degeneration. Redistribution exercises are the most effective approaches to treat BPPV, and canalith repositioning procedure (CRP) cure most BPPV cases. However, the mechanisms through which the treatment modulates systemic molecules in BPPV patients remain largely unknown. In this study, we report that the miR-34a and Sirtuin 1 (SIRT1) genes correlated with the treatment effects of CRP in BPPV subjects. We found that miR-34a expression was largely inhibited and SIRT1 expression was significantly reversed after BPPV maneuver treatment. We also confirmed that the PPAR-γ, PGC-1 and FoxO gene expressions were decreased immediately after canalith repositioning procedure (CRP) for BPPV, and were largely increased after a complete cure of BPPV. Moreover, we observed that after a complete recovery of BPPV, the ROS concentrations, pro-inflammatory cytokine concentrations and p53 expression levels were attenuated. We conclude that BPPV treatment might involve some epigenetic regulations through the mediation of miR-34a, SIRT1 functions and repression of redox status.
BibTeX: @article{Tsai2016, author = {Tsai, Kun-Ling and Wang, Chia-To and Kuo, Chia-Hua and Cheng, Yuan-Yang and Ma, Hsin-I and Hung, Ching-Hsia and Tsai, Yi-Ju and Kao, Chung-Lan}, title = {The potential role of epigenetic modulations in BPPV maneuver exercises.}, journal = {Oncotarget}, year = {2016}, volume = {7}, issue = {24}, pages = {35522--35534}, doi = {https://doi.org/10.18632/oncotarget.9446}, keywords = {Age Factors; Aged; Benign Paroxysmal Positional Vertigo, blood, genetics, therapy; Cytokines, metabolism; Epigenesis, Genetic; Exercise Therapy; Forkhead Box Protein O1, metabolism; Gene Expression Regulation; Humans; MicroRNAs, blood, metabolism; Middle Aged; Otolithic Membrane, physiopathology; PPAR gamma, metabolism; Peroxisome Proliferator-Activated Receptor Gamma Coactivator 1-alpha, metabolism; Reactive Oxygen Species, metabolism; Semicircular Canals, physiopathology; Sirtuin 1, metabolism; Treatment Outcome; Tumor Suppressor Protein p53, metabolism; Gerotarget; Sirtuin 1; benign paroxysmal positional vertigo; maneuver exercises; microRNA}, pmid = {27203679} }
McCaslin, D.L., Jacobson, G.P. and Gruenwald, J.M.	The predominant forms of vertigo in children and their associated findings on balance function testing. [Abstract] [BibTeX]	2011	Otolaryngologic clinics of North America Vol. 44(2), pp. 291-307, vii	article	DOI
Abstract: This article reports vestibular laboratory findings from the most common disorders known to cause dizziness and vertigo in children. Specific information regarding migraine, trauma, benign paroxysmal vertigo of childhood, vestibular neuritis, and otitis media is reviewed, along with indications for balance function testing in children.
BibTeX: @article{McCaslin2011, author = {McCaslin, Devin L and Jacobson, Gary P and Gruenwald, Jill M}, title = {The predominant forms of vertigo in children and their associated findings on balance function testing.}, journal = {Otolaryngologic clinics of North America}, year = {2011}, volume = {44}, issue = {2}, pages = {291--307, vii}, doi = {https://doi.org/10.1016/j.otc.2011.01.003}, keywords = {Algorithms; Benign Paroxysmal Positional Vertigo; Caloric Tests; Craniocerebral Trauma, complications; Diagnosis, Differential; Electronystagmography; Humans; Migraine Disorders, complications; Nystagmus, Pathologic, physiopathology; Otitis Media, complications, physiopathology; Postural Balance; Vertigo, diagnosis, etiology, physiopathology; Vestibular Function Tests; Vestibular Neuronitis, complications, diagnosis, physiopathology}, pmid = {21474005} }
Bruintjes, T.D., van der Zaag-Loonen, H.J., Eggelmeijer, F. and van Leeuwen, R.B.	The prevalence of benign paroxysmal positional vertigo in patients with osteoporosis. [Abstract] [BibTeX]	2018	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 275(12), pp. 3083-3086	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of dizziness. There is some evidence that osteoporosis is a risk factor for BPPV. To determine the prevalence of BPPV in patients with proven osteoporosis. We examined 187 new consecutive patients who attended our osteoporosis clinic. All patients had proven osteoporosis (DEXA scan resulting in a T score ≤ - 2.5). Patients completed a screening questionnaire assessing the presence of episodic vertigo provoked by changes in head position. When we suspected the presence of BPPV, we performed a Dix-Hallpike manoeuvre and a supine roll test. If the diagnostic procedure was positive, a (therapeutic) canalith repositioning manoeuvre (CRM) was performed. Twelve out of 187 patients had a history of typical vertigo compatible with BPPV. In four patients, the presence of BPPV was confirmed by means of a positive Dix-Hallpike manoeuvre. The prevalence of BPPV in this population of patients with osteoporosis was 2.1% (95% CI 0.8-5.4%). The prevalence of BPPV in patients with osteoporosis is low. Based on this study, we suggest that there does not seem to be a relation between osteoporosis and BPPV.
BibTeX: @article{Bruintjes2018, author = {Bruintjes, Tjasse D and van der Zaag-Loonen, Hester J and Eggelmeijer, Frank and van Leeuwen, Roeland B}, title = {The prevalence of benign paroxysmal positional vertigo in patients with osteoporosis.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2018}, volume = {275}, issue = {12}, pages = {3083--3086}, doi = {https://doi.org/10.1007/s00405-018-5164-4}, keywords = {Absorptiometry, Photon; Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, diagnosis, epidemiology, therapy; Cohort Studies; Dizziness, etiology; Female; Humans; Male; Middle Aged; Osteoporosis, complications; Prevalence; BPPV; Osteoporosis; Vertigo}, pmid = {30315360} }
Sari, K., Yildirim, T., Borekci, H., Akin, I., Aydin, R. and Ozkiris, M.	The relationship between benign paroxysmal positional vertigo and thyroid autoimmunity. [Abstract] [BibTeX]	2015	Acta oto-laryngologica Vol. 135(8), pp. 754-757	article	DOI
Abstract: Although there have been few studies concerning BPPV and thyroid autoimmunity and a positive relation was found between them, this study didn't find any relation between BPPV and thyroid autoimmunity. IT is thought that further large-scale studies must be done to clarify the relation. Benign paroxysmal positional vertigo (BPPV) consists of ∼ 20% of vestibular disorders. Self-limited rotatory nystagmus with positional vertigo are the main findings of BPPV. Although canalolithiasis theory was confirmed by demonstrating freely floating debris in the endolymph of the posterior semicircular channel in following studies, currently, the etiology hasn't been explained totally. This study investigated the relation of BPPV and thyroid autoimmunity evaluated via measurement of serum thyroid autoantibodies. Fifty patients (37 female, 13 male) with BPPV (BPPV group), 52 patients (40 female, 12 male) with non-BPPV vertigo (non-BPPV group) and 60 otherwise normal control (38 female, 22 male) samples were enrolled in the study. All samples of BPPV, non-BPPV groups and controls had undergone a cochleovestibular test following thorough ENT examination. After blood samples were drawn from each subject, thyroid-stimulating hormone (TSH), anti-thyroid peroxidase antibody (TPO-Ab) and anti-thyroglobulin antibody (TG-Ab) levels were measured accordingly. In the study, eight patients of the BPPV group (16%) had a high thyroid antibody level. In the non-BPPV group, six patients (11.5%) had elevated thyroid antibodies. In the control group, 15 patients (25%) had elevated thyroid antibodies. TSH values of all subjects were detected to be within normal range. No statistical difference was found between the groups with respect to TG-Ab and TPO-Ab values (p-values = 0.729 and 0.812, respectively).
BibTeX: @article{Sari2015, author = {Sari, Kamran and Yildirim, Tekin and Borekci, Hasan and Akin, Ibrahim and Aydin, Reha and Ozkiris, Mahmut}, title = {The relationship between benign paroxysmal positional vertigo and thyroid autoimmunity.}, journal = {Acta oto-laryngologica}, year = {2015}, volume = {135}, issue = {8}, pages = {754--757}, doi = {https://doi.org/10.3109/00016489.2015.1021932}, keywords = {Adult; Autoantibodies, immunology, metabolism; Autoimmunity; Benign Paroxysmal Positional Vertigo, etiology, immunology, physiopathology; Female; Humans; Male; Middle Aged; Posture, physiology; Retrospective Studies; Thyroid Gland, immunology, metabolism; Thyroiditis, Autoimmune, complications, immunology, metabolism; Positional vertigo; anti-thyroglobulin antibody; anti-thyroid peroxidase antbody; autoimmun thyroidit; immun complex}, pmid = {25761528} }
Aydın, E., Babakurban, S.T., Ozgirgin, O.N. and Ozlüoğlu, L.N.	The relationship of homocysteine, vitamin B12, folic acid levels with vertigo. [Abstract] [BibTeX]	2012	Kulak burun bogaz ihtisas dergisi : KBB = Journal of ear, nose, and throat Vol. 22(4), pp. 214-218	article	DOI
Abstract: In this study the relationship of serum homocysteine, vitamin B12, folic acid levels and peripheral vestibular dysfunction (PVD) was investigated. Forty-one patients (31 females, 10 males; mean age 57.34±14.3 years; range 12 to 80 years) who admitted to Baskent University Hospital Ear Nose and Throat Department between the dates of April 2005 - December 2007 with complaint of vertigo were prospectively analyzed and diagnosed using audio-vestibular test, at the same time serum homocysteine, vitamin B12, folic acid measurements was done from the blood samples of patients. The patients were divided into three groups as Meniere's disease, vestibular neurinitis, and benign paroxismal positional vertigo (BPPV) according to the diagnoses and serum homocysteine, vitamin B12, folic acid levels of patients were compared to normal values in and between groups. Of the patients, 29.3% (n=12) were diagnosed with Meniere's disease, 36.6% (n=15) with vestibular neurinitis, and 34.1% (n=14) with BPPV. Serum homocysteine leves of patients were 12.42±3.56 umol/L, 11.32±4.14 umol/L and 10.72±2.95 umol/L (p>0.05) in Meniere's disease, vestibular neurinitis, and BPPV respectively; vitamin B12 levels were 371.58±141.35 pg/ml, 288.13±139.51 pg/ml, 352.14±150.41 pg/ml (p>0.05) respectively and folic acid levels were 8.76±3.2 umol/L, 10.63±6.59 umol/L, 8.8±3.18 umol/L (p>0.05) respectively. The values were similar in all patients. No statistically significant difference was found in and between groups comparing with normal values. This is the first prospective study investigating the relationship of serum homocystein, vitamin B12 and folic acid levels with PVD. We found that there is no relationship of homocysteine, vitamin B12, folic acid levels with PVD.
BibTeX: @article{Aydin2012, author = {Aydın, Erdinç and Babakurban, Seda Türkoğlu and Ozgirgin, Osman Nuri and Ozlüoğlu, Levent Naci}, title = {The relationship of homocysteine, vitamin B12, folic acid levels with vertigo.}, journal = {Kulak burun bogaz ihtisas dergisi : KBB = Journal of ear, nose, and throat}, year = {2012}, volume = {22}, issue = {4}, pages = {214--218}, doi = {https://doi.org/10.5606/kbbihtisas.2012.041}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Audiology; Benign Paroxysmal Positional Vertigo; Child; Electronystagmography; Female; Folic Acid, blood; Homocysteine, blood; Humans; Male; Meniere Disease, blood, diagnosis; Middle Aged; Prospective Studies; Vertigo, blood, diagnosis; Vestibular Diseases, blood; Vestibular Neuronitis, blood, diagnosis; Vitamin B 12, blood; Young Adult}, pmid = {22770256} }
Yanik, B., Külcü, D.G., Kurtais, Y., Boynukalin, S., Kurtarah, H. and Gökmen, D.	The reliability and validity of the Vertigo Symptom Scale and the Vertigo Dizziness Imbalance Questionnaires in a Turkish patient population with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2008	Journal of vestibular research : equilibrium & orientation Vol. 18(2-3), pp. 159-170	article
Abstract: The aim of this study was to adapt the Vertigo Symptom Scale (VSS) and the Vertigo Dizziness Imbalance (VDI) Questionnaires to the Turkish population and investigate the reliability and validity of the Turkish version. One hundred and three patients with Benign Paroxysmal Positional Vertigo (BPPV) were included in the study. The patients were evaluated with the VSS and the VDI twice, at recruitment and 24 hours later. To perform concurrent validity study study, patients were also assessed by the Beck Depression Inventory (BDI) and the Medical Outcomes Survey Short Form 36 (SF-36) which were formerly proved to be valid and reliable for use in Turkish population. The internal consistency of the VSS, VDI-symptom scale, and VDI-health-related quality of life scale were good with Cronbach's alpha of 0.91, 0.85, and 0.93 respectively which showed high reliability for the Turkish versions. Test-retest reliability was also good, with a high intraclass correlation coefficient (ICC) between the two time points; being 0.83 for the VSS, 0.90 for the VDI-symptom scale and 0.89 for the VDI-health related quality of life scale. Regarding concurrent validity, significant expected correlations were detected between the VSS and BDI (r = 0.55 p < 0.001) and the VSS and SF-36 (r = -0.43 p < 0.001). Significant low correlations were detected between the VDI-SS and BDI (r = 0.20 p < 0.05) and the VDI-SS and SF-36 (r = -0.21 p < 0.05). High correlations were observed between the VDI-HRQoL and BDI (r = -0.75 p < 0.001) and the VDI-HRQoL and SF-36 (r = 0.82, p < 0.001) which indicates high concurrent validity. The correlation between VDI-SS subscale scores and VDI-HRQoL subscale scores were 0.028 (P = 0.778) at the first time point. From the perspective of discriminant validity, it means that the VDI-SS measures a construct different from the one underlying the VDI-HRQoL. The adaptation of the VSS and VDI to the Turkish population was successful and both scales were found to be valid and reliable. Thus, they can be used in Turkish people with BPPV for assessment and monitoring the treatments. Besides, the results of the national studies in which these Turkish versions are used can be compared with those of the international studies.
BibTeX: @article{Yanik2008, author = {Yanik, Burcu and Külcü, Duygu Geler and Kurtais, Yesim and Boynukalin, Serife and Kurtarah, Hanifi and Gökmen, Derya}, title = {The reliability and validity of the Vertigo Symptom Scale and the Vertigo Dizziness Imbalance Questionnaires in a Turkish patient population with benign paroxysmal positional vertigo.}, journal = {Journal of vestibular research : equilibrium & orientation}, year = {2008}, volume = {18}, issue = {2-3}, pages = {159--170}, keywords = {Adult; Aged; Cross-Cultural Comparison; Female; Humans; Male; Middle Aged; Postural Balance; Quality of Life, psychology; Reproducibility of Results; Sensitivity and Specificity; Severity of Illness Index; Surveys and Questionnaires; Turkey; Vertigo, diagnosis, psychology}, pmid = {19126986} }
Hong, S.M., Yeo, S.G., Kim, S.W. and Cha, C.I.	The results of vestibular evoked myogenic potentials, with consideration of age-related changes, in vestibular neuritis, benign paroxysmal positional vertigo, and Meniere's disease. [Abstract] [BibTeX]	2008	Acta oto-laryngologica Vol. 128(8), pp. 861-865	article	DOI
Abstract: We interpreted VEMP findings in patients with the three major peripheral vertigo diseases, taking age-related changes into consideration. We found different abnormal VEMP rates among the three diseases, as well as differences in the proportion of parameters that were abnormal, according to the type of disease. Vestibular neuritis, benign paroxysmal positional vertigo (BPPV), and Meniere's disease, common diseases that cause peripheral vertigo, often affect the saccule or inferior vestibular nerve, which are pathways of vestibular evoked myogenic potential (VEMP). Also, aging could have a primary effect on diminished VEMP responses. Our study investigated VEMP the findings in patients with the diseases in relation to their age. A total of 134 patients with vestibular neuritis, 62 with BPPV, and 29 with Meniere's disease were enrolled in this study. The VEMP findings in patients within the three disease groups were interpreted using our own normative ranges according to age. Abnormal VEMP rates in the vestibular neuritis, BPPV, and Meniere's disease groups were 36.6%, 25.8%, and 69%, respectively. The proportion of prolonged p13 latency in BPPV patients with abnormal VEMP responses was relatively high compared with the other two diseases. VEMP asymmetry in the patients with Meniere's disease was relatively high.
BibTeX: @article{Hong2008a, author = {Hong, Seok Min and Yeo, Seung Geun and Kim, Sung Wan and Cha, Chang Il}, title = {The results of vestibular evoked myogenic potentials, with consideration of age-related changes, in vestibular neuritis, benign paroxysmal positional vertigo, and Meniere's disease.}, journal = {Acta oto-laryngologica}, year = {2008}, volume = {128}, issue = {8}, pages = {861--865}, doi = {https://doi.org/10.1080/00016480701784981}, keywords = {Acoustic Stimulation; Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Electromyography; Evoked Potentials, physiology; Female; Humans; Male; Meniere Disease, physiopathology; Middle Aged; Neck Muscles, physiopathology; Vertigo, physiopathology; Vestibular Function Tests; Vestibular Neuronitis, physiopathology; Young Adult}, pmid = {18607943} }
Dallan, I., Bruschini, L., Neri, E., Nacci, A., Segnini, G., Rognini, F. and Casani, A.P.	The role of high-resolution magnetic resonance in atypical and intractable benign paroxysmal positional vertigo: our preliminary experience. [Abstract] [BibTeX]	2007	ORL; journal for oto-rhino-laryngology and its related specialties Vol. 69(4), pp. 212-217	article	DOI
Abstract: The diagnosis of benign paroxysmal positional vertigo (BPPV) is easy when typical nystagmus is present. However, diagnostic doubts arise when faced with cases presenting atypical features of the positional paroxysmal nystagmus as well as the clinical course and disease evolution. A morphological evaluation of inner ear structures via high-resolution magnetic resonance (HR-MR) studies has been performed in 2 patients that did not respond to traditional therapeutic manoeuvres. In 1 patient, a filling defect at the level of the middle portion of the right lateral semicircular canal (LSC) has been demonstrated, while in the second one, a geometric-architectural abnormality - a 'fold' in the LSC - has been observed. HR-MR study of the inner ear offers a meaningful contribution to interpreting the physiopathogenesis of atypical cases of BPPV. HR-MR of the inner ear is a safe and useful tool to investigate patients with atypical and intractable BPPV.
BibTeX: @article{Dallan2007, author = {Dallan, Iacopo and Bruschini, Luca and Neri, Emanuele and Nacci, Andrea and Segnini, Giovanni and Rognini, Ferdinando and Casani, Augusto Pietro}, title = {The role of high-resolution magnetic resonance in atypical and intractable benign paroxysmal positional vertigo: our preliminary experience.}, journal = {ORL; journal for oto-rhino-laryngology and its related specialties}, year = {2007}, volume = {69}, issue = {4}, pages = {212--217}, doi = {https://doi.org/10.1159/000101541}, keywords = {Adult; Brain Injuries, complications; Female; Humans; Magnetic Resonance Imaging, methods; Male; Middle Aged; Otologic Surgical Procedures, methods; Reconstructive Surgical Procedures, methods; Semicircular Canals, pathology, surgery; Vertigo, diagnosis, etiology, surgery}, pmid = {17409779} }
Güçlütürk, M.T., Ünal, Z.N., İsmi, O., Çimen, M.B.Y. and Ünal, M.	The Role of Oxidative Stress and Inflammatory Mediators in Benign Paroxysmal Positional Vertigo. [Abstract] [BibTeX]	2016	The journal of international advanced otology Vol. 12(1), pp. 101-105	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral cause of vertigo. It can be defined as transient vertigo induced by rapid changes in head position associated with a characteristic paroxysmal positional nystagmus. The aim of this study was to search for the possible role of oxidative stress and inflammatory mediators in the pathogenesis of BPPV. Total antioxidant status as well as paraoxonase, tumor necrosis factor alpha, interleukin (IL) 6, and IL-1β levels were evaluated in peripheral venous serum samples of 30 BPPV and 30 control patients. Total antioxidant status levels were lower in the BPPV group than in the control group (p=0.008). After Epley's repositioning maneuver in the vertigo group, there was a statistically significant decline in IL-1β levels at the first and third month visits (p=0.014 for first month and p=0.013 for third month). Our findings suggested that IL-1β and oxidative stress contributed to the pathogenesis of BPPV.
BibTeX: @article{Guecluetuerk2016, author = {Güçlütürk, Mehmet Taylan and Ünal, Zeynep Nil and İsmi, Onur and Çimen, Mehmet Burak Yavuz and Ünal, Murat}, title = {The Role of Oxidative Stress and Inflammatory Mediators in Benign Paroxysmal Positional Vertigo.}, journal = {The journal of international advanced otology}, year = {2016}, volume = {12}, issue = {1}, pages = {101--105}, doi = {https://doi.org/10.5152/iao.2015.1412}, keywords = {Aryldialkylphosphatase, blood; Benign Paroxysmal Positional Vertigo, diagnosis, physiopathology; Female; Humans; Inflammation Mediators, blood; Interleukin-1beta, blood; Interleukin-6, blood; Male; Middle Aged; Oxidative Stress, physiology; Reference Values; Tumor Necrosis Factor-alpha, blood}, pmid = {27340993} }
Papacharalampous, G.X., Vlastarakos, P.V., Kotsis, G.P., Davilis, D. and Manolopoulos, L.	The Role of Postural Restrictions after BPPV Treatment: Real Effect on Successful Treatment and BPPV's Recurrence Rates. [Abstract] [BibTeX]	2012	International journal of otolaryngology Vol. 2012, pp. 932847	article	DOI
Abstract: Background. Canalith repositioning techniques are adequately established in the literature, as the treatment of choice for benign paroxysmal positional vertigo. However, the role of the posttreatment instructions is still not clearly defined. Patients and Methods. A retrospective chart review of 82 patients was conducted in order to determine the efficacy of postural restrictions, when combined with the classic canalith repositioning techniques, in terms of successful treatment and recurrence rates. Follow-up period reached at least 12 months after the initial treatment. Results. In this study, postural restrictions did not appear to significantly affect the outcomes of repositioning maneuvers, as well as the recurrence rate. Conclusions. Although this study, as well as most recent control studies, states that there is no significant effect of postmaneuver postural restrictions on both treatment and recurrence rates, larger multicentric research projects, adopting improved methodology, are still necessary in order to determine the contribution of such restrictions to both the therapeutic results and the prevention of recurrence. Adequate followup, focusing on the first six months after the initially successful repositioning maneuver, is also of paramount importance.
BibTeX: @article{Papacharalampous2012, author = {Papacharalampous, George X and Vlastarakos, P V and Kotsis, G P and Davilis, D and Manolopoulos, L}, title = {The Role of Postural Restrictions after BPPV Treatment: Real Effect on Successful Treatment and BPPV's Recurrence Rates.}, journal = {International journal of otolaryngology}, year = {2012}, volume = {2012}, pages = {932847}, doi = {https://doi.org/10.1155/2012/932847}, pmid = {22518162} }
Phillips, J.S., FitzGerald, J.E. and Bath, A.P.	The role of the vestibular assessment. [Abstract] [BibTeX]	2009	The Journal of laryngology and otology Vol. 123(11), pp. 1212-1215	article	DOI
Abstract: To evaluate the role of vestibular assessment in the management of the dizzy patient. A retrospective review of case notes and vestibular assessment reports of 100 consecutive patients referred for vestibular assessment. Sixty of the 100 patients had an abnormal vestibular assessment. Eleven patients had benign paroxysmal positional vertigo as the sole diagnosis, of whom nine had not had a Dix-Hallpike manoeuvre performed before referral. Of patients referred for vestibular rehabilitation, 76 per cent had an abnormal electrophysiological assessment. After vestibular assessment, 35 patients were discharged with no further follow-up appointments in the ENT department. All patients should have a Dix-Hallpike manoeuvre performed prior to referral for vestibular assessment. The majority of our patients undergoing vestibular rehabilitation had abnormal test results, although a significant number did not. Prior to referral, it is worth considering the implication of a 'normal' and 'abnormal' result for the management of the patient. Careful consideration should be given to the development of dedicated dizziness clinics run by practitioners with a specialist interest in balance disorders, in order to ensure appropriate requests for vestibular assessment.
BibTeX: @article{Phillips2009, author = {Phillips, J S and FitzGerald, J E and Bath, A P}, title = {The role of the vestibular assessment.}, journal = {The Journal of laryngology and otology}, year = {2009}, volume = {123}, issue = {11}, pages = {1212--1215}, doi = {https://doi.org/10.1017/S0022215109005611}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Dizziness, diagnosis, rehabilitation; Female; Humans; Male; Medical Audit; Middle Aged; Referral and Consultation, statistics & numerical data; Retrospective Studies; Vertigo, diagnosis, rehabilitation; Vestibular Function Tests, methods; Young Adult}, pmid = {19566970} }
Krempaska, S. and Koval, J.	The role of vestibular evoked myogenic potentials (VEMPs) in vestibulopathy diagnostics. [Abstract] [BibTeX]	2012	Bratislavske lekarske listy Vol. 113(5), pp. 301-306	article
Abstract: This study presents the role of vestibular evoked myogenic potentials (VEMPs) in the vestibular system investigation focused on the function of the saccule and inferior portion of the vestibular nerve. The main goal of the study is to report VEMP findings in different groups of patients with inner ear disorders symptoms and to identify some clinical application of this test in our patients. WE have examined 218 patients with cochleovestibular symptomatology (sudden sensorineural cochlear hearing loss, retrocochlear hearing loss, vestibular neuronitis, benign paroxysmal positional vertigo (BPPV), Meniere´s disease, central vestibular disorder, as well as vertigo of non vestibular ethiology and 32 patients with conductive hearing loss with VEMP testing. We performed I channel and II channels measurements. We found no VEMP response in the group of conductive or mixed hearing loss in all cases - 100 % of 32 patients, in sudden sensorineural cochlear hearing loss in 35.4 % of 48 patients, in retrocochlear hearing loss in 19 % of 26 patients, in vestibular neuronitis in 40 % of 35 patients , in (BPPV) in 10 % of 43 patients, in Meniere´s disease in 61 % of 18 patients, in non vestibular vertigo in no case of 22 patients and in central vestibular disorders in 35 % of 23 patients. The present study shows the potential value of VEMP investigation in periferal vestibulopathy diagnosis (Tab. 1, Fig. 7, Ref. 33).
BibTeX: @article{Krempaska2012, author = {Krempaska, S and Koval, J}, title = {The role of vestibular evoked myogenic potentials (VEMPs) in vestibulopathy diagnostics.}, journal = {Bratislavske lekarske listy}, year = {2012}, volume = {113}, issue = {5}, pages = {301--306}, keywords = {Adolescent; Adult; Aged; Female; Hearing Loss, complications, etiology; Humans; Male; Middle Aged; Vestibular Diseases, complications, diagnosis; Vestibular Evoked Myogenic Potentials; Young Adult}, pmid = {22616590} }
Meghji, S., Murphy, D., Nunney, I. and Phillips, J.S.	The Seasonal Variation of Benign Paroxysmal Positional Vertigo. [Abstract] [BibTeX]	2017	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 38(9), pp. 1315-1318	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is characterized by recurrent episodes of positional vertigo due to dislodged otoconia debris within the semicircular canals. Many studies have proposed a correlation between Vitamin-D deficiency and recurrent BPPV. In the UK, serum Vitamin-D falls during the winter, reaching its lowest level in May and it is highest level in September. We hypothesize that if there is a relationship between BPPV and Vitamin-D levels, one would expect to see a seasonal variation in the incidence of BPPV among UK residents. A retrospective review of clinic letters and general practitioner referrals for patients presenting to a University Otolaryngology department over a 4-year period. Patients were divided into two groups: those presenting during the months associated with low serum Vitamin-D levels, and those presenting during the months associated with high serum Vitamin-D levels. Three hundred thirty-nine patients were identified with posterior canal BPPV as a consequence of having had a positive Dix-Hallpike maneuver recorded in the clinical notes between October 2012 and October 2016. A Wilcoxon rank-sum test demonstrated there to be a statistically significant difference between the low serum Vitamin-D group and the high serum Vitamin-D group (p = 0.0367). The results confirm that there is a seasonal variation in the incidence of BPPV. This study is important as it adds to the mounting literature suggesting an association between serum Vitamin-D levels and BPPV. Second, it suggests a therapeutic strategy to improve outcomes in affected patients. Third, it adds significance to the hypothesized role of calcium metabolism for the development of inner ear disease.
BibTeX: @article{Meghji2017, author = {Meghji, Sheneen and Murphy, Declan and Nunney, Ian and Phillips, John S}, title = {The Seasonal Variation of Benign Paroxysmal Positional Vertigo.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2017}, volume = {38}, issue = {9}, pages = {1315--1318}, doi = {https://doi.org/10.1097/MAO.0000000000001534}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, blood, epidemiology, physiopathology; Female; Humans; Incidence; Male; Middle Aged; Otolithic Membrane, physiopathology; Physical Examination; Retrospective Studies; Seasons; Semicircular Canals, physiopathology; Vitamin D, blood; Vitamin D Deficiency, blood, epidemiology, physiopathology}, pmid = {28796081} }
Lim, H.J., Park, K., Park, H.Y. and Choung, Y.-H.	The significance of 180-degree head rotation in supine roll test for horizontal canal benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2013	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 34(4), pp. 736-742	article	DOI
Abstract: The relatively low success rate of the treatment maneuver for horizontal semicircular canal (HSC) benign paroxysmal positional vertigo (BPPV) may be caused by the difficulty determining the affected side. We developed a 180-degree supine roll test (SRT) by modifying the 90-degree SRT to increase diagnostic accuracy and evaluated its significance. A prospective study. Tertiary referral center. A total of 122 patients with HSC-BPPV performed both the 90- and 180-degree SRTs. The affected side was determined by the 90- and 180-degree SRTs. The bow and lean (BL) test was also performed in cases with ambiguous or opposite results on both SRTs. A comparison of the difference in slow phase velocity (SPV) of nystagmus among the 90- and 180-degree SRTs and BL test. The maximum SPV of nystagmus during the 180-degree SRT was significantly greater than that during the 90-degree SRT. The SPV difference was less in the 180-degree SRT than that in the 90-degree SRT. Although the 180-degree SRT showed fewer meaningful results (n = 65) than the 90-degree SRT (n = 71), the affected side was determined by the 180-degree SRT in 15 cases with ambiguous results on the 90-degree SRT. Among 10 cases showing opposite results, 7 were identified by the BL test. Five (71.4%) of 7 cases had consistent affected sides with the 180-degree SRT. The 180-degree SRT can be an additional method when it is difficult to determine the affected side from the 90-degree SRT.
BibTeX: @article{Lim2013, author = {Lim, Hye Jin and Park, Keehyun and Park, Hun Yi and Choung, Yun-Hoon}, title = {The significance of 180-degree head rotation in supine roll test for horizontal canal benign paroxysmal positional vertigo.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2013}, volume = {34}, issue = {4}, pages = {736--742}, doi = {https://doi.org/10.1097/MAO.0b013e31827de2d1}, keywords = {Adolescent; Adult; Aged; Benign Paroxysmal Positional Vertigo; Electronystagmography; Female; Head Movements, physiology; Humans; Male; Middle Aged; Nystagmus, Pathologic, physiopathology, therapy; Prospective Studies; Rotation; Semicircular Canals, physiopathology; Supine Position, physiology; Vertigo, physiopathology, therapy}, pmid = {23370558} }
Böhmer, A. and Rickenmann, J.	The subjective visual vertical as a clinical parameter of vestibular function in peripheral vestibular diseases. [Abstract] [BibTeX]	1995	Journal of vestibular research : equilibrium & orientation Vol. 5(1), pp. 35-45	article
Abstract: The subjective visual vertical, SV, was measured in the upright and side positions in 25 normal subjects and in 73 patients with various peripheral vestibular disorders. Significant deviations of SV (toward the affected ear) were found in 100% of the patients with vestibular nerve section and with Ramsay Hunt syndrome, in 89% of the patients with vestibular neuritis, and in 0% of the patients with benign paroxysmal positional vertigo. The deviation of SV gradually disappeared within a few weeks of the onset of the disease in all patients except in those with total VIIth nerve resection. SV is a parameter of tonic afferent differences between the two labyrinths similar to vestibular spontaneous nystagmus but is mediated by other parts of the inner ear (probably the otolith organs) and thus provides additional information on the labyrinthine function. SV measured in 90 degrees side positions, however, did not reveal asymmetric vestibular sensitivity, which is in contrast to SV tested during eccentric rotation in patients after vestibular neurectomy.
BibTeX: @article{Boehmer1995, author = {Böhmer, A and Rickenmann, J}, title = {The subjective visual vertical as a clinical parameter of vestibular function in peripheral vestibular diseases.}, journal = {Journal of vestibular research : equilibrium & orientation}, year = {1995}, volume = {5}, issue = {1}, pages = {35--45}, keywords = {Adolescent; Adult; Humans; Middle Aged; Orientation; Vestibular Diseases, physiopathology, surgery; Vestibular Nerve, surgery; Vestibule, Labyrinth, physiology; Visual Perception, physiology}, pmid = {7711946} }
Boleas-Aguirre, F.M.S., Sánchez-Ferrándiz, N. and Perez, N.	The subjective visual vertical in benign paroxysmal positional vertigo. A preliminary study. [Abstract] [BibTeX]	2005	Revue de laryngologie - otologie - rhinologie Vol. 126(4), pp. 253-255	article
Abstract: In Benign Paroxysmal Positional Vertigo (BPPV), the existence of otoconial debris in the cupula or canal explains most of the symptoms and signs characteristic of this common inner ear disorder. We have studied the ability of patients with BPPV to correctly determine the subjective visual vertical, as this is a good test to evaluate utricular function. Only 1 of 10 patients with BPPV displayed a clearly abnormal response, and there was no correlation between the side of the lesion and the perceived tilt. This might imply that the limited damage induced by the dislodged otoconia does not disrupt utricular function or that the saccule is the source of the problem.
BibTeX: @article{Boleas-Aguirre2005, author = {Boleas-Aguirre, F M S and Sánchez-Ferrándiz, N and Perez, N}, title = {The subjective visual vertical in benign paroxysmal positional vertigo. A preliminary study.}, journal = {Revue de laryngologie - otologie - rhinologie}, year = {2005}, volume = {126}, issue = {4}, pages = {253--255}, keywords = {Adult; Aged; Caloric Tests; Ear, Inner, physiopathology; Humans; Middle Aged; Nystagmus, Physiologic; Posture; Risk Assessment; Saccule and Utricle, physiopathology; Vertigo, diagnosis, physiopathology; Vestibular Function Tests, methods}, pmid = {16496553} }
Rahko, T.	The test and treatment methods of benign paroxysmal positional vertigo and an addition to the management of vertigo due to the superior vestibular canal (BPPV-SC). [Abstract] [BibTeX]	2002	Clinical otolaryngology and allied sciences Vol. 27(5), pp. 392-395	article
Abstract: A review of the tests and treatment manoeuvres for benign paroxysmal positional vertigo of the posterior, horizontal and superior vestibular canals is presented. Additionally, a new way to test and treat positional vertigo of the superior vestibular canal is presented. In a prospective study, 57 out of 305 patients' visits are reported. They had residual symptoms and dizziness after the test and the treatment of benign paroxysmal positional vertigo of the horizontal canal (BPPV-HC) and posterior canal (PC). They were tested with a new test and treated with a new manoeuvre for superior canal benign paroxysmal positional vertigo (BPPV-SC). Results for vertigo in 53 patients were good; motion sickness and acrophobia disappeared. Reactive neck tension to BPPV was relieved. Older people were numerous among patients and their quality of life (QOL) improved.
BibTeX: @article{Rahko2002, author = {Rahko, T}, title = {The test and treatment methods of benign paroxysmal positional vertigo and an addition to the management of vertigo due to the superior vestibular canal (BPPV-SC).}, journal = {Clinical otolaryngology and allied sciences}, year = {2002}, volume = {27}, issue = {5}, pages = {392--395}, keywords = {Adult; Aged; Female; Humans; Male; Middle Aged; Physical Therapy Modalities; Prospective Studies; Semicircular Canals, physiopathology; Vertigo, diagnosis, etiology, physiopathology, therapy; Vestibular Diseases, complications, diagnosis, physiopathology; Vestibular Function Tests}, pmid = {12383304} }
Gacek, R.R. and Gacek, M.R.	The three faces of vestibular ganglionitis. [Abstract] [BibTeX]	2002	The Annals of otology, rhinology, and laryngology Vol. 111(2), pp. 103-114	article	DOI
Abstract: We present temporal bone and clinical evidence that common syndromes of recurrent vertigo are caused by a viral infection of the vestibular ganglion. In the present series, histopathologic and radiologic changes in the vestibular ganglion and meatal ganglion were consistent with a viral inflammation of ganglion cells in cases of Meniere's disease, benign paroxysmal positional vertigo, and vestibular neuronitis. Clinical observations of multiple neuropathies involving cranial nerves V, VII, and VIII on the same side in patients with recurrent vertigo are best explained by a cranial polyganglionitis caused by a neurotrophic virus, which is reactivated by a stressful event later in life. The reactivation of the latent virus may manifest as one of the above vertigo syndromes, depending on the part of the vestibular ganglion that is inflamed, the type and strain of the virus, and host resistance.
BibTeX: @article{Gacek2002b, author = {Gacek, Richard R and Gacek, Mark R}, title = {The three faces of vestibular ganglionitis.}, journal = {The Annals of otology, rhinology, and laryngology}, year = {2002}, volume = {111}, issue = {2}, pages = {103--114}, doi = {https://doi.org/10.1177/000348940211100201}, keywords = {Adult; Aged; Aged, 80 and over; Facial Nerve, pathology; Female; Ganglia, Sensory, pathology; Geniculate Ganglion, pathology; Herpes Simplex, complications; Herpes Zoster, complications; Humans; Male; Meniere Disease, pathology; Middle Aged; Recurrence; Satellite Cells, Perineuronal, pathology; Temporal Bone, pathology; Vertigo, etiology; Vestibular Neuronitis, pathology, virology}, pmid = {11860061} }
Strupp, M., Dieterich, M. and Brandt, T.	The treatment and natural course of peripheral and central vertigo. [Abstract] [BibTeX]	2013	Deutsches Arzteblatt international Vol. 110(29-30), pp. 505-15; quiz 515-6	article	DOI
Abstract: Recent studies have extended our understanding of the pathophysiology, natural course, and treatment of vestibular vertigo. The relative frequency of the different forms is as follows: benign paroxysmal positional vertigo (BPPV) 17.1%; phobic vestibular vertigo 15%; central vestibular syndromes 12.3%; vestibular migraine 11.4%; Menière's disease 10.1%; vestibular neuritis 8.3%; bilateral vestibulopathy 7.1%; vestibular paroxysmia 3.7%. Selective literature survey with particular regard to Cochrane reviews and the guidelines of the German Neurological Society. In more than 95% of cases BPPV can be successfully treated by means of liberatory maneuvers (controlled studies); the long-term recurrence rate is 50%. Corticosteroids improve recovery from acute vestibular neuritis (one controlled, several noncontrolled studies); the risk of recurrence is 2-12%. A newly identified subtype of bilateral vestibulopathy, termed cerebellar ataxia, neuropathy, and vestibular areflexia syndrome (CANVAS), shows no essential improvement in the long term. Long-term high-dose treatment with betahistine is probably effective against Menière's disease (noncontrolled studies); the frequency of episodes decreases spontaneously in the course of time (> 5 years). The treatment of choice for vestibular paroxysmia is carbamazepine (noncontrolled study). Aminopyridine, chlorzoxazone, and acetyl-DL-leucine are new treatment options for various cerebellar diseases. Most vestibular syndromes can be treated successfully. The efficacy of treatments for Menière's disease, vestibular paroxysmia, and vestibular migraine requires further research.
BibTeX: @article{Strupp2013, author = {Strupp, Michael and Dieterich, Marianne and Brandt, Thomas}, title = {The treatment and natural course of peripheral and central vertigo.}, journal = {Deutsches Arzteblatt international}, year = {2013}, volume = {110}, issue = {29-30}, pages = {505--15; quiz 515-6}, doi = {https://doi.org/10.3238/arztebl.2013.0505}, keywords = {Brain Diseases, diagnosis, epidemiology, therapy; Causality; Comorbidity; Disease Progression; Disease-Free Survival; Evidence-Based Medicine; Humans; Prevalence; Risk Factors; Treatment Outcome; Vertigo, diagnosis, epidemiology, therapy; Vestibular Diseases, diagnosis, epidemiology, therapy}, pmid = {24000301} }
Griech, S.F. and Carroll, M.A.	The use of mastoid vibration with canalith repositioning procedure to treat persistent benign paroxysmal positional vertigo: A case report. [Abstract] [BibTeX]	2018	Physiotherapy theory and practice Vol. 34(11), pp. 894-899	article	DOI
Abstract: The Canalith Repositioning Procedure (CRP) was originally described as a non-invasive treatment for Benign Paroxysmal Positional Vertigo (BPPV) by Epley. Since its inception, the maneuver has undergone several modifications; and currently is performed in the absence of induced mastoid vibration (oscillation). Clinically, mastoid vibration may be used to assist in treatment of persistent cases of BPPV, where a simple CRP may fail to improve symptoms. This case describes a patient with a three-month history of BPPV (right posterior canalithiasis), who was previously treated unsuccessfully with standard CRP. Mastoid vibration was introduced as part of the treatment due to persistent BPPV. After one treatment utilizing CRP with mastoid vibration, the patient had complete resolution of symptoms, and remained symptom free at a six-month follow-up. It can be concluded that introducing mastoid oscillation via vibration to the CRP in persistent cases of semicircular canalithiasis BPPV may produce positive patient outcomes.
BibTeX: @article{Griech2018, author = {Griech, Sean F and Carroll, Melissa A}, title = {The use of mastoid vibration with canalith repositioning procedure to treat persistent benign paroxysmal positional vertigo: A case report.}, journal = {Physiotherapy theory and practice}, year = {2018}, volume = {34}, issue = {11}, pages = {894--899}, doi = {https://doi.org/10.1080/09593985.2018.1425937}, keywords = {Benign Paroxysmal Positional Vertigo, therapy; Female; Humans; Mastoid; Middle Aged; Physical Therapy Modalities; Vibration; BPPV; canalith repositioning procedure; mastoid vibration}, pmid = {29336656} }
Sahin, C., Varim, C., Uyanik, M., Acar, B., Acar, T. and Nalbant, A.	THE USEFULNESS OF MONITORING THE NEUTROPHIL TO LYMPHOCYTE RATIO IN PATIENTS WITH PERIPHERAL VERTIGO. [Abstract] [BibTeX]	2016	Georgian medical news(256-257), pp. 52-57	article
Abstract: The purpose of this study was to evaluate the usefulness of the neutrophil to lymphocyte ratio (NLR) in a differential diagnosis and follow-up of patients with peripheral vertigo. Twenty patients with benign positional paroxysmal vertigo (BPPV) and 20 patients diagnosed with vestibular neuritis (VN) were included in the study. Serum samples were analysed at the initial presentation and on the seventh day of admission retrospectively. The WBC (white blood cell) count was 10500±2100 /mm3, the neutrophil count was 4700±1100/mm3, the lymphocyte count was 5000±1200/mm3 and the NLR was 0.9±0.2 in the VN group. In patients with BPPV, the WBC count was 9200±1300/mm3, the neutrophil count was 5200±1200/mm3, the lymphocyte count was 3100±1200/mm3 and the NLR was 1.9±0.9. The NLR was lower in patients with VN than in patients diagnosed with BPPV. The WBC and lymphocyte count was significantly higher in the patients with VN than in the patients diagnosed with BPPV. Within the first week of admission, the WBC and lymphocyte counts in patients with VN decreased, and the NLR was more elevated than at the admission. It is highly recommended that NLR is used in the diagnosis and follow-up of the most commonly observed aetiological factors of peripheral vertigo, BPPV and VN.
BibTeX: @article{Sahin2016, author = {Sahin, C and Varim, C and Uyanik, M and Acar, B and Acar, T and Nalbant, A}, title = {THE USEFULNESS OF MONITORING THE NEUTROPHIL TO LYMPHOCYTE RATIO IN PATIENTS WITH PERIPHERAL VERTIGO.}, journal = {Georgian medical news}, year = {2016}, issue = {256-257}, pages = {52--57}, keywords = {Adolescent; Adult; Benign Paroxysmal Positional Vertigo, blood, diagnosis; Blood Cell Count; Female; Humans; Lymphocytes, pathology; Male; Middle Aged; Neutrophils, pathology; Vestibular Neuronitis, blood, diagnosis; Young Adult}, pmid = {27661276} }
Emami, S.F. and Gohari, N.	The vestibular-auditory interaction for auditory brainstem response to low frequencies. [Abstract] [BibTeX]	2014	ISRN otolaryngology Vol. 2014, pp. 103598	article	DOI
Abstract: Since saccular projection is sound sensitive, the objective is to investigate the possibility that the saccular projections may contribute to auditory brainstem response to 500 HZ tone burst (ABR500 HZ). During the case-control research, twenty healthy controls compared to forty selected case groups as having chronic and resistant BPPV were evaluated in the audiology department of Hamadan University of Medical Sciences (Hamadan, Iran). Assessment is comprised of audiologic examinations, cervical vestibular evoked myogenic potentials (cVEMPs), and ABR500 HZ. We found that forty affected ears of BPPV patients with decreased vestibular excitability as detected by abnormal cVEMPs had abnormal results in ABR500 HZ, whereas unaffected ears presented normal findings. Multiple comparisons of mean p13, n23 latencies, and peak-to-peak amplitudes between three groups (affected, unaffected, and healthy ears) were significant. In conclusion, the saccular nerves can be projective to auditory bundles and interact with auditory brainstem response to low frequencies. Combine the cVEMPs and ABR500 HZ in battery approach tests of vestibular assessment and produce valuable data for judgment on the site of lesion. Regarding vestibular cooperation for making of wave V, it is reasonable that the term of ABR500 HZ is not adequate and the new term or vestibular-auditory brainstem response to 500 HZ tone burst is more suitable.
BibTeX: @article{Emami2014, author = {Emami, Seyede Faranak and Gohari, Nasrin}, title = {The vestibular-auditory interaction for auditory brainstem response to low frequencies.}, journal = {ISRN otolaryngology}, year = {2014}, volume = {2014}, pages = {103598}, doi = {https://doi.org/10.1155/2014/103598}, pmid = {25006510} }
House, M.G. and Honrubia, V.	Theoretical models for the mechanisms of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2003	Audiology & neuro-otology Vol. 8(2), pp. 91-99	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is a common vestibular disorder resulting from a malfunction of the semicircular canal. Prior studies attempting to elucidate the mechanics of BPPV have focused on clinical and laboratory findings, and have discussed theoretical aspects only in qualitative terms. The goal of this study is to create a mathematical description of BPPV mechanics based on biophysical principles, in order to improve the physiopathological understanding of the most common varieties of the disorder, canalithiasis and cupulolithiasis. First, the abnormal stimulus being applied to the vestibular system during BPPV episodes is estimated by an analysis of the vestibulo-ocular reflex (VOR) response of clinical BPPV patients. The magnitude and time course of the head motion stimulus that would, in a normal test subject, produce a VOR response similar to that observed during BPPV nystagmus are inferred from eye motion data using an inverse transfer function approach. Next, physicomathematical models to describe the mechanics of the abnormal stimulations of the crista are created: the cupulolithiasis model is based on the principle that dense particulate matter becomes attached to the cupula of affected patients and effectively changes the specific gravity of the cupula; the canalithiasis model is based on the hydrodynamic effects from a cluster of particles falling within the canal endolymph. The stimuli predicted by these two models are compared to the stimuli estimated from physiological and clinical studies. The model predictions are found to be consistent with the empirical evidence for a reasonable set of model parameters. The cupulolithiasis model predicts a value of 0.69 micro g as the mass of particles contributing to the disorder. The canalithiasis model predicts a value of 0.087 micro g. These results support and expand our understanding of the mechanisms underlying the production of the cupulolithiasis and canalithiasis varieties of vertigo in humans. On the basis of these models, several predictions that can help the clinician improve the evaluation of BPPV patients are discussed.
BibTeX: @article{House2003, author = {House, Mattew G and Honrubia, Vicente}, title = {Theoretical models for the mechanisms of benign paroxysmal positional vertigo.}, journal = {Audiology & neuro-otology}, year = {2003}, volume = {8}, issue = {2}, pages = {91--99}, doi = {https://doi.org/10.1159/000068998}, keywords = {Calcinosis, pathology; Humans; Models, Biological; Nystagmus, Pathologic, complications; Reflex, Vestibulo-Ocular, physiology; Semicircular Canals, pathology, physiopathology; Vertigo, complications, physiopathology}, pmid = {12634457} }
Yang, X.-K., Zheng, Y.-Y. and Yang, X.-G.	Theoretical observation on diagnosis maneuver for benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2017	Acta oto-laryngologica Vol. 137(6), pp. 567-571	article	DOI
Abstract: To make a comprehensive analysis with a variety of diagnostic maneuvers is conducive to the correct diagnosis and classification of BPPV. Based on the standard spatial coordinate-based semicircular canal model for theoretical observation on diagnostic maneuvers for benign paroxysmal positional vertigo (BPPV) to analyze the meaning and key point of each step of the maneuver. This study started by building a standard model of semicircular canal with space orientation by segmentation of the inner ear done with the 3D Slicer software based on MRI scans, then gives a demonstration and observation of BPPV diagnostic maneuvers by using the model. The supine roll maneuver is mainly for diagnosis of lateral semicircular canal BPPV. The Modified Dix-Hallpike maneuver is more specific for the diagnosis of posterior semicircular canal BPPV. The side-lying bow maneuver designed here is theoretically suitable for diagnosis of anterior semicircular canal BPPV.
BibTeX: @article{Yang2017, author = {Yang, Xiao-Kai and Zheng, Yan-Yan and Yang, Xiao-Guo}, title = {Theoretical observation on diagnosis maneuver for benign paroxysmal positional vertigo.}, journal = {Acta oto-laryngologica}, year = {2017}, volume = {137}, issue = {6}, pages = {567--571}, doi = {https://doi.org/10.1080/00016489.2016.1271451}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis; Humans; Imaging, Three-Dimensional; Magnetic Resonance Imaging; Models, Biological; Physical Examination, methods; Retrospective Studies; Semicircular canal; diagnosis maneuver; model; theory; vertigo}, pmid = {28084876} }
Ciodaro, F., Mannella, V.K., Nicita, R.A., Cammaroto, G., Bruno, R., Galletti, B., Freni, F. and Galletti, F.	Therapeutic efficacy of the Galletti-Contrino manoeuvre for benign paroxysmal positional vertigo of vertical semicircular canals in overweight subjects. [Abstract] [BibTeX]	2018	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 275(10), pp. 2449-2455	article	DOI
Abstract: To compare the Galletti-Contrino manoeuvre with the more widely used Semont-Toupet in overweight subjects presenting with benign paroxysmal positional vertigo (BPBV) of vertical semicircular canals (posterior and anterior canals). Prospective cohort study. 204 patients (BMI range 25-30) with a diagnosis of BPPV of vertical semicircular canals were randomly divided in two groups treated with two different maneuvers: Galletti-Contrino (Group A) and Semont-Toupet manoeuvre (Group B). The results were compared with those obtained from a control group (204 non-overweight subjects with BPV of vertical semicircular canals.) INTERVENTION: Galletti Contrino/ Semont Toupet manoeuvres. Liberatory nystagmus or vertigo after maximum 2 maneuvers. Vertigo and dizziness intensity scores (Visual analogue scale VAS 0-10) from day 0 to day 5 following the repositioning manoeuvre were also recorded in responsive patients. While in non-overweight subjects no significant difference comparing the effectiveness of the two manoeuvres was found, liberatory nystagmus and vertigo were more frequently observed after Galletti Contrino manoeuvre in overweight subjects; this difference was statistically significant when posterior canals were involved (P < 0.03). Vertigo and dizziness VAS scores reduced significantly from day 0 to day 5 after therapy in all groups. A more significant reduction of dizziness VAS was recorded in patients undergoing Galletti-Contrino manoeuvre at days 4-5 (P < 0.005). Galletti-Contrino manoeuvre seems to be significantly more effective than Semont-Toupet manoeuvre in the treatment of BPPV of posterior semicircular canal and may be preferential in patients with limited body movements.
BibTeX: @article{Ciodaro2018, author = {Ciodaro, Francesco and Mannella, Valentina Katia and Nicita, Rita Angela and Cammaroto, Giovanni and Bruno, Rocco and Galletti, Bruno and Freni, Francesco and Galletti, Francesco}, title = {Therapeutic efficacy of the Galletti-Contrino manoeuvre for benign paroxysmal positional vertigo of vertical semicircular canals in overweight subjects.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2018}, volume = {275}, issue = {10}, pages = {2449--2455}, doi = {https://doi.org/10.1007/s00405-018-5086-1}, keywords = {Benign Paroxysmal Positional Vertigo, physiopathology, rehabilitation; Case-Control Studies; Cohort Studies; Female; Humans; Male; Middle Aged; Overweight, epidemiology; Semicircular Canals, physiopathology; Visual Analog Scale; BPPV; Manoeuvre}, pmid = {30097716} }
Ushio, K., Morizono, T. and Yagi, T.	Three-component analysis of benign paroxysmal positional nystagmus. [Abstract] [BibTeX]	1995	Acta oto-laryngologica. Supplementum Vol. 519, pp. 107-109	article
Abstract: Three-component analysis of Benign Paroxysmal Positional Nystagmus (BPPN), focusing on the horizontal, vertical, and torsional, using a computerized eye movement analysis system, was carried out in 10 patients. Using a pendular rotation stimulus, we also measured three components of eye movement elicited from the vertical semicircular canals in normal subjects. We compared two components (vertical and torsional) of BPPN with that of eye movements elicited from the vertical semicircular canals. In BPPN, the torsional component of eye movements was larger than that of the vertical component. Conversely, the vertical component from the vertical semicircular canals was larger than that of the torsional component. From these results, by analysing the vestibulo-ocular reflex of the vertical semicircular canals, it is difficult to support the idea that the pathology of the BPPV is localized in the posterior semi-circular canal alone.
BibTeX: @article{Ushio1995, author = {Ushio, K and Morizono, T and Yagi, T}, title = {Three-component analysis of benign paroxysmal positional nystagmus.}, journal = {Acta oto-laryngologica. Supplementum}, year = {1995}, volume = {519}, pages = {107--109}, keywords = {Electronic Data Processing; Eye Movements; Humans; Nystagmus, Pathologic, physiopathology; Saccule and Utricle, physiopathology; Semicircular Canals, physiopathology; Time Factors}, pmid = {7610842} }
Fetter, M. and Sievering, F.	Three-dimensional (3-D) eye movement analysis in patients with positioning nystagmus. [Abstract] [BibTeX]	1995	Acta oto-laryngologica. Supplementum Vol. 520 Pt 2, pp. 369-371	article
Abstract: Benign paroxysmal positioning vertigo (BPPV), and nystagmus (BPPN) is the commonest type of rotational vertigo. Typical BPPN is generally believed to arise from one posterior semicircular canal. If this is true, the syndrome would offer the unique possibility to study vestibular responses when just one single semicircular canal is excited. In this study we used search coils to measure 3-D eye positions in 3 patients with BPPN. We present a complete 3-D description of the eye movements induced in BPPN. We found that in our patients the eyes rotate rather precisely in the plane of one posterior semicircular canal, suggesting that BPPN in our cases is indeed solely produced by the posterior semicircular canal.
BibTeX: @article{Fetter1995a, author = {Fetter, M and Sievering, F}, title = {Three-dimensional (3-D) eye movement analysis in patients with positioning nystagmus.}, journal = {Acta oto-laryngologica. Supplementum}, year = {1995}, volume = {520 Pt 2}, pages = {369--371}, keywords = {Adult; Algorithms; Calculi, diagnosis, physiopathology; Humans; Image Processing, Computer-Assisted, instrumentation; Male; Meniere Disease, diagnosis, physiopathology; Middle Aged; Nystagmus, Physiologic, physiology; Postural Balance, physiology; Posture, physiology; Reflex, Vestibulo-Ocular, physiology; Semicircular Canals, physiology; Vertigo, diagnosis, physiopathology}, pmid = {8749164} }
Imai, T., Takeda, N., Ito, M., Nakamae, K., Sakae, H., Fujioka, H. and Kubo, T.	Three-dimensional analysis of benign paroxysmal positional nystagmus in a patient with anterior semicircular canal variant. [Abstract] [BibTeX]	2006	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 27(3), pp. 362-366	article
Abstract: To show the positional nystagmus in a patient who had suffered from benign paroxysmal positional vertigo (BPPV) that was thought to be caused by involvement of the anterior semicircular canal (ASCC) (A-BPPV). Retrospective case report. City hospital. The present study reports a rare case of A-BPPV in a 41-year-old woman. The patient is 41-year-old woman who developed a positional vertigo after playing volleyball on March 22, 2005 and consulted our hospital the next day. When left Dix-Hallpike maneuver was performed, she showed a positional nystagmus of which fast phase direction of the torsional component was clockwise while that of the vertical component was downward. We plotted the slow phase eye velocity of the positional nystagmus during the left Dix-Hallpike maneuver on three-dimensional coordinates that showed the axis of the positional nystagmus to be perpendicular to the plane of the right ASCC. These results suggested that the patient was suffering from A-BPPV.
BibTeX: @article{Imai2006, author = {Imai, Takao and Takeda, Noriaki and Ito, Mahito and Nakamae, Koji and Sakae, Hideki and Fujioka, Hiromu and Kubo, Takeshi}, title = {Three-dimensional analysis of benign paroxysmal positional nystagmus in a patient with anterior semicircular canal variant.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2006}, volume = {27}, issue = {3}, pages = {362--366}, keywords = {Adult; Electronystagmography; Eye Movements; Female; Head Movements; Humans; Imaging, Three-Dimensional; Nystagmus, Pathologic, diagnosis, physiopathology; Posture; Retrospective Studies; Semicircular Canals, pathology, physiopathology; Vertigo, physiopathology; Vestibular Function Tests; Videotape Recording}, pmid = {16639275} }
Hayashi, Y., Kanzaki, J., Etoh, N., Higashino, K., Goto, F., Schneider, E. and Kunihiro, T.	Three-dimensional analysis of nystagmus in benign paroxysmal positional vertigo. New insights into its pathophysiology. [Abstract] [BibTeX]	2002	Journal of neurology Vol. 249(12), pp. 1683-1688	article	DOI
Abstract: Nystagmus is a rhythmical rotation of the eyeball. Its characteristics can be defined mathematically by the axis of rotation and the angular velocity around this axis. We analysed the axis of rotation for the nystagmus in benign paroxysmal positional vertigo (BPPV) to elucidate its pathophysiology. Thirteen patients with typical unilateral BPPV participated in the present study. The axis of rotation for the nystagmus was calculated from images recorded on digital videotape with an infrared CCD camera, using an algorithm that we developed. The patients' responsiveness to Semont's liberatory maneuver was also assessed.The results showed that patients could be assigned to one of two groups based on the rotation axis of the nystagmus. In one group of patients (n = 7; Group A), the axis of rotation was almost vertical to the plane containing the posterior semicircular canal (PSC) on the presumed affected side. In the other group of patients (n = 6; Group B), it was clustered around the naso-occipital axis. These results suggest that in the patients in Group A the responsible lesion is confined to the PSC, whereas the pathogenesis underlying the conditions in those in Group B is considered to be more complicated. This speculation was reinforced by the difference in responsiveness to Semont's liveratory maneuver. All of the patients in Group A showed remission of vertigo within 10 days (mean, 2.4 days) after onset of treatment using Semont's liberatory maneuver, whereas the patients in Group B required much longer periods of time for remission to occur (mean, 25.7 days). Our findings lead to the conclusion that by considering the spatial orientation of individual semicircular canals, in the patients in Group B the pathophysiology is not confined to the PSC, but most probably all three semicircular canals are involved.
BibTeX: @article{Hayashi2002, author = {Hayashi, Yujiro and Kanzaki, Jin and Etoh, Norihito and Higashino, Kazutaka and Goto, Fumiyuki and Schneider, Erich and Kunihiro, Takanobu}, title = {Three-dimensional analysis of nystagmus in benign paroxysmal positional vertigo. New insights into its pathophysiology.}, journal = {Journal of neurology}, year = {2002}, volume = {249}, issue = {12}, pages = {1683--1688}, doi = {https://doi.org/10.1007/s00415-002-0905-z}, keywords = {Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, diagnosis, physiopathology, therapy; Nystagmus, Physiologic, physiology; Vertigo, diagnosis, physiopathology, therapy}, pmid = {12529790} }
Rajguru, S.M., Ifediba, M.A. and Rabbitt, R.D.	Three-dimensional biomechanical model of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2004	Annals of biomedical engineering Vol. 32(6), pp. 831-846	article
Abstract: A morphologically descriptive 3-canal mathematical model was developed to quantify the biomechanical origins of gravity-dependent semicircular canal responses under pathological conditions of canalithiasis and cupulolithiasis--conditions associated with the vestibular disorder benign paroxysmal positional vertigo (BPPV). The model describes the influence of displaced calcium carbonate debris (particles) located within the labyrinth on the time-dependent responses of the ampullary organs. The particles were modeled as spheres free to move in the canal lumen (canalithiasis) or adhered to a cupula (cupulolithiasis). The model predicts canal responses to the diagnostic Dix-Hallpike maneuver, and to a modified Epley canalith repositioning (CRP) treatment. Results for canalithiasis predict activation latencies and response magnitudes consistent with clinical observations during the Dix-Hallpike maneuver. The magnitude of the response evoked by the Dix-Hallpike test was primarily due to the total weight of the particles while the latency to peak response was due to the time required for the stone to move from the ampulla to the posterior apex of the canal. Results further illustrate the effectiveness of the Epley CRP in repositioning the particles and relieving the symptoms of the canalithiasis type of BPPV.
BibTeX: @article{Rajguru2004, author = {Rajguru, Suhrud M and Ifediba, Marytheresa A and Rabbitt, Richard D}, title = {Three-dimensional biomechanical model of benign paroxysmal positional vertigo.}, journal = {Annals of biomedical engineering}, year = {2004}, volume = {32}, issue = {6}, pages = {831--846}, keywords = {Biomechanical Phenomena, methods; Computer Simulation; Humans; Lithiasis, complications, diagnosis, physiopathology; Models, Biological; Movement; Posture; Semicircular Canals, physiopathology; Vertigo, diagnosis, etiology, physiopathology; Vestibular Function Tests, methods}, pmid = {15255214} }
Fetter, M. and Sievering, F.	Three-dimensional eye movement analysis in benign paroxysmal positioning vertigo and nystagmus. [Abstract] [BibTeX]	1995	Acta oto-laryngologica Vol. 115(3), pp. 353-357	article
Abstract: Benign paroxysmal positioning vertigo (BPPV) and nystagmus (BPPN) is the commonest type of rotational vertigo, but its origin is not fully understood. In this study we used search coils to measure 3-D eye position in 5 patients with BPPN. We present for the first time a complete three-dimensional description of the eye movements induced in BPPN. By calculating the eye movement direction in head co-ordinates we are able to relate the elicited nystagmus very precisely to a particular canal and thereby localize the lesion.
BibTeX: @article{Fetter1995, author = {Fetter, M and Sievering, F}, title = {Three-dimensional eye movement analysis in benign paroxysmal positioning vertigo and nystagmus.}, journal = {Acta oto-laryngologica}, year = {1995}, volume = {115}, issue = {3}, pages = {353--357}, keywords = {Adult; Eye Movements; Female; Humans; Magnetics; Male; Middle Aged; Nystagmus, Pathologic, physiopathology; Posture; Vertigo, physiopathology; Video Recording}, pmid = {7653253} }
Imai, T., Takeda, N., Uno, A., Morita, M., Koizuka, I. and Kubo, T.	Three-dimensional eye rotation axis analysis of benign paroxysmal positioning nystagmus. [Abstract] [BibTeX]	2002	ORL; journal for oto-rhino-laryngology and its related specialties Vol. 64(6), pp. 417-423	article	DOI
Abstract: We have developed a new technique for analyzing the rotation vector of eye movement with an infrared CCD camera [Imai et al.: Acta Otolaryngol 1999;119:24-28]. We used this technique to analyze the eye rotation axis of benign paroxysmal positioning nystagmus (BPPN) that was induced by the Dix-Hallpike maneuver in 14 patients with benign paroxysmal positioning vertigo (BPPV). Eye rotation axes of BPPN in 8 patients were closely perpendicular to the posterior canal of the undermost ear in the provocative head position. Under the hypothesis that BPPN is due to a mechanical stimulation of the posterior canal by canalolithiasis, this finding suggested that the posterior canal of the undermost ear is the lesion. On the other hand, eye rotation axes of BPPN in the other 6 patients were closely aligned with the naso-occipital axis. It is suggested that canalolithiasis induces endolymphatic flow in both posterior and anterior canals via the common crus and the summation of the eye movements induced by stimulation of both the posterior and anterior canals rotates the eye along the naso-occipital axis.
BibTeX: @article{Imai2002, author = {Imai, Takao and Takeda, Noriaki and Uno, Atsuhiko and Morita, Masahiro and Koizuka, Izumi and Kubo, Takeshi}, title = {Three-dimensional eye rotation axis analysis of benign paroxysmal positioning nystagmus.}, journal = {ORL; journal for oto-rhino-laryngology and its related specialties}, year = {2002}, volume = {64}, issue = {6}, pages = {417--423}, doi = {https://doi.org/10.1159/000067567}, keywords = {Adult; Aged; Eye Movements, physiology; Female; Humans; Male; Middle Aged; Nystagmus, Physiologic, physiology; Vertigo, physiopathology}, pmid = {12499766} }
Smouha, E.E.	Time course of recovery after Epley maneuvers for benign paroxysmal positional vertigo. [Abstract] [BibTeX]	1997	The Laryngoscope Vol. 107(2), pp. 187-191	article
Abstract: The canalith repositioning maneuver (CRP) of Epley is an effective treatment for benign paroxysmal positional vertigo (BPPV). While CRP has been advocated by some as a "single treatment" for BPPV, others have had less uniform results for this self-limited disorder. In order to better define the role of CRP in relieving vertigo, we studied the time course of recovery in 27 consecutive cases of BPPV. We recorded nystagmus after each head maneuver and at each evaluation until complete resolution took place, using absence of nystagmus as a strict criterion for cure. We found that while 93% of patients improved, many had persistent nystagmus at the first evaluation, and in only 63% was resolution clearly related to a CRP session. We believe that in certain cases, the effect of CRP may be due to adaptive conditioning, rather than particle redistribution.
BibTeX: @article{Smouha1997, author = {Smouha, E E}, title = {Time course of recovery after Epley maneuvers for benign paroxysmal positional vertigo.}, journal = {The Laryngoscope}, year = {1997}, volume = {107}, issue = {2}, pages = {187--191}, keywords = {Adult; Aged; Female; Humans; Male; Middle Aged; Time Factors; Treatment Outcome; Vertigo, surgery}, pmid = {9023241} }
Gavalas, G.J., Passou, E.M. and Vathilakis, J.M.	Tinnitus of vestibular origin. [Abstract] [BibTeX]	2001	Scandinavian audiology. Supplementum(52), pp. 185-186	article
Abstract: During the exercises devised by Seymont and/or Epley for rehabilitation of benign paroxysmal positional vertigo, we observed that the accompanying tinnitus disappeared immediately in some patients. Following this observation and using the same maneuver, we examined two groups of patients. The first group included 86 patients with continuous tinnitus, or tinnitus in specific head/body positions. whose origination was associated with recent vestibular symptomatology. The second group included 100 patients with positional tinnitus, but without any vestibular disorder. Ages ranged between 35 and 78 years and gender distribution was 114 females and 72 males. It was shown that 29 patients in the first group (33.2%) and 18 patients in the second group (18%) could be released from their tinnitus. Eleven patients in the first group (12.7%) and 7 patients in the second group (7%) noticed a reduction of their tinnitus. These results show that in the above-mentioned cases relief of vestibular symptoms alleviates the tinnitus. This could be mediated by a reduction in autonomic activity, known to affect tinnitus.
BibTeX: @article{Gavalas2001, author = {Gavalas, G J and Passou, E M and Vathilakis, J M}, title = {Tinnitus of vestibular origin.}, journal = {Scandinavian audiology. Supplementum}, year = {2001}, issue = {52}, pages = {185--186}, keywords = {Adult; Aged; Female; Humans; Male; Middle Aged; Tinnitus, complications, physiopathology; Vertigo, complications, rehabilitation; Vestibular Function Tests; Vestibule, Labyrinth, physiopathology}, pmid = {11318463} }
Thompson-Harvey, A. and Mikulec, A.A.	Total caloric eye speed in patients with vestibular migraine. [Abstract] [BibTeX]	2018	American journal of otolaryngology Vol. 39(2), pp. 180-183	article	DOI
Abstract: Vestibular migraine is a common cause of dizziness that lacks a known objective test. This study examined total eye speed on caloric testing as a diagnostic marker for vestibular migraine. Retrospective chart review of patients seen in a tertiary otologic practice between 2004 and 2016 who had undergone caloric testing with water irrigation and had a diagnosis of vestibular migraine (n=34). A group of patients with benign paroxysmal positional vertigo (n=10) were used as a control group. Patients were grouped into quartiles based on total eye speed. Only patients in the lowest quartile (total eye speed<79) had a diagnosis of vestibular migraine. All other quartiles included a mix of control and vestibular migraine patients. Low total eye speed may be suggestive of a diagnosis of vestibular migraine, but most patients with vestibular migraine do not have low total eye speed.
BibTeX: @article{Thompson-Harvey2018, author = {Thompson-Harvey, Adam and Mikulec, Anthony A}, title = {Total caloric eye speed in patients with vestibular migraine.}, journal = {American journal of otolaryngology}, year = {2018}, volume = {39}, issue = {2}, pages = {180--183}, doi = {https://doi.org/10.1016/j.amjoto.2017.11.007}, keywords = {Caloric Tests, methods; Electronystagmography; Eye Movements, physiology; Female; Humans; Male; Middle Aged; Migraine Disorders, diagnosis, physiopathology; Retrospective Studies; Vestibular Diseases, diagnosis, physiopathology; Vestibular Function Tests, methods; Caloric testing; Dizziness; Migraine; Total eye speed; Vestibular function testing; Vestibular migraine}, pmid = {29169953} }
Kos, M.I., Feigl, G., Anderhuber, F., Wall, C., Fasel, J.H.D. and Guyot, J.-P.	Transcanal approach to the singular nerve. [Abstract] [BibTeX]	2006	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 27(4), pp. 542-546	article	DOI
Abstract: Intractable benign paroxysmal positional vertigo is rare, and surgery is indicated in only a very small number of cases. Transcanal singular neurectomy is considered a difficult and risky procedure possibly leading to hearing loss and vertigo. The objective of this study was to evaluate the feasibility of the singular neurectomy through the external ear canal in an attempt to explain the contradictory results of previous reports of anatomists and of surgeons who abandoned the technique, considering that the singular neurectomy could not be reached via the external auditory canal without damaging the labyrinth. Anatomical study on 100 halves of human heads in which the canal of the singular nerve (SN) was identified and opened at its extremities, the internal auditory canal and the ampulla of the posterior semicircular canal, via a posterior fossa approach. Next, the canal of the SN was dissected via the external auditory canal, at the floor of the round window (RW) niche. The relation of the SN canal to the ampulla of the posterior semicircular canal was evaluated. In 90 cases, the canal was transected medially to and away from the ampulla of the posterior semicircular canal, and in 8, at its emergence from the posterior ampullary recess. In these 98 cases, the RW membrane and the bony labyrinth were kept intact. In two cases, the canal of the SN could not be reached at the floor of the RW niche. Singular neurectomy is feasible via the external auditory canal, without damaging the RW membrane or the labyrinth in 98% of the cases. Because singular neurectomy is indicated in a very small number of cases, it is difficult to master this particular surgical procedure. This may explain why most surgeons abandoned the technique after a few attempts, followed by an unacceptable rate of sensorineural hearing loss.
BibTeX: @article{Kos2006, author = {Kos, Maria Izabel and Feigl, Georg and Anderhuber, Friedrich and Wall, Conrad and Fasel, Jean H D and Guyot, Jean-Philippe}, title = {Transcanal approach to the singular nerve.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2006}, volume = {27}, issue = {4}, pages = {542--546}, doi = {https://doi.org/10.1097/01.mao.0000217349.09796.d1}, keywords = {Aged; Aged, 80 and over; Auditory Threshold; Cadaver; Denervation, adverse effects, methods; Feasibility Studies; Female; Hearing Loss, Sensorineural, etiology; Humans; Male; Microsurgery, instrumentation, methods; Middle Aged; Semicircular Ducts, innervation; Treatment Outcome; Vertigo, surgery; Vestibular Nerve, physiology, surgery}, pmid = {16791047} }
Gacek, R.R.	Transection of the posterior ampullary nerve for the relief of benign paroxysmal positional vertigo. [BibTeX]	1974	The Annals of otology, rhinology, and laryngology Vol. 83(5), pp. 596-605	article	DOI
BibTeX: @article{Gacek1974, author = {Gacek, R R}, title = {Transection of the posterior ampullary nerve for the relief of benign paroxysmal positional vertigo.}, journal = {The Annals of otology, rhinology, and laryngology}, year = {1974}, volume = {83}, issue = {5}, pages = {596--605}, doi = {https://doi.org/10.1177/000348947408300504}, keywords = {Adult; Anesthesia, Local; Audiometry; Bone Conduction; Deafness, etiology; Denervation, adverse effects, methods; Ear, Inner, innervation; Female; Hearing Tests; Humans; Labyrinthitis, etiology; Middle Aged; Posture; Tympanic Membrane, surgery; Vertigo, surgery; Vestibular Function Tests; Vestibular Nerve, surgery}, pmid = {4416691} }
Uetsuka, S., Kitahara, T., Horii, A., Imai, T., Uno, A., Okazaki, S., Kamakura, T., Takimoto, Y. and Inohara, H.	Transient low-tone air-bone gaps during convalescence immediately after canal plugging surgery for BPPV. [Abstract] [BibTeX]	2012	Auris, nasus, larynx Vol. 39(4), pp. 356-360	article	DOI
Abstract: The aim of the present study was to elucidate the time course and frequency patterns of transient low-tone air-bone gaps (ABGs) after canal plugging for intractable BPPV. We investigated eight patients with intractable BPPV who underwent canal plugging. Four were cases with posterior type (pBPPV) and the other four were those with horizontal type (hBPPV). Pure-tone audiometries (PTAs) were performed before and 7 days, 1 month and 6 months after surgery. ABGs (+) were defined as the three-tone-average ≥20dB formulated by (a+b+c)/3, where a, b, and c are ABGs at 0.25, 0.5, and 1kHz, respectively. The ratio of the number of patients with ABGs (+) at the post-operative 7th day and 1st month was 100.0% (8/8). The ratio at the post-operative 6th month was 0.0% (0/8). There were no significant differences in the time course or frequency patterns of the ABGs between pBPPV and hBPPV. We clearly demonstrated eight cases with intractable BPPV showing transient low-tone ABGs during convalescence immediately after canal plugging. During that period, patients also complained of motion-evoked dizziness. All these findings suggest that, during such a convalescence period, the plugged area might not be fixed yet and could still induce the dizziness and low-tone ABGs, as enlarged vestibular aqueduct syndrome and superior semicircular canal deficiency syndrome exhibit low-tone ABGs due to the third mobile inner ear window. More than one month after surgery, both the ABGs and dizziness could disappear according to fixation of the plugged area.
BibTeX: @article{Uetsuka2012, author = {Uetsuka, Satoru and Kitahara, Tadashi and Horii, Arata and Imai, Takao and Uno, Atsuhiko and Okazaki, Suzuyo and Kamakura, Takefumi and Takimoto, Yasumitsu and Inohara, Hidenori}, title = {Transient low-tone air-bone gaps during convalescence immediately after canal plugging surgery for BPPV.}, journal = {Auris, nasus, larynx}, year = {2012}, volume = {39}, issue = {4}, pages = {356--360}, doi = {https://doi.org/10.1016/j.anl.2011.06.005}, keywords = {Adult; Audiometry, Pure-Tone; Benign Paroxysmal Positional Vertigo; Dizziness, etiology; Female; Hearing Loss, etiology; Humans; Male; Middle Aged; Postoperative Complications; Semicircular Canals, surgery; Surgical Instruments; Vertigo, surgery}, pmid = {21862256} }
Beyea, J.A., Agrawal, S.K. and Parnes, L.S.	Transmastoid semicircular canal occlusion: a safe and highly effective treatment for benign paroxysmal positional vertigo and superior canal dehiscence. [Abstract] [BibTeX]	2012	The Laryngoscope Vol. 122(8), pp. 1862-1866	article	DOI
Abstract: Transmastoid occlusion of the superior semicircular canal in superior semicircular canal dehiscence (SSCD) syndrome and the posterior semicircular canal in intractable benign paroxysmal positional vertigo (BPPV) will produce resolution of preoperative symptoms. Retrospective review, quality assurance. Sixteen patients with SSCD and 61 patients (65 ears) with intractable BPPV who underwent canal occlusion were reviewed. All patients underwent occlusion of the affected semicircular canal through a transmastoid approach. Preoperative symptoms (vestibular, 13 patients; pulsatile tinnitus, 2 patients; or hyperacusis, 1 patient) were greatly improved or completely resolved in 15 of the 16 SSCD patients who underwent transmastoid occlusion of the superior canal. Hearing was preserved in 14 patients and improved in two patients. Vestibular symptoms were resolved in all intractable BPPV patients who underwent transmastoid occlusion of the posterior canal. One patient had a late recurrence of atypical BPPV. Almost all BPPV patients with normal preoperative hearing have an initial transient postoperative hearing loss, which when tested for is usually a mild to moderate mixed loss. Delayed sensorineural hearing loss was noted in three patients; one loss was profound whereas two were mild. The transmastoid approach to canal plugging is successful in the treatment of symptoms in both SSCD and intractable BPPV, and is a familiar approach for the otologist. This is a viable alternative to the middle fossa approach for SSCD, thereby avoiding a craniotomy. Transmastoid is the definitive approach for posterior canal occlusion.
BibTeX: @article{Beyea2012, author = {Beyea, Jason A and Agrawal, Sumit K and Parnes, Lorne S}, title = {Transmastoid semicircular canal occlusion: a safe and highly effective treatment for benign paroxysmal positional vertigo and superior canal dehiscence.}, journal = {The Laryngoscope}, year = {2012}, volume = {122}, issue = {8}, pages = {1862--1866}, doi = {https://doi.org/10.1002/lary.23390}, keywords = {Benign Paroxysmal Positional Vertigo; Humans; Mastoid, surgery; Otologic Surgical Procedures; Postoperative Complications, etiology; Postural Balance; Retrospective Studies; Semicircular Canals, surgery; Syndrome; Vertigo, surgery}, pmid = {22753296} }
Luryi, A.L., LaRouere, M., Babu, S., Bojrab, D.I., Zappia, J., Sargent, E.W. and Schutt, C.A.	Traumatic versus Idiopathic Benign Positional Vertigo: Analysis of Disease, Treatment, and Outcome Characteristics. [Abstract] [BibTeX]	2018	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, pp. 194599818797892	article	DOI
Abstract: Objective To compare characteristics between traumatic and idiopathic benign paroxysmal positional vertigo (BPPV) focusing on outcomes. Study Design Retrospective chart review. Setting High-volume tertiary otology center. Subjects and Methods Records of patients with BPPV treated at a single institution from 2007 to 2017 were analyzed. Traumatic BPPV was defined as BPPV symptoms beginning within 30 days following head trauma. Patient, disease, treatment, and outcome characteristics were compared between traumatic and idiopathic BPPV groups. Results A total of 1378 patients with BPPV were identified, 110 (8%) of which had traumatic BPPV. The overall resolution rate was 76%, and the recurrence rate was 38%. Patients with traumatic BPPV were younger (mean age: 61 vs 65 years, P = .007) and more likely to be male (40% vs 27%, P = .004) than patients with idiopathic BPPV. Traumatic BPPV was more likely to affect both ears (32% vs 19%, P = .009). No significant association was detected between trauma history and resolution rate, recurrence rate, number of treatment visits, or affected semicircular canals. Conclusion Patients with traumatic BPPV are more likely to be young and male than those with idiopathic disease. Although traumatic BPPV is often bilateral, outcomes for traumatic BPPV may be similar to those for idiopathic BPPV, contrary to prior reports.
BibTeX: @article{Luryi2018, author = {Luryi, Alexander L and LaRouere, Michael and Babu, Seilesh and Bojrab, Dennis I and Zappia, John and Sargent, Eric W and Schutt, Christopher A}, title = {Traumatic versus Idiopathic Benign Positional Vertigo: Analysis of Disease, Treatment, and Outcome Characteristics.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2018}, pages = {194599818797892}, doi = {https://doi.org/10.1177/0194599818797892}, keywords = {benign paroxysmal positional vertigo; neurotology; trauma; vertigo}, pmid = {30324864} }
Ouchterlony, D., Masanic, C., Michalak, A., Topolovec-Vranic, J. and Rutka, J.A.	Treating Benign Paroxysmal Positional Vertigo in the Patient With Traumatic Brain Injury: Effectiveness of the Canalith Repositioning Procedure. [Abstract] [BibTeX]	2016	The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses Vol. 48(2), pp. 90-9; quiz E1	article	DOI
Abstract: The aim of this study was to determine the effectiveness of the canalith repositioning procedure (CRP) in the treatment of benign paroxysmal positional vertigo (BPPV) among patients after mild-to-moderate traumatic brain injury. An unblinded, nonrandomized, case comparison interventional study with repeated measures (1, 5, 9, and 12 weeks postenrollment) of three groups of patients with traumatic brain injury (BPPV, n = 21; nonspecific dizziness, n = 23; no dizziness, n = 12) was conducted. Patients in the BPPV group received the CRP at baseline and repeatedly until a negative Dix-Hallpike Maneuver was observed. Participants in the other two groups did not receive the CRP. Symptom resolution at the 12-week follow-up was observed in 75% of patients in the BPPV group versus 8.3% in the nonspecific dizziness group (p = .0006). A significant Group × Time interaction was observed for the Dizziness Handicap Inventory (F = 4.2, p = .003) and 36-item Short Form Health Questionnaire physical component scores (F = 2.16, p = .035) with the BPPV group showing significantly improved scores by the 12-week follow-up. Although there were between-group differences on the 36-item Short Form Health Questionnaire mental health component scores (F = 4.06, p = .022), changes over time were not significant in the groups. Treatment with the CRP for posttraumatic BPPV resulted in significant symptom resolution and improvement in perceived physical health status.
BibTeX: @article{Ouchterlony2016, author = {Ouchterlony, Donna and Masanic, Cheryl and Michalak, Alicja and Topolovec-Vranic, Jane and Rutka, John A}, title = {Treating Benign Paroxysmal Positional Vertigo in the Patient With Traumatic Brain Injury: Effectiveness of the Canalith Repositioning Procedure.}, journal = {The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses}, year = {2016}, volume = {48}, issue = {2}, pages = {90--9; quiz E1}, doi = {https://doi.org/10.1097/JNN.0000000000000186}, keywords = {Adult; Benign Paroxysmal Positional Vertigo, etiology, nursing, therapy; Brain Injuries, Traumatic, complications; Dizziness, etiology; Female; Health Status; Humans; Male; Middle Aged; Patient Positioning; Physical Therapy Modalities; Prospective Studies}, pmid = {26895567} }
Anagnostou, E., Kararizou, E. and Evdokimidis, I.	Treatment Maneuvers for Benign Paroxysmal Positional Vertigo in the Very Old. [BibTeX]	2017	European neurology Vol. 77(1-2), pp. 23-24	article	DOI
BibTeX: @article{Anagnostou2017, author = {Anagnostou, Evangelos and Kararizou, Evangelia and Evdokimidis, Ioannis}, title = {Treatment Maneuvers for Benign Paroxysmal Positional Vertigo in the Very Old.}, journal = {European neurology}, year = {2017}, volume = {77}, issue = {1-2}, pages = {23--24}, doi = {https://doi.org/10.1159/000452994}, pmid = {27907918} }
Brantberg, K. and Bergenius, J.	Treatment of anterior benign paroxysmal positional vertigo by canal plugging: a case report. [Abstract] [BibTeX]	2002	Acta oto-laryngologica Vol. 122(1), pp. 28-30	article
Abstract: A 75-year-old man with incapacitating anterior canal benign paroxysmal positional vertigo (BPPV) was relieved of symptoms following anterior semicircular canal occlusion using a transmastoid approach. The preoperative symptoms were similar to those of posterior canal BPPV. The preoperative findings on Dix-Hallpike's maneuver were a paroxysmal torsional nystagmus with a down-beating component that increased when the patient's gaze was directed towards the affected ear. The most provoking head movement for the vertigo/nystagmus was Dix-Hallpike's maneuver with the affected ear lowermost.
BibTeX: @article{Brantberg2002, author = {Brantberg, Krister and Bergenius, Johan}, title = {Treatment of anterior benign paroxysmal positional vertigo by canal plugging: a case report.}, journal = {Acta oto-laryngologica}, year = {2002}, volume = {122}, issue = {1}, pages = {28--30}, keywords = {Aged; Head Movements, physiology; Humans; Male; Nystagmus, Physiologic, physiology; Posture, physiology; Semicircular Canals, physiopathology; Vertigo, physiopathology, therapy}, pmid = {11876594} }
Crevits, L.	Treatment of anterior canal benign paroxysmal positional vertigo by a prolonged forced position procedure. [Abstract] [BibTeX]	2004	Journal of neurology, neurosurgery, and psychiatry Vol. 75(5), pp. 779-781	article
Abstract: This report presents a therapeutic procedure for refractory benign paroxysmal positional vertigo (antBPPV) of the anterior canal. Two patients with refractory antBPPV were treated by a prolonged forced position procedure (PFPP). The technique is based on the assumption that the pathophysiological mechanism of antBPPV is similar to that generating posterior canal canalolithiasis. The patients recovered from refractory antBPPV after one or more PFPPs. The rationale for this therapy is that when the patient lies in the proposed forced position, the affected anterior canal is uppermost in an almost gravitationally vertical position. If the patient remains in this position for several hours, the floating particles lying in the non-ampullary arm of the canal can gradually slip out of the canal towards the vestibule due to gravity. We recommend trying PFPP when the side of lithiasis cannot be determined, in cases that are resistant to particle repositioning canal manoeuvres, and before considering canal plugging for refractory antBPPV.
BibTeX: @article{Crevits2004, author = {Crevits, L}, title = {Treatment of anterior canal benign paroxysmal positional vertigo by a prolonged forced position procedure.}, journal = {Journal of neurology, neurosurgery, and psychiatry}, year = {2004}, volume = {75}, issue = {5}, pages = {779--781}, keywords = {Caloric Tests; Female; Humans; Middle Aged; Posture; Rotation; Semicircular Canals, physiopathology; Vertigo, physiopathology, therapy}, pmid = {15090581} }
Lorin, P.	Treatment of anterior semi-circular canalithiasis by a sedimentation procedure in a vertical rotatory chair. [Abstract] [BibTeX]	2007	Annales d'oto-laryngologie et de chirurgie cervico faciale : bulletin de la Societe d'oto-laryngologie des hopitaux de Paris Vol. 124(4), pp. 184-188	article	DOI
Abstract: To describe the video-nystagmographic characteristics, treatment, and results of a specific canalith repositioning procedure (CRP) on patients with canalolithiasis of the anterior semicircular canal (ASC). This was a retrospective study conducted from January 2005 to March 2006 on 16 patients treated for a benign paroxysmal positional vertigo (BPPV) of the ASC. Each patient after analysis and diagnosis using two-dimensional video-nystagmography (2DVNG) was treated with a specific CRP in a specific vertical rotatory chair with control of pulse and blood pressure. The effect of this procedure was determined after 1 week with video-nystagmoscopic (VNS) positional control. A 2DVNG bithermic caloric test, an impulse rotatory test, and a vibratory test were performed. Patients were contacted in May 2006 to measure the long-term effect of the CRP results. In this retrospective study of 16 anterior BPPVs (a BPPV), the sex ratio, the average age, and the symptoms were comparable to those in patients with posterior BPPV (p BPPV). The sedimentation CRP proved to be effective, with all patients cured after 8 days, even though the length of illness before treatment was 11.68 weeks on average. At the time of the study, 13 patients were already cured, 8.07 months on average after the CRP. Three patients relapsed (one in an anterior form, two in a posterior form). ASC BPPV is rare, possibly because the DIX HALLPIKE (DH) test does not sufficiently provoke the condition. The hyperextension with the head in the 45-degree upper position, especially in a rotatory chair, is probably more effective. It seems that the prolonged sedimentation in this position is the key to the treatment.
BibTeX: @article{Lorin2007, author = {Lorin, P}, title = {Treatment of anterior semi-circular canalithiasis by a sedimentation procedure in a vertical rotatory chair.}, journal = {Annales d'oto-laryngologie et de chirurgie cervico faciale : bulletin de la Societe d'oto-laryngologie des hopitaux de Paris}, year = {2007}, volume = {124}, issue = {4}, pages = {184--188}, doi = {https://doi.org/10.1016/j.aorl.2007.04.005}, keywords = {Adult; Aged; Aged, 80 and over; Ear Diseases, pathology, surgery; Equipment Design; Female; Humans; Lithiasis, pathology, surgery; Male; Middle Aged; Otologic Surgical Procedures, instrumentation; Posture; Semicircular Canals, pathology, surgery; Videotape Recording}, pmid = {17624295} }
Yimtae, K., Srirompotong, S. and Kraitrakul, S.	Treatment of benign paroxysmal positional vertigo by canalith repositioning procedure: experience from Srinagarind Hospital. [Abstract] [BibTeX]	2000	Journal of the Medical Association of Thailand = Chotmaihet thangphaet Vol. 83(12), pp. 1478-1485	article
Abstract: Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo. The diagnosis is confirmed by observing a classical response during the Dix-Hallpike maneuver. The cause of BPPV is usually idiopathic. There are two popular hypotheses described regarding the pathogenesis of BPPV. The first one is the "cupulolithiasis" hypothesis, and the second hypothesis, the so-called "canalithiasis" hypothesis. The clinical course of BPPV is spontaneous recovery in weeks or months. Treatments for BPPV have ranged from no intervention to surgical treatment. The new treatment, "Canalith-repositioning procedure (CRP)" which was introduced by Epley in 1992 produces a very high rate of success. This treatment has caused interest and has been modified and studied worldwide in recent years. To study the efficacy of the canalith-repositioning procedure that we modified from Epley's maneuver in the treatment of BPPV patients. A descriptive study. The BPPV patients, who came to the neurotologic clinic at Srinagarind Hospital from January 1997 to December 1998, were treated with our technique that was modified from Epley's maneuver. We neither used pre-medication, a mastoid oscillator, nor post-treatment instruction. The total number of patients included in this study was 19. The efficacy of this procedure for curing nystagmus and vertigo was 89.5 per cent. One patient did not follow-up and one patient did not respond to the CRP. Complication such as vago-vagal reflex, lateral canalithiasis, occurred in 5.3 per cent of the patients. The recurrence of BPPV in our study was 26.3 per cent. However, CRP was also effective in treatment of both patients with recurrence as well as those without recurrence. The canalith-repositioning procedure that is modified from Epley is effective in the treatment of BPPV.
BibTeX: @article{Yimtae2000, author = {Yimtae, K and Srirompotong, S and Kraitrakul, S}, title = {Treatment of benign paroxysmal positional vertigo by canalith repositioning procedure: experience from Srinagarind Hospital.}, journal = {Journal of the Medical Association of Thailand = Chotmaihet thangphaet}, year = {2000}, volume = {83}, issue = {12}, pages = {1478--1485}, keywords = {Adult; Aged; Female; Humans; Male; Middle Aged; Posture; Vertigo, therapy}, pmid = {11253887} }
Califano, L., Capparuccia, P.G., Di Maria, D., Melillo, M.G. and Villari, D.	Treatment of benign paroxysmal positional vertigo of posterior semicircular canal by "Quick Liberatory Rotation Manoeuvre". [Abstract] [BibTeX]	2003	Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale Vol. 23(3), pp. 161-167	article
Abstract: Treatment of Benign Paroxysmal Positional Vertigo is based on Semont's Liberatory Manoeuvre and on so-called "Canalith Repositioning Manoeuvres", derived from the original Epley technique. Both manoeuvres are very effective and choice of which to use depends on the experience of the physician. Semont's manoeuvre requires a quick movement of the patient in mass in the frontal plane, from the involved, to the contralateral side, which sometimes causes symptoms such as nausea or vomiting. In this technique, a secondary liberatory nystagmus is often observed as sign of the success of the manoeuvre. Repositioning manoeuvres are less fastidious because of the slow movements, but we rarely observe an objective sign of success like the liberatory nystagmus. In the present randomised trial, 300 patients with posterior canalo/cupulolithias were divided into 3 treatment groups: 100 treated by Semont Technique; 100 by a Repositioning procedure (Parnes technique); 100 by a new manoeuvre called "Quick Liberatory Rotation". Results of treatment are also compared with the natural evolution of Benign Paroxysmal Positional Vertigo observed in 18 untreated patients. Quick Liberatory Rotation is similar in the sequence of the positions of the head in the horizontal plane, to repositioning procedures, but is more like the Semont manoeuvre in the speed of the movement (about 180 degrees in less than one second). Quick Liberatory Rotation is easy to perform, well tolerated and very effective (success rate: 98% in one-three cycles). In the present investigation, a secondary liberatory nystagmus was observed in 76.1%, with a sensitivity of 81.9% in detecting patients who had completely recovered and a specificity of 43.8% in detecting failures. Effectiveness, in short and medium period (1-15 months), is similar to Semont and Parnes techniques. Authors consider Quick Liberatory Rotation, at present, a possible first choice technique in the treatment of posterior canalolithiasis.
BibTeX: @article{Califano2003, author = {Califano, L and Capparuccia, P G and Di Maria, D and Melillo, M G and Villari, D}, title = {Treatment of benign paroxysmal positional vertigo of posterior semicircular canal by "Quick Liberatory Rotation Manoeuvre".}, journal = {Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale}, year = {2003}, volume = {23}, issue = {3}, pages = {161--167}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Female; Follow-Up Studies; Humans; Male; Middle Aged; Posture; Rotation; Semicircular Canals, physiopathology; Vertigo, physiopathology, rehabilitation}, pmid = {14677308} }
Roberts, R.A., Gans, R.E., DeBoodt, J.L. and Lister, J.J.	Treatment of benign paroxysmal positional vertigo: necessity of postmaneuver patient restrictions. [Abstract] [BibTeX]	2005	Journal of the American Academy of Audiology Vol. 16(6), pp. 357-366	article
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo, resulting from migration of otoconia into the semicircular canals. Several treatment methods involving positioning maneuvers that return the otoconia to the utricle have been described. Following treatment, most patients are provided with a variety of activity restrictions. Previous studies suggest that, overall, BPPV treatment may be successful without these restrictions. The purpose of this study was to determine the necessity of postmaneuver restrictions using an experimental and control group with participants matched for age, gender, involved ear, and symptoms. A canalith repositioning maneuver was used to treat the BPPV. During postmaneuver instruction, the 21 participants assigned to the restricted group were provided with typical activity restrictions. Twenty-one participants assigned to the nonrestricted group were given no postmaneuver restrictions. Only one participant in the restricted group and two participants in the nonrestricted group were not clear at the one-week follow-up appointment. Results indicated that postmaneuver restrictions do not improve treatment efficacy.
BibTeX: @article{Roberts2005, author = {Roberts, Richard A and Gans, Richard E and DeBoodt, Jennifer L and Lister, Jennifer J}, title = {Treatment of benign paroxysmal positional vertigo: necessity of postmaneuver patient restrictions.}, journal = {Journal of the American Academy of Audiology}, year = {2005}, volume = {16}, issue = {6}, pages = {357--366}, keywords = {Adult; Aged; Aged, 80 and over; Ear, Inner, physiopathology; Female; Humans; Male; Middle Aged; Movement; Nystagmus, Physiologic, physiology; Posture; Severity of Illness Index; Vertigo, diagnosis, physiopathology, therapy}, pmid = {16178407} }
Nuti, D., Nati, C. and Passali, D.	Treatment of benign paroxysmal positional vertigo: no need for postmaneuver restrictions. [Abstract] [BibTeX]	2000	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 122(3), pp. 440-444	article	DOI
Abstract: The liberatory maneuver of Semont is an effective physical treatment for benign paroxysmal positional vertigo. It works because it causes otoconia to move out the posterior canal. The effectiveness of the maneuver is thought to be indicated by the appearance of a liberatory nystagmus. After the maneuver, patients are usually instructed to keep their heads erect for several days and not to lie on the pathologic side for about a week. Here we investigated the prognostic value of liberatory nystagmus and whether restrictions are necessary after treatment. Fifty-six patients with posterior canal benign paroxysmal positional vertigo underwent the Semont maneuver and were checked after 20 minutes, 24 hours, and 1 week. The patients were told that they could sleep or move as they pleased, without any particular precautions. We found that liberatory nystagmus had a high prognostic value and that it was not necessary for patients to avoid certain positions or movements after treatment.
BibTeX: @article{Nuti2000, author = {Nuti, D and Nati, C and Passali, D}, title = {Treatment of benign paroxysmal positional vertigo: no need for postmaneuver restrictions.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2000}, volume = {122}, issue = {3}, pages = {440--444}, doi = {https://doi.org/10.1067/mhn.2000.97986}, keywords = {Adult; Aftercare; Aged; Electronystagmography; Female; Humans; Male; Meniere Disease, etiology, therapy; Middle Aged; Otolithic Membrane; Posture; Prognosis; Semicircular Canals; Treatment Outcome}, pmid = {10699824} }
Herdman, S.J.	Treatment of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	1990	Physical therapy Vol. 70(6), pp. 381-388	article
Abstract: Peripheral vestibular disorders result in vertigo, disequilibrium, and frequently nausea and vomiting. The purpose of this article is to describe the physical therapy management of one of the more common peripheral vestibular disorders--benign paroxysmal positional vertigo (BPPV). Several different approaches have been used in the treatment of BPPV. These approaches are compared, and the criteria used in choosing the appropriate approach are presented. Case studies are used to illustrate the different treatment approaches.
BibTeX: @article{Herdman1990, author = {Herdman, S J}, title = {Treatment of benign paroxysmal positional vertigo.}, journal = {Physical therapy}, year = {1990}, volume = {70}, issue = {6}, pages = {381--388}, keywords = {Exercise Therapy; Female; Humans; Male; Middle Aged; Posture; Vertigo, diagnosis, rehabilitation}, pmid = {2189146} }
Pérez-Vázquez, P. and Franco-Gutiérrez, V.	Treatment of benign paroxysmal positional vertigo. A clinical review. [Abstract] [BibTeX]	2017	Journal of otology Vol. 12(4), pp. 165-173	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most frequent episodic vestibular disorder. It is due to otolith rests that are free into the canals or attached to the cupulas. Well over 90% of patients can be successfully treated with manoeuvres that move the particles back to the utriculus. Among the great variety of procedures that have been described, the manoeuvres that are supported by evidenced-based studies or extensive series are commented in this review. Some topics regarding BPPV treatment, such as controlling the accuracy of the procedures or the utility of post-manoeuvre restrictions are also discussed.
BibTeX: @article{Perez-Vazquez2017, author = {Pérez-Vázquez, Paz and Franco-Gutiérrez, Virginia}, title = {Treatment of benign paroxysmal positional vertigo. A clinical review.}, journal = {Journal of otology}, year = {2017}, volume = {12}, issue = {4}, pages = {165--173}, doi = {https://doi.org/10.1016/j.joto.2017.08.004}, keywords = {Benign Paroxysmal Positional Vertigo; Treatment; Vestibular disorder}, pmid = {29937852} }
Salvinelli, F., Trivelli, M., Casale, M., Firrisi, L., Di Peco, V., D'Ascanio, L., Greco, F., Miele, A., Petitti, T. and Bernabei, R.	Treatment of benign positional vertigo in the elderly: a randomized trial. [Abstract] [BibTeX]	2004	The Laryngoscope Vol. 114(5), pp. 827-831	article	DOI
Abstract: The objective of the study was to evaluate the efficacy of three therapeutic strategies (Semont maneuver, flunarizine, and no treatment) in patients with benign paroxysmal positional vertigo. Randomized prospective trial. One hundred fifty-six consecutive patients older than 60 years of age who were affected by benign paroxysmal positional vertigo of the posterior semicircular canal were enrolled. The diagnosis was made on the basis of the history of recurrent sudden crisis of vertigo and positional-induced typical nystagmus after Dix-Hallpike positioning maneuver. Patients were randomly allocated to receive Semont liberatory maneuver (intended as a statoconia-detachment maneuver), flunarizine, or no treatment. A post-treatment negative Dix-Hallpike test result was considered as a proof of vertigo resolution. Cure rates with Semont maneuver were significantly higher (94.2%) than those obtained with flunarizine (57.7%) and no treatment (36.4%) (P <.001). Within a 6-month follow-up, relapse rates were lower among patients treated with Semont maneuver (3.8%) than those obtained with flunarizine (5.8%) and no treatment (21.1%). All patients with resolution of symptoms and negative Dix-Hallpike test results showed a great improvement in daily activities and quality of life (P <.001). Semont liberatory maneuver is the most successful therapy for benign paroxysmal positional vertigo and improves patients' quality of life. Diagnostic and therapeutic maneuvers are easy to perform and should be part of the medical knowledge of every general practitioner and geriatrician.
BibTeX: @article{Salvinelli2004a, author = {Salvinelli, Fabrizio and Trivelli, Maurizio and Casale, Manuele and Firrisi, Luca and Di Peco, Valerio and D'Ascanio, Luca and Greco, Fabio and Miele, Angela and Petitti, Tommaso and Bernabei, Roberto}, title = {Treatment of benign positional vertigo in the elderly: a randomized trial.}, journal = {The Laryngoscope}, year = {2004}, volume = {114}, issue = {5}, pages = {827--831}, doi = {https://doi.org/10.1097/00005537-200405000-00007}, keywords = {Aged; Calcium Channel Blockers, therapeutic use; Combined Modality Therapy; Flunarizine, therapeutic use; Follow-Up Studies; Humans; Middle Aged; Posture; Prospective Studies; Quality of Life; Vertigo, drug therapy, therapy}, pmid = {15126738} }
Haynes, D.S., Resser, J.R., Labadie, R.F., Girasole, C.R., Kovach, B.T., Scheker, L.E. and Walker, D.C.	Treatment of benign positional vertigo using the semont maneuver: efficacy in patients presenting without nystagmus. [Abstract] [BibTeX]	2002	The Laryngoscope Vol. 112(5), pp. 796-801	article	DOI
Abstract: To evaluate and compare the efficacy of the Semont liberatory maneuver on "objective" benign paroxysmal positional vertigo (BPPV) defined as vertigo with geotropic nystagmus in Dix-Hallpike positioning versus "subjective" BPPV defined as vertigo without nystagmus in Dix-Hallpike positioning. Retrospective chart review. One hundred sixty-two patients with positional vertigo during Dix- Hallpike positioning were identified. Patients were evaluated for the presence or absence of nystagmus. All patients underwent the Semont liberatory maneuver. The patient's condition at follow-up was documented at 3 weeks as complete, partial, or failure. Repeated procedures were performed if necessary. There were 127 cases of objective BPPV and 35 cases of subjective BPPV. Overall, 90% of all patients tested had significant improvement of their vertigo after 1.49 maneuvers on average. Improvement was seen in 91% of patients with objective BPPV after 1.59 maneuvers on average, compared with 86% in subjective BPPV after 1.13 maneuvers on average (chi2 test, not significant [P = .5]). Patients with a history of traumatic origin or cause had an overall success rate of 81% compared with 92% for nontraumatic causes or origins (chi2 test, not significant [P = .1]). Recurrences were seen in 29% of patients after a successful initial maneuver; however, 96% of these patients responded to further maneuvers. Four patients with persistent symptoms after conservative management underwent posterior semicircular canal occlusion with resolution of symptoms. The Semont liberatory maneuver provides relief of vertigo in patients with positional vertigo, even in patients without objective nystagmus.
BibTeX: @article{Haynes2002, author = {Haynes, David S and Resser, John R and Labadie, Robert F and Girasole, Christopher R and Kovach, Bradley T and Scheker, Luis E and Walker, Donald C}, title = {Treatment of benign positional vertigo using the semont maneuver: efficacy in patients presenting without nystagmus.}, journal = {The Laryngoscope}, year = {2002}, volume = {112}, issue = {5}, pages = {796--801}, doi = {https://doi.org/10.1097/00005537-200205000-00006}, keywords = {Electronystagmography; Female; Follow-Up Studies; Humans; Male; Middle Aged; Physical Therapy Modalities; Posture; Retreatment; Retrospective Studies; Treatment Outcome; Vertigo, etiology, rehabilitation}, pmid = {12150609} }
Iglebekk, W., Tjell, C. and Borenstein, P.	Treatment of chronic canalithiasis can be beneficial for patients with vertigo/dizziness and chronic musculoskeletal pain, including whiplash related pain. [Abstract] [BibTeX]	2015	Scandinavian journal of pain Vol. 8(1), pp. 1-7	article	DOI
Abstract: Background and aim Chronic musculoskeletal pain, e.g. whiplash associated disorders (WAD), fibromyalgia and myalgia, causes significant burden on both the individual and on society as a whole. In a previous study, the authors concluded that there is a likely connection between chronic benign paroxysmal positional vertigo (BPPV)/canalithiasis and headache, neck pain, generalized pain, fatigue, cognitive dysfunctions as well as tinnitus. The balance dysfunction in BPPV/canalithiasis is dynamic and not static. This leads to a perpetual postural mismatch. The vicious cycle of a disturbed equilibrium control system may be the driving force behind the vicious cycle of pain. The aim of this study is to investigate if otolith-repositioning manoeuvres in patients with chronic BPPV/canalithiasis can be beneficial. Methods During a period of about two years a prospective observational study on patients with chronic musculoskeletal pain referred for physiotherapy was performed. Those with a Dizziness Handicap Inventory (DHI) inquiry score above 20 underwent further investigations to diagnose chronic BPPV/canalithiasis. Diagnostic criteria: (A) The diagnosis of BPPV/canalithiasis was confirmed with the following: (1) specific history of vertigo or dizziness provoked by acceleration/deceleration, AND (2) nystagmus and symptoms during at least one of the test positions; (B) the disorder had persisted for at least one year. Specific otolith repositioning manoeuvre for each semi-circular canal (SCC) was performed. Symptom questionnaire ("yes" or "no" answers during a personal interview) and a follow-up questionnaire were used. Results The responders of the follow-up questionnaire constituted the study group. Thirty-nine patients responded (i.e. 87%) (31 females, 8 males) with a median age of 44 years (17-65). The median duration of the disease was5 years. Seventy-nine percent had ahistory ofhead or neck trauma. The DHI median score was 48 points (score >60 indicates a risk of fall). The video-oculography confirmed BPPV/canalithiasis in more than one semi-circular canal in all patients. In the present study the frequency of affected anterior semi-circular canal (SSC) was at a minimum of 26% and could be as high as 65%. Ninety-five percent suffered from headache, 92% from neck pain, 54% had generalized pain, and 56% had temporo-mandibular joint region pain. Fatigue (97%), aggravation by physical exertion (87%), decreased ability to concentrate (85%) aswellas visual disturbances (85%) were the most frequently reported symptoms, and 49% suffered from tinnitus. The median number of otolith repositioning manoeuvres done was six (2-29). Median time span between finishing otolith repositioning manoeuvres and answering the questionnaire was 7 months. Effects of treatment and conclusion The present study has shown that repositioning of otoliths in the SCCs in nearly all patients with chronic BPPV/canalithiasis ameliorated pain and other symptoms. The correlation between vertigo/dizziness and the majority of symptoms was significant. Therefore, there is strong evidence to suggest that there is a connection between chronic BPPV/canalithiasis and chronic pain as well as the above-mentioned symptoms. Implications Patients with unexplained pain conditions should be evaluated withthe Dizziness Handicap Inventory-questionnaire, which can identify treatable balance disorders.
BibTeX: @article{Iglebekk2015, author = {Iglebekk, Wenche and Tjell, Carsten and Borenstein, Peter}, title = {Treatment of chronic canalithiasis can be beneficial for patients with vertigo/dizziness and chronic musculoskeletal pain, including whiplash related pain.}, journal = {Scandinavian journal of pain}, year = {2015}, volume = {8}, issue = {1}, pages = {1--7}, doi = {https://doi.org/10.1016/j.sjpain.2015.02.002}, keywords = {Canalithiasis; Chronic BPPV; Pain; Temporo-mandibular joint region pain; Vertigo; Whiplash}, pmid = {29911614} }
Spiegel, R., Rust, H., Baumann, T., Friedrich, H., Sutter, R., Göldlin, M., Rosin, C., Müri, R., Mantokoudis, G., Bingisser, R., Strupp, M. and Kalla, R.	Treatment of dizziness: an interdisciplinary update. [Abstract] [BibTeX]	2017	Swiss medical weekly Vol. 147, pp. w14566	article	DOI
Abstract: This review provides an update on interdisciplinary treatment for dizziness. Dizziness can have various causes and the treatment offered should depend on the cause. After reading this article, the clinician will have an overview of current treatment recommendations. Recommendations are made for the most prevalent causes of dizziness including acute and chronic vestibular syndromes, vestibular neuritis, benign paroxysmal positional vertigo, endolymphatic hydrops and Menière’s disease, vestibular paroxysmia and vestibular migraine, cardiac causes, transient ischaemic attacks and strokes, episodic ataxia type 2, persistent postural-perceptual dizziness, bilateral vestibulopathy, degenerative, autoimmune and neoplastic diseases, upbeat- and downbeat nystagmus. Recommendations include clinical approaches (repositioning manoeuvres), medication (adding, removing or changing current medication depending on aetiology), vestibular physiotherapy, ergotherapy and rehabilitation, treatment of chest pain or stroke units and surgical interventions. If symptoms are acute and severe, medication with antivertigo agents is recommended as a first step, for a maximum period of 3 days. Following initial symptom control, treatment is tailored depending on aetiology. To assist the clinician in obtaining a useful overview, the level of evidence and number needed to treat are reported whenever possible based on study characteristics. In addition, warnings about possible arrhythmias due to medication are issued, and precautions to enable these to be avoided are discussed.
BibTeX: @article{Spiegel2017, author = {Spiegel, Rainer and Rust, Heiko and Baumann, Thomas and Friedrich, Hergen and Sutter, Raoul and Göldlin, Martina and Rosin, Christiane and Müri, René and Mantokoudis, Georgios and Bingisser, Roland and Strupp, Michael and Kalla, Roger}, title = {Treatment of dizziness: an interdisciplinary update.}, journal = {Swiss medical weekly}, year = {2017}, volume = {147}, pages = {w14566}, doi = {https://doi.org/10.4414/smw.2017.14566}, keywords = {Dizziness, therapy; Humans; Interdisciplinary Studies; Ischemic Attack, Transient, therapy; Patient Positioning, methods; Physical Therapy Modalities; Stroke, therapy; Vertigo, therapy; Vestibular Diseases, therapy}, pmid = {29282702} }
Testa, D., Castaldo, G., De Santis, C., Trusio, A. and Motta, G.	Treatment of horizontal canal benign paroxysmal positional vertigo: a new rehabilitation technique. [Abstract] [BibTeX]	2012	TheScientificWorldJournal Vol. 2012, pp. 160475	article	DOI
Abstract: The aim of this study was to evaluate the effectiveness of a new technical variant applied to the Gufoni's manoeuvre, in the treatment of horizontal canal benign paroxysmal positional vertigo (HSC-BPPV). 87 patients with BPPV of HSC (55 women and 32 men), aged between 21 and 80 years, were randomized either to modified Gufoni's manoeuvre or to the Gufoni's manoeuvre. 93% of patients treated with modified Gufoni's manoeuvre was cured after the first treatment session, of which only 2% had a conversion into PSC-BPPV, while the Gufoni's manoeuvre led to a symptoms resolution in 88% of cases, of which 16% had a conversion into PSC-BPPV. Therefore, the modified Gufoni's manoeuvre shows the same effectiveness in the resolution of symptoms of Gufoni's manoeuvre, but it appears more effective than the latter to reduce the percentage of conversion of the HSC-BPPV into PSC-BPPV (χ(2) = 6.13, P = 0.047).
BibTeX: @article{Testa2012, author = {Testa, D and Castaldo, G and De Santis, C and Trusio, A and Motta, G}, title = {Treatment of horizontal canal benign paroxysmal positional vertigo: a new rehabilitation technique.}, journal = {TheScientificWorldJournal}, year = {2012}, volume = {2012}, pages = {160475}, doi = {https://doi.org/10.1100/2012/160475}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Female; Humans; Male; Middle Aged; Physical Therapy Modalities; Vertigo, rehabilitation}, pmid = {22619605} }
Oron, Y., Cohen-Atsmoni, S., Len, A. and Roth, Y.	Treatment of horizontal canal BPPV: pathophysiology, available maneuvers, and recommended treatment. [Abstract] [BibTeX]	2015	The Laryngoscope Vol. 125(8), pp. 1959-1964	article	DOI
Abstract: To describe the pathophysiology of horizontal canal benign paroxysmal positional vertigo, the available maneuvers for its management, and the recommended treatment. PubMed, Cochrane library. Review of the available literature. Two theories of pathophysiology underlying the disease are described, along with available maneuvers reflecting those theories; and videos of the maneuvers are provided. A comparison of available treatments is made. A variety of maneuvers is available related to the pathophysiology underlying the disease. The treatment chosen should be appropriate to the patients' ages, general conditions, and other diseases they may have. No treatment was found to be superior over the others regarding the success rate. In the case of geotropic nystagmus, the Gufoni maneuver is superior in its ease of performance. When it comes to apogeotropic nystagmus, the Barbecue and Gufoni maneuvers have comparable success rates.
BibTeX: @article{Oron2015, author = {Oron, Yahav and Cohen-Atsmoni, Smadar and Len, Assaf and Roth, Yehudah}, title = {Treatment of horizontal canal BPPV: pathophysiology, available maneuvers, and recommended treatment.}, journal = {The Laryngoscope}, year = {2015}, volume = {125}, issue = {8}, pages = {1959--1964}, doi = {https://doi.org/10.1002/lary.25138}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis, physiopathology, therapy; Disease Management; Humans; Posture, physiology; Semicircular Canals, physiopathology; Vertigo; pathophysiology; treatment}, pmid = {25644058} }
Vannucchi, P., Giannoni, B. and Pagnini, P.	Treatment of horizontal semicircular canal benign paroxysmal positional vertigo. [Abstract] [BibTeX]	1997	Journal of vestibular research : equilibrium & orientation Vol. 7(1), pp. 1-6	article
Abstract: We evaluated a new therapeutic maneuver-Prolonged Position on the healthy side, for Benign Paroxysmal Positional Vertigo (BPPV) of the horizontal semicircular canal. We devised this type of physical treatment in accordance with the "canalolithiasis" theory of BPPV, in order to try to free the horizontal semicircular canal of otoconial debris. We compared the results obtained by Prolonged Position with two other physical therapies by dividing our horizontal canal BPPV patients into three therapeutic groups: 1) 35 patients treated with Prolonged Position; 2) 24 patients treated with head shaking in a supine position; 3) 15 patients for whom therapy was omitted. More than 90% of the patients treated with Prolonged Position recovered within 3 days, although 6 patients out of 35 subsequently developed BPPV of the posterior semicircular canal, which then responded well to a particular repositioning maneuver. The results of Prolonged Position were significantly better than those obtained by performing head shaking or by omitting treatment. Prolonged Position can be applied to patients of all ages and general conditions and does not require hospitalization.
BibTeX: @article{Vannucchi1997, author = {Vannucchi, P and Giannoni, B and Pagnini, P}, title = {Treatment of horizontal semicircular canal benign paroxysmal positional vertigo.}, journal = {Journal of vestibular research : equilibrium & orientation}, year = {1997}, volume = {7}, issue = {1}, pages = {1--6}, keywords = {Adult; Aged; Aged, 80 and over; Calculi, complications; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, etiology, physiopathology, therapy; Physical Therapy Modalities; Posture; Retrospective Studies; Semicircular Canals, pathology, physiopathology; Treatment Outcome; Vertigo, etiology, physiopathology, therapy}, pmid = {9057155} }
Huebner, A.C., Lytle, S.R., Doettl, S.M., Plyler, P.N. and Thelin, J.T.	Treatment of objective and subjective benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2013	Journal of the American Academy of Audiology Vol. 24(7), pp. 600-606	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo in adults and is a result of otolithic particles or debris that become free floating within a semicircular canal or adhere to the cupula. Characteristics of BPPV include brief episodes of latent onset vertigo that occur with changes in head position, transient rotary nystagmus beating toward the dependent ear, and reversed nystagmus upon sitting up. Both the vertigo and nystagmus fatigue quickly while maintaining the same head position. The BPPV may be classified as objective or subjective. Objective BPPV presents all the aforementioned symptoms whereas subjective BPPV presents all the symptoms without nystagmus. The accepted method of treatment for objective BPPV is canalith repositioning maneuvers (CRM); however, CRM are not traditionally used as the method of treatment for cases of subjective BPPV. The purpose of the study was to determine if the subjective report of dizziness using the Dizziness Handicap Inventory (DHI) was different in patients with objective and subjective BPPV and to determine if the two groups showed similar improvements in perceived dizziness handicap following CRM treatment. The present study utilized a retrospective, repeated measures design. Sixty-three adults with BPPV that were given the DHI both before and after CRM treatment. Pre and post DHI results were analyzed for participants with objective versus subjective BPPV. A five-question DHI subscale was also analyzed between the groups. A significant difference was noted between initial and posttreatment DHI scores for patients in both the subjective and objective groups when using the full-scale and subscale DHI. No significant difference was noted between groups for their initial or posttreatment DHI scores. The two groups also did not differ significantly in their initial or posttreatment DHI subscale scores. The results of the study indicated that individuals with both objective and subjective BPPV demonstrated significant improvement in DHI scores following CRM treatment. Additionally, there was no difference in DHI improvement for the subjective versus objective group suggesting CRM are effective for both subjective BPPV and objective BPPV. This improvement in DHI scores was also noted in the five-question DHI subscale with no significant difference noted between groups. These findings combined with previous studies suggest the presence or absence of nystagmus during Dix-Hallpike maneuvers is not related to the effectiveness of treatment using CRM.
BibTeX: @article{Huebner2013, author = {Huebner, Alexandra C and Lytle, Susan R and Doettl, Steven M and Plyler, Patrick N and Thelin, James T}, title = {Treatment of objective and subjective benign paroxysmal positional vertigo.}, journal = {Journal of the American Academy of Audiology}, year = {2013}, volume = {24}, issue = {7}, pages = {600--606}, doi = {https://doi.org/10.3766/jaaa.24.7.8}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Analysis of Variance; Benign Paroxysmal Positional Vertigo; Disability Evaluation; Dizziness, physiopathology, therapy; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, complications, diagnosis, physiopathology; Outcome Assessment (Health Care), statistics & numerical data; Patient Positioning, methods; Retrospective Studies; Semicircular Canals, pathology; Vertigo, complications, physiopathology, therapy; Young Adult}, pmid = {24047947} }
Luryi, A.L., Lawrence, J., LaRouere, M., Babu, S., Bojrab, D.I., Zappia, J., Sargent, E.W. and Schutt, C.A.	Treatment of Patients With Benign Paroxysmal Positional Vertigo and Severe Immobility Using the Particle Repositioning Chair: A Retrospective Cohort Study. [Abstract] [BibTeX]	2018	The Annals of otology, rhinology, and laryngology Vol. 127(6), pp. 390-394	article	DOI
Abstract: To report treatment of benign paroxysmal positional vertigo (BPPV) in patients unable to undergo traditional canalith repositioning maneuvers (CRMs) using a particle repositioning chair (PRC). A retrospective chart review was conducted at a single high-volume otology practice of patients diagnosed with BPPV from 2007 to 2017 with immobility prohibiting use of traditional CRMs. Patients were diagnosed and treated using a PRC, and outcome measures including resolution, recurrence, and number of treatment visits were recorded. A total of 34 patients meeting criteria were identified, 24 of whom had cervical spine disease and 10 of whom had other prohibitive immobility. Symptoms were present for between 5 days and 11 years at presentation, with mean and median of 552 and 90 days, respectively. Symptoms resolved in 68% of patients and recurred in 13% of those patients. Most patients required 1 treatment visit. Successful treatment of patients with BPPV and concomitant immobility prohibiting traditional CRMs is reported using the PRC. Benign paroxysmal positional vertigo in the setting of immobility is an indication for treatment with a PRC if available.
BibTeX: @article{Luryi2018c, author = {Luryi, Alexander L and Lawrence, Juliana and LaRouere, Michael and Babu, Seilesh and Bojrab, Dennis I and Zappia, John and Sargent, Eric W and Schutt, Christopher A}, title = {Treatment of Patients With Benign Paroxysmal Positional Vertigo and Severe Immobility Using the Particle Repositioning Chair: A Retrospective Cohort Study.}, journal = {The Annals of otology, rhinology, and laryngology}, year = {2018}, volume = {127}, issue = {6}, pages = {390--394}, doi = {https://doi.org/10.1177/0003489418771988}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, complications, therapy; Cohort Studies; Female; Humans; Male; Middle Aged; Mobility Limitation; Patient Positioning, instrumentation; Retrospective Studies; Treatment Outcome; BPPV; Epley; benign paroxysmal positional vertigo; immobility; maneuver; repositioning chair}, pmid = {29732909} }
Korres, S., Riga, M.G., Xenellis, J., Korres, G.S. and Danielides, V.	Treatment of the horizontal semicircular canal canalithiasis: pros and cons of the repositioning maneuvers in a clinical study and critical review of the literature. [Abstract] [BibTeX]	2011	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 32(8), pp. 1302-1308	article	DOI
Abstract: Several repositioning maneuvers have been proposed for the treatment of benign paroxysmal positional vertigo (BPPV) due to canalithiasis of the horizontal semicircular canal (HSC). However, comparisons between these canalith repositioning procedures as well as a generally accepted algorithm for the management of HSC canalithiasis are currently lacking. The aim of this study was to compare the efficacy of 3 different treatment proposals and review the relevant literature. Prospective clinical study. Tertiary neurotology department. Sixty patients diagnosed with HSC canalithiasis. A single application of Baloh's maneuver (n = 13), Vannucchi's forced prolonged position (n = 29), or Asprella-Gufoni maneuver (n = 18). Bilateral geotropic nystagmus. The first application of the Baloh's maneuver seemed to be significantly less effective than both Vannucchi's forced prolonged position (p = 0.035) and the Asprella-Gufoni maneuver (p = 0.006). No significant difference was detected in the efficiency of Vannucchi's forced prolonged position and the Asprella-Gufoni maneuver for this population (p = 0.4). The Asprella-Gufoni maneuver and Vannucchi's forced prolonged position both seem to be significantly more effective than the Baloh's maneuver in the treatment of HSC canalithiasis. The important pros of the Asprella-Gufoni maneuver versus Vannucchi's forced prolonged position are patient's convenience and maximal use of gravitational and angular acceleration forces. Controlled clinical studies are needed to conclude to an evidence-based proposal for the therapeutical steps that should be followed after the diagnosis of HSC canalithiasis.
BibTeX: @article{Korres2011a, author = {Korres, Stavros and Riga, Maria G and Xenellis, John and Korres, George S and Danielides, Vasilios}, title = {Treatment of the horizontal semicircular canal canalithiasis: pros and cons of the repositioning maneuvers in a clinical study and critical review of the literature.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2011}, volume = {32}, issue = {8}, pages = {1302--1308}, doi = {https://doi.org/10.1097/MAO.0b013e31822f0bc5}, keywords = {Adult; Aged; Female; Humans; Labyrinth Diseases, pathology, therapy; Lithiasis, pathology, therapy; Male; Middle Aged; Nystagmus, Pathologic, pathology, therapy; Patient Positioning; Prospective Studies; Semicircular Canals, pathology; Treatment Outcome}, pmid = {21897315} }
Nomura, Y., Okuno, T. and Mizuno, M.	Treatment of vertigo using laser labyrinthectomy. [Abstract] [BibTeX]	1993	Acta oto-laryngologica Vol. 113(3), pp. 261-262	article
Abstract: Benign paroxysmal positional vertigo developed in a patient with perilymph fistula 3 years after closure of the fistula which was in the lower margin of the annular ligament. The patient's symptoms were long-lasting and intractable. The macula utriculi and utriculoampullary nerve were irradiated by argon laser beams through the stapedectomized oval window. Singular neurectomy was performed using Argon laser, although the nerve could not be identified. After surgery, the patient's symptoms disappeared. Pure tone average of the operated side was 50 dB which remained unchanged after surgery. The macula utriculi may have been completely destroyed. Ocular counter-rolling was indicative of hypofunction of the irradiated utricle. The singular nerve may or may not have been sectioned. The ampullary nerves to the lateral canal and probably the anterior canal were intact, judging from the normal caloric reaction.
BibTeX: @article{Nomura1993, author = {Nomura, Y and Okuno, T and Mizuno, M}, title = {Treatment of vertigo using laser labyrinthectomy.}, journal = {Acta oto-laryngologica}, year = {1993}, volume = {113}, issue = {3}, pages = {261--262}, keywords = {Acoustic Maculae, surgery; Ear, Inner, innervation, surgery; Female; Humans; Laser Therapy; Middle Aged; Posture, physiology; Vertigo, etiology, surgery}, pmid = {8100107} }
Swartz, R. and Longwell, P.	Treatment of vertigo. [Abstract] [BibTeX]	2005	American family physician Vol. 71(6), pp. 1115-1122	article
Abstract: Vertigo is the illusion of motion, usually rotational motion. As patients age, vertigo becomes an increasingly common presenting complaint. The most common causes of this condition are benign paroxysmal positional vertigo, acute vestibular neuronitis or labyrinthitis, Ménière's disease, migraine, and anxiety disorders. Less common causes include vertebrobasilar ischemia and retrocochlear tumors. The distinction between peripheral and central vertigo usually can be made clinically and guides management decisions. Most patients with vertigo do not require extensive diagnostic testing and can be treated in the primary care setting. Benign paroxysmal positional vertigo usually improves with a canalith repositioning procedure. Acute vestibular neuronitis or labyrinthitis improves with initial stabilizing measures and a vestibular suppressant medication, followed by vestibular rehabilitation exercises. Meniere's disease often responds to the combination of a low-salt diet and diuretics. Vertiginous migraine headaches generally improve with dietary changes, a tricyclic antidepressant, and a beta blocker or calcium channel blocker. Vertigo associated with anxiety usually responds to a selective serotonin reuptake inhibitor.
BibTeX: @article{Swartz2005, author = {Swartz, Randy and Longwell, Paxton}, title = {Treatment of vertigo.}, journal = {American family physician}, year = {2005}, volume = {71}, issue = {6}, pages = {1115--1122}, keywords = {Diagnosis, Differential; Humans; Posture; Vertigo, diagnosis, etiology, therapy}, pmid = {15791890} }
Sherman, D. and Massoud, E.A.	Treatment outcomes of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2001	The Journal of otolaryngology Vol. 30(5), pp. 295-299	article
Abstract: The purpose of this study was to examine the efficacy of the particle repositioning manoeuvre (PRM) in the treatment of benign paroxysmal positional vertigo (BPPV). A randomized prospective study of patients with BPPV. Seventy-one patients were randomized to one of three groups at their first clinic visit. These groups included the PRM, a sham PRM, and a control group. Patients were followed up in clinic at 2 weeks and 3 months. The mean long-term follow-up was 12 months. A telephone questionnaire was also conducted. At 2-week follow-up, 81.8% of patients in the PRM group had a resolution of symptoms and a negative Dix-Hallpike test compared with 15.3% in the sham PRM group and 60% in the control group. This difference was statistically significant between the treatment (PRM) and sham PRM groups and between the sham and control groups. It nearly reached significance between the treatment and control groups (p = .06). The sham treatment group had by far the worst outcome at the 2-week interval. There was no statistically significant difference between the groups after 2 weeks. The PRM is side specific. It may help induce remission of the vertiginous symptoms of BPPV in the short term. This cannot be attributable to a placebo effect. The PRM does not seem to affect the natural history of the disorder in the long term. The sham treatment causes a delay in spontaneous recovery, possibly by preventing the particles from falling into the utricle. This study has not compared the frequency or severity of symptoms.
BibTeX: @article{Sherman2001, author = {Sherman, D and Massoud, E A}, title = {Treatment outcomes of benign paroxysmal positional vertigo.}, journal = {The Journal of otolaryngology}, year = {2001}, volume = {30}, issue = {5}, pages = {295--299}, keywords = {Calculi, complications; Endolymph; Follow-Up Studies; Head, physiology; Head Movements; Humans; Labyrinth Diseases, complications; Posture; Prospective Studies; Saccule and Utricle, pathology; Semicircular Canals; Treatment Outcome; Vertigo, etiology, therapy}, pmid = {11771023} }
Cohen, H.S. and Kimball, K.T.	Treatment variations on the Epley maneuver for benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2004	American journal of otolaryngology Vol. 25(1), pp. 33-37	article
Abstract: To determine if using more head rotation during the Epley maneuver or specific posttreatment instructions for sleeping position would affect treatment effectiveness, compared with the usual maneuver without extra instructions. Patients with unilateral benign paroxysmal positional vertigo of the posterior semicircular canal were randomized to a standard Epley maneuver group, a group that received an additional 45 degrees head rotation during the maneuver (Augmented Epley), and a group that received instructions about sleeping position after treatment. Posttests from 1 week to 6 months showed no differences in vertigo intensity or frequency or responses to the Dix-Hallpike maneuver. All groups showed significant decreases in vertigo and Dix-Hallpike responses. Some subjects in each group had abnormal pretreatment scores on computerized dynamic posturography. Those subjects in the Augmented Epley group who had abnormal pretreatment posturography scores had significantly better posttreatment scores than those subjects in the Home Instruction group who had abnormal pretreatment scores. All subjects with abnormal responses, however, showed improvement. Although clinicians continue to give patients home instructions and to use additional head rotation during the maneuver, these variations are not essential for achieving improvement in symptoms.
BibTeX: @article{Cohen2004b, author = {Cohen, Helen S and Kimball, Kay T}, title = {Treatment variations on the Epley maneuver for benign paroxysmal positional vertigo.}, journal = {American journal of otolaryngology}, year = {2004}, volume = {25}, issue = {1}, pages = {33--37}, keywords = {Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Models, Statistical; Physical Therapy Modalities; Posture; Rotation; Semicircular Canals; Treatment Outcome; Vertigo, physiopathology, therapy}, pmid = {15011204} }
Yin, S., Yu, D., Li, M. and Wang, J.	Triple semicircular canal occlusion in guinea pigs with endolymphatic hydrops. [Abstract] [BibTeX]	2006	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 27(1), pp. 78-85	article
Abstract: Triple semicircular canal occlusion will eliminate rotatory stimulation to the vestibular peripheral system (as it blocks endolymphatic fluid movement) and therefore release rotatory vertigo attack. This surgery is safe in ears with endolymphatic hydrops. Semicircular canal occlusion has been used as an alternative treatment of intractable benign paroxysmal positional vertigo with varied success. Triple semicircular canal occlusion in animal models blocks the responses of the semicircular canals to rotation and spares cochleae and the otolithic apparatus. This result suggests that triple semicircular canal occlusion is a prospective method in vertigo management for patients with Ménière's disease. However, the effectiveness and safety of triple semicircular canal occlusion has not been fully evaluated in ears with endolymphatic hydrops. Endolymphatic hydrops was established in 20 guinea pigs by endolymphatic sac obliteration. Triple semicircular canal occlusion was performed in 12 of them 120 days after endolymphatic hydrops surgery, whereas 8 others were killed for morphologic observation to confirm endolymphatic hydrops. Auditory and vestibular functions were monitored from the time before endolymphatic hydrops until 1 month after triple semicircular canal occlusion. Endolymphatic hydrops and canal occlusion were confirmed by morphologic observation. Successful establishment of endolymphatic hydrops was indicated by mild elevation of the auditory brainstem response threshold and tentative asymmetry in nystagmus. Endolymphatic hydrops was confirmed by cochlear morphology in all eight animals that were killed 120 days after endolymphatic hydrops surgery. After triple semicircular canal occlusion, all 12 animals showed spontaneous nystagmus with a slow component toward the side that had been operated on, head tilt, rotated walking, and tentative asymmetry in rotatory nystagmus. The static symptoms disappeared within 1 month after triple semicircular canal occlusion. Caloric nystagmus was only slightly reduced after endolymphatic hydrops as compared with the contralateral ears but could not be elicited at all after triple semicircular canal occlusion. No significant elevation in auditory brainstem response threshold was found after triple semicircular canal occlusion. The canal occlusion and endolymphatic hydrops were confirmed in all surgical ears. Triple semicircular canal occlusion is effective for eliminating the response of semicircular canals to rotation and caloric stimulation and is safe in ears with endolymphatic hydrops. Also, the static compensation to the disequilibrium is quick and complete. These results suggest that triple semicircular canal occlusion should be an option for controlling rotatory vertigo in Ménière's disease.
BibTeX: @article{Yin2006, author = {Yin, Shankai and Yu, Dongzhen and Li, Manna and Wang, Jian}, title = {Triple semicircular canal occlusion in guinea pigs with endolymphatic hydrops.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2006}, volume = {27}, issue = {1}, pages = {78--85}, keywords = {Animals; Disease Models, Animal; Endolymphatic Hydrops, complications, surgery; Evoked Potentials, Auditory, Brain Stem; Female; Guinea Pigs; Male; Nystagmus, Physiologic; Semicircular Canals, surgery; Treatment Outcome; Vertigo, etiology, surgery; Vestibule, Labyrinth, physiology}, pmid = {16371851} }
Maranhão, E.T., Whitney, S.L. and Maranhão-Filho, P.	Tumarkin-like phenomenon as a sign of therapeutic success in benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2018	Arquivos de neuro-psiquiatria Vol. 76(8), pp. 534-538	article	DOI
Abstract: To describe an unusual patient reaction to maneuvers used in the treatment of posterior canal benign paroxysmal positional vertigo (PC-BPPV) that we termed the "Tumarkin-like phenomenon". At a private practice, 221 outpatients were diagnosed and treated for PC-BPPV. The treatment consisted of performing the Epley or Semont maneuvers. At the end of these maneuvers, when assuming the sitting position, the patients' reactions were recorded. Thirty-three patients showed a Tumarkin-like phenomenon described by a self-reported sensation of suddenly being thrown to the ground. In the follow-up, this group of patients remained without PC-BPPV symptoms up to at least 72 hours after the maneuvers. The occurrence of a Tumarkin-like phenomenon at the end of Epley and Semont maneuvers for PC-BPPV may be linked with treatment success.
BibTeX: @article{Maranhao2018, author = {Maranhão, Eliana T and Whitney, Susan L and Maranhão-Filho, Péricles}, title = {Tumarkin-like phenomenon as a sign of therapeutic success in benign paroxysmal positional vertigo.}, journal = {Arquivos de neuro-psiquiatria}, year = {2018}, volume = {76}, issue = {8}, pages = {534--538}, doi = {https://doi.org/10.1590/0004-282X20180073}, pmid = {30231127} }
Kitahara, T., Kondoh, K., Kizawa, K., Horii, A. and Kubo, T.	Two cases of spinal cord extramedullary tumor with positional vertiginous sensation. [Abstract] [BibTeX]	2009	Acta oto-laryngologica. Supplementum(562), pp. 50-52	article
Abstract: We conclude that neck imaging should be carried out for patients with persistent paroxysmal positional vertigo following diagnostic and/or therapeutic maneuvers. It is sometimes complicated to diagnose patients with vertigo that is transiently induced by head and neck positioning. Neck-vestibular diseases also induce vertiginous sensation with head and neck movement and need to be ruled out for the diagnosis of benign paroxysmal positional vertigo (BPPV). Two elderly female patients visited our hospital with complaints of transient vertigo induced by Dix-Hallpike positioning, suggesting posterior canal BPPV. We carried out gadolinium-enhanced neck MRI in both these cases. The positional nystagmus was not clearly observed or vertiginous sensation did not show any decay during repeated vestibular examination in either case. These cases were finally diagnosed as spinal cord intradural extramedullary tumor (C3-C4) by means of neck MRI.
BibTeX: @article{Kitahara2009, author = {Kitahara, Tadashi and Kondoh, Kazumasa and Kizawa, Kaoru and Horii, Arata and Kubo, Takeshi}, title = {Two cases of spinal cord extramedullary tumor with positional vertiginous sensation.}, journal = {Acta oto-laryngologica. Supplementum}, year = {2009}, issue = {562}, pages = {50--52}, keywords = {Aged, 80 and over; Cervical Vertebrae, pathology; Contrast Media; Female; Gadolinium DTPA; Humans; Magnetic Resonance Imaging; Middle Aged; Neurilemmoma, diagnosis; Spinal Cord Neoplasms, diagnosis; Vertigo, etiology}, pmid = {19848240} }
van Esch, B.F., van Benthem, P.P.G., van der Zaag-Loonen, H.J. and Bruintjes, T.D.	Two Common Second Causes of Dizziness in Patients With Ménière's Disease. [Abstract] [BibTeX]	2016	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 37(10), pp. 1620-1624	article	DOI
Abstract: There are no epidemiological studies quantifying the prevalence of second causes of dizziness in Ménière's disease (MD). Therefore, we aimed to quantify which dizziness-inducing causes are prevalent alongside MD. Moreover, we analyzed which second cause of dizziness was more common in a specific age group and if age was a risk factor. Retrospective cohort study. Tertiary referral center. Data were retrospectively obtained from all MD patients who visited our clinic between January 2000 and December 2013. Workup included vestibular tests, pure tone audiometry, blood pressure monitoring, and the hyperventilation provocation test, the Nijmegen Questionnaire (NQ) and the Hospital Anxiety and Depression Scale (HADS). The final causes of dizziness were based on consensus between an ENT-surgeon and a neurologist who were consulted simultaneously. We found that 143 (30%) of 469 MD patients suffered from a second cause of dizziness. The two most common causes were psychological distress (PD) (70%) and benign paroxysmal positional vertigo (BPPV) (18%). The mean age for MD patients with PD was 58.7 ± 13.3 years compared with the mean age of 63.9 ± 14.3 years for MD patients without PD (mean difference = -5.2 years, 95% CI: -8.3 to -2.2, p = 0.001). MD patients younger than 60 of age had a 15% higher risk of suffering from psychological distress than those who were older than 60 (risk difference, 15%, 95% CI, 7.0-22%). Age could not be identified as a risk factor for BPPV in older MD patients. In 30% of the patients with MD a second cause of dizziness is present. PD most commonly coincides with MD, especially in younger patients. The second most common cause is BPPV.
BibTeX: @article{Esch2016, author = {van Esch, Babette F and van Benthem, Peter Paul G and van der Zaag-Loonen, Hester J and Bruintjes, Tjasse D}, title = {Two Common Second Causes of Dizziness in Patients With Ménière's Disease.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2016}, volume = {37}, issue = {10}, pages = {1620--1624}, doi = {https://doi.org/10.1097/MAO.0000000000001215}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo, complications; Cohort Studies; Dizziness, etiology; Female; Humans; Meniere Disease, complications; Middle Aged; Retrospective Studies; Risk Factors; Stress, Psychological, complications; Surveys and Questionnaires; Young Adult}, pmid = {27642667} }
Hiruma, K., Numata, T., Mitsuhashi, T., Tomemori, T., Watanabe, R. and Okamoto, Y.	Two types of direction-changing positional nystagmus with neutral points. [Abstract] [BibTeX]	2011	Auris, nasus, larynx Vol. 38(1), pp. 46-51	article	DOI
Abstract: We encountered patients who had static direction-changing positional nystagmus (DCPN) canceled at about 20-30° yaw head rotation from the supine position. This nystagmus was also canceled when the head was rotated 180° from this position. We termed these head positions neutral points. The positional nystagmus observed (except at the neutral points) was thought to occur due to a "heavy cupula" or "light cupula". The purpose of this study was to examine DCPN with neutral points as well as the pathomechanism of this condition. Retrospective case review of patients attending two hospitals. Sixteen patients who exhibited DCPN with neutral points were examined using an infrared camera (installed in goggles). Using this system, the vestibulo-ocular reflex (VOR) was recorded, and VOR gain was obtained. Vestibular function and the affected side were determined. In addition, the angle between the supine position and neutral point was measured in each patient. We also examined other positional nystagmus occurring at other times. In the heavy cupula type group, we noted positional nystagmus for which repositioning maneuvers were successful, whereas, in the light cupula type group, repositioning maneuvers were not effective. The angle between supine position and neutral point was 26.5 ± 11.6°. Heavy cupula type may occur as a result of otoconia while light cupula type may be due to the specific gravity of the endolymph. The VOR gain and side of the benign paroxysmal positional vertigo (BPPV) observed suggested that the affected side was that to which the neutral point was deviated.
BibTeX: @article{Hiruma2011, author = {Hiruma, Kiyoshi and Numata, Tsutomu and Mitsuhashi, Toshio and Tomemori, Takuya and Watanabe, Ryoko and Okamoto, Yoshitaka}, title = {Two types of direction-changing positional nystagmus with neutral points.}, journal = {Auris, nasus, larynx}, year = {2011}, volume = {38}, issue = {1}, pages = {46--51}, doi = {https://doi.org/10.1016/j.anl.2010.07.004}, keywords = {Aged; Aged, 80 and over; Endolymph, physiology; Female; Head, physiology; Humans; Male; Middle Aged; Nystagmus, Physiologic, physiology; Otolithic Membrane, physiopathology; Posture; Retrospective Studies; Rotation; Supine Position}, pmid = {20724087} }
Alimoğlu, Y., Altın, F., Açıkalın, R.M. and Yaşar, H.	Two-Hour Follow-Up is Equivalent to One-Day Follow-Up of Posterior Canal Benign Paroxysmal Positional Vertigo. [Abstract] [BibTeX]	2018	The journal of international advanced otology	article	DOI
Abstract: To evaluate short-term outcome for posterior canal benign paroxysmal positional vertigo (p-BPPV) after modified Epley's maneuver (mEM). Patients who were diagnosed with p-BPPV between September 2017 and January 2018 in a tertiary care center were included. Patients were treated with mEM. Five follow-up points were set at one hour, two hours, one day, three days and one week. If Dix-Hallpike test (DH) was positive, mEM was performed and patient was scheduled for follow-up at the next follow-up point. If negative, the patient was accepted as completely resolved and scheduled for follow-up at one week. The proportion of completely resolved patients at each follow-up point, recurrence, lateral canal conversion rate and time were noted. A retrospective control group was created from patients treated for p-BPPV between April and August 2017. The outcome of the study and control groups were compared. There were 93 patients in study group. 63 (67.7%), 8 (8.6%), 3 (3.2%), 0 (0%) and 9 (9.7%) patients completely resolved at one-hour, two-hour, one-day, three-days and one-week follow-ups. 1.96±1.60 (1-5) mEMs were performed. Control group included 61 patients. At one-week follow-up a total of 83 (89.2%) patients in study group and 48 (78.7%) in control group were completely resolved(p=0.1043). In study group 5 (5.37%) of patients had lateral canal conversion within one day. 2(2.15%) had recurrence one day later after two-hour follow-up. The number of patients completely resolved at two-hour follow-up and before (76.34%) compared to the patients completely resolved at one-day follow-up and before (79.56%) were not significantly different (p=0.7235). Two-hour follow-up is equivalent to one-day follow-up of p-BPPV in terms of therapy outcome and adverse affects.
BibTeX: @article{Alimoglu2018, author = {Alimoğlu, Yalçın and Altın, Fazilet and Açıkalın, Reşit Murat and Yaşar, Hüsamettin}, title = {Two-Hour Follow-Up is Equivalent to One-Day Follow-Up of Posterior Canal Benign Paroxysmal Positional Vertigo.}, journal = {The journal of international advanced otology}, year = {2018}, doi = {https://doi.org/10.5152/iao.2018.5328}, pmid = {30411707} }
Zur, O., Berner, Y., Ohel, Y. and Carmeli, E.	Two-Year Follow-Up of Fall Prediction Among Older Adults in an Independent-Living Community. [Abstract] [BibTeX]	2018	Advances in experimental medicine and biology Vol. 1040, pp. 63-71	article	DOI
Abstract: Adults over the age of 70 are at risk of falls. Early detection of risk of falls can suggest early interventions. In this study, we attempted to determine valid clinical tests that can differentiate older individuals who are at risk of falling. Older adults from an independent-living community volunteered to participate in this descriptive, cohort study. They were administered the Berg Balance Scale (BBS), Zur Balance Scale (ZBS), Head Shaking Nystagmus Head Impulse Test, Dynamic Visual Acuity, and the Hallpike maneuver for evaluating benign paroxysmal positional vertigo (BPPV); a questionnaire including sociodemographics and a health characteristics survey. Multivariate analysis indicated that a ZBS score < 51, previous fall, and number of medications strongly predict falls in older adults. ZBS score, BBS score, Hallpike maneuver, number of medications, deficit of vestibular ocular reflex, along with positive ZBS score and past fall differentiate between fallers and non-fallers. ZBS <51, taking >6 medications, and history of falls were a benchmark for high-risk of falling.
BibTeX: @article{Zur2018, author = {Zur, Oz and Berner, Yitshal and Ohel, Yair and Carmeli, Eli}, title = {Two-Year Follow-Up of Fall Prediction Among Older Adults in an Independent-Living Community.}, journal = {Advances in experimental medicine and biology}, year = {2018}, volume = {1040}, pages = {63--71}, doi = {https://doi.org/10.1007/5584_2017_100}, keywords = {Accidental Falls; Aged; Aged, 80 and over; Aging, physiology; Female; Follow-Up Studies; Geriatric Assessment; Humans; Male; Postural Balance, physiology; Reflex, physiology; Surveys and Questionnaires; Vestibular Function Tests; Aging; Balance; Falls; Vestibular ocular reflex; Vestibular system}, pmid = {29067628} }
Büki, B., Mandalà, M. and Nuti, D.	Typical and atypical benign paroxysmal positional vertigo: literature review and new theoretical considerations. [Abstract] [BibTeX]	2014	Journal of vestibular research : equilibrium & orientation Vol. 24(5-6), pp. 415-423	article	DOI
Abstract: Atypical variants of benign paroxysmal positional vertigo (BPPV) are often encountered and frequently confusing. The authors present a hypothetical framework that accounts for all classical patterns of BPPV and several unusual variants such as BPPV without nystagmus, BPPV with downbeat nystagmus and BPPV with paradoxically direction-changing nystagmus. The authors introduce new concepts, such as "ipsicanal switch" and "horizontal short arm canalolithiasis" and suggest that their use may improve diagnosis and treatment in everyday clinical practice. The possible consequences of saccular otoconia detachment are reviewed according to the literature.
BibTeX: @article{Bueki2014, author = {Büki, Béla and Mandalà, Marco and Nuti, Daniele}, title = {Typical and atypical benign paroxysmal positional vertigo: literature review and new theoretical considerations.}, journal = {Journal of vestibular research : equilibrium & orientation}, year = {2014}, volume = {24}, issue = {5-6}, pages = {415--423}, doi = {https://doi.org/10.3233/VES-140535}, keywords = {Benign Paroxysmal Positional Vertigo, diagnosis, etiology, physiopathology; Diagnosis, Differential; Eye Movements, physiology; Humans; Lithiasis, complications, diagnosis, physiopathology; Models, Theoretical; Nystagmus, Pathologic, diagnosis, physiopathology; Nystagmus, Physiologic, physiology; Patient Positioning; Semicircular Canals, physiology, physiopathology; Vestibular Function Tests; Type 2 BPPV; canalolithiasis; cupulolithiasis; ipsicanal switch}, pmid = {25564084} }
Vibert, D., Sans, A., Kompis, M., Travo, C., Muhlbauer, R.C., Tschudi, I., Boukhaddaoui, H. and Häusler, R.	Ultrastructural changes in otoconia of osteoporotic rats. [Abstract] [BibTeX]	2008	Audiology & neuro-otology Vol. 13(5), pp. 293-301	article	DOI
Abstract: The etiology of benign paroxysmal positional vertigo (BPPV) remains obscure in many cases and women are affected more often than men. A recent prospective study, performed in women >50 years of age suffering from recurrent BPPV, showed associated osteopenia or osteoporosis in a large percentage of these patients. These results suggested the possible relationship between recurrent BPPV and a decreased fixation of calcium in bone in women >50 years. To test this hypothesis, an experimental study was performed in adult female rats. Utricular otoconia of female rats in which osteopenia/osteoporosis was induced by bilateral ovariectomy (OVX) were compared to those of sham-operated adult females rats (SHAM), as control group. FIRST STUDY: The morphology of theutricles of OVX and SHAM rats was analyzed with scanning electron microscopy. In osteopenic/osteoporotic rats, the density of otoconia (i.e. the number of otoconia per unit area) was decreased (p = 0.036)and their size was increased (p = 0.036) compared to the control group. SECOND STUDY: To test the role of calcium turnover in such morphological changes, utricular otoconia of 2 other groups of OVX and SHAM rats, previously injected with calcein subcutaneously, were examined by conventional and epifluorescence microscopy. In epifluorescence microscopy, labeling with calcein showed no significant fluorescence in either group. This finding was interpreted as a lack of external calcium turnover into otoconia of adult female rats. The ultrastructural modifications of otoconia in osteopenic/osteoporotic female adult rats as well as the role of estrogenic receptors in the inner ear are discussed. The possible pathophysiological mechanisms which support the relationship between recurrent BPPV in women and the disturbance of the calcium metabolism of osteopenia/osteoporosis are debated.
BibTeX: @article{Vibert2008, author = {Vibert, Dominique and Sans, Alain and Kompis, Martin and Travo, Cécile and Muhlbauer, Roman C and Tschudi, Ingrid and Boukhaddaoui, Hassan and Häusler, Rudolf}, title = {Ultrastructural changes in otoconia of osteoporotic rats.}, journal = {Audiology & neuro-otology}, year = {2008}, volume = {13}, issue = {5}, pages = {293--301}, doi = {https://doi.org/10.1159/000124277}, keywords = {Acoustic Maculae, pathology, ultrastructure; Animals; Bone Density; Bone Diseases, Metabolic, pathology; Calcium, metabolism; Female; Microscopy, Electron, Scanning; Microscopy, Fluorescence; Osteoporosis, pathology; Otolithic Membrane, metabolism, pathology, ultrastructure; Ovariectomy; Rats; Rats, Wistar; Vertigo, pathology}, pmid = {18391565} }
Rizvi, S.S. and Gauthier, M.G.	Unexpected complication of posterior canal occlusion surgery for benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2002	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 23(6), pp. 938-940	article
Abstract: The purpose of this report was to illustrate how an unusual complication of posterior canal occlusion surgery for benign paroxysmal positional vertigo (BPPV) may be recognized and prevented. Recurrence of BPPV after occlusion surgery of the posterior semicircular canal has not previously been reported in the literature, to the authors' knowledge. Failure of occlusion not only permits the continued symptoms of BPPV but also burdens the patient with the additional morbidity of a fistula of the PSCC. The authors describe the successful treatment of a patient with recurrent and incapacitating BPPV after the failure of occlusion surgery of the posterior semicircular canal, when the patient was simultaneously crippled by the distressing morbidity of an iatrogenic fistula. Case report. Tertiary care referral center. Surgical excision of the fistulous segment of the membranous posterior semicircular canal. The BPPV was resolved. The distressing symptom of a fistula was eliminated. Hearing was preserved. Failure to completely occlude the posterior semicircular canal during posterior canal occlusion surgery results in recurrence of BPPV and an iatrogenic fistula, both of which are preventable. The occurrence of such an event is described, its management is outlined, and some thoughts are offered about its prevention.
BibTeX: @article{Rizvi2002, author = {Rizvi, Syed S and Gauthier, Marie G}, title = {Unexpected complication of posterior canal occlusion surgery for benign paroxysmal positional vertigo.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2002}, volume = {23}, issue = {6}, pages = {938--940}, keywords = {Electronystagmography; Fistula, diagnosis, surgery; Follow-Up Studies; Humans; Labyrinth Diseases, diagnosis, surgery; Magnetic Resonance Imaging; Male; Middle Aged; Postoperative Complications, diagnosis, surgery; Reoperation; Semicircular Canals, pathology, surgery; Speech Reception Threshold Test; Surgical Wound Dehiscence, diagnosis, surgery; Tomography, X-Ray Computed; Vertigo, diagnosis, surgery; Vestibular Function Tests}, pmid = {12438859} }
Steddin, S. and Brandt, T.	Unilateral mimicking bilateral benign paroxysmal positioning vertigo. [Abstract] [BibTeX]	1994	Archives of otolaryngology--head & neck surgery Vol. 120(12), pp. 1339-1341	article
Abstract: Unilateral benign paroxysmal positioning vertigo (BPPV) may mimic bilateral BPPV if the diagnostic positioning maneuver is executed without appropriate alignment of the head and neck with the trunk. Appropriate alignment is achieved by adjusting the plane of the affected posterior semicircular canal so that it is parallel to the plane of diagnostic head tilt, ie, 45 degrees horizontal head rotation to the left before a head tilt to the right in suspected right-sided BPPV. With inappropriate head alignment and head tilt to the side of the unaffected ear, a free-floating clot within the long arm of the uppermost posterior canal may gravitate toward the cupula and become settled on it. This causes ampullopetal cupulolithiasis, evoking geotropic nystagmus, which may mimic BPPV of the unaffected ear. This hypothesis explains the seemingly paradoxical observation of immediate relief from "bilateral BPPV" following unilateral surgical canal occlusion on the "more symptomatic" side.
BibTeX: @article{Steddin1994, author = {Steddin, S and Brandt, T}, title = {Unilateral mimicking bilateral benign paroxysmal positioning vertigo.}, journal = {Archives of otolaryngology--head & neck surgery}, year = {1994}, volume = {120}, issue = {12}, pages = {1339--1341}, keywords = {Calculi, complications; Cochlear Diseases, complications; Diagnosis, Differential; Head; Humans; Neck; Physical Examination, methods; Posture; Rotation; Vertigo, diagnosis, etiology, physiopathology}, pmid = {7980898} }
Hotta, S., Imai, T., Higashi-Shingai, K., Okazaki, S., Okumura, T., Uno, A., Ohta, Y., Morihana, T., Sato, T. and Inohara, H.	Unilateral posterior canal-plugging surgery for intractable bilateral posterior canal-type benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2017	Auris, nasus, larynx Vol. 44(5), pp. 540-547	article	DOI
Abstract: To investigate the effectiveness of unilateral posterior semicircular canal (PSCC)-plugging surgery for patients with intractable bilateral PSCC-type benign paroxysmal positional vertigo (P-BPPV). From July 2011 to December 2015, we diagnosed 136 patients with P-BPPV. Of these, 3 patients had bilateral P-BPPV, and in 2 of the 3, the condition had been refractory to conservative treatment for more than 1 year. We planned a staged PSCC-plugging surgery for these 2 patients; initially one side was treated, and the contralateral side was treated 6 months later. After the first surgery, both patients experienced improvement in symptoms of vertigo and nystagmus on the operated side and no change on the non-operated side. Patients underwent the Epley maneuver for the non-operated side. In one case, the non-operated side was cured. In the other case, although the P-BPPV was not completely resolved, the patient was satisfied with the result of unilateral surgery because he was now able to turn in bed to the operated side without vertigo. Before surgery, he had experienced vertigo when turning even slightly in bed. We propose that even unilateral PSCC-plugging surgery is effective for some patients with intractable bilateral P-BPPV.
BibTeX: @article{Hotta2017, author = {Hotta, Sayaka and Imai, Takao and Higashi-Shingai, Kayoko and Okazaki, Suzuyo and Okumura, Tomoko and Uno, Atsuhiko and Ohta, Yumi and Morihana, Tetsuo and Sato, Takashi and Inohara, Hidenori}, title = {Unilateral posterior canal-plugging surgery for intractable bilateral posterior canal-type benign paroxysmal positional vertigo.}, journal = {Auris, nasus, larynx}, year = {2017}, volume = {44}, issue = {5}, pages = {540--547}, doi = {https://doi.org/10.1016/j.anl.2016.11.010}, keywords = {Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, surgery; Female; Humans; Male; Nystagmus, Pathologic, surgery; Otologic Surgical Procedures, methods; Patient Satisfaction; Semicircular Canals, surgery; Therapeutic Occlusion; Bilateral; Canalolithiasis; Plugging surgery; Rotation vector; Three-dimensional}, pmid = {27979611} }
Keleş, M.K., Aksakal, İ.A., Park, T.H., Yağmur, Ç. and Küçüker, İ.	Unintentional Complications After Uneventful Rhinoplasty Operations: Case Reports and a Review of the Literature. [Abstract] [BibTeX]	2016	Aesthetic plastic surgery Vol. 40(1), pp. 54-61	article	DOI
Abstract: No surgical procedure is free of complications; however, some of these complications are unintentional. Plastic surgeons may be unfamiliar with certain complications after rhinoplasty operations. In this study, we aimed to present four unintentional complications that have occurred in our patients and review the literature related to these complications. In this study, we conducted a review of 1400 patients who were operated on from 2007 to 2015. The medical recordings of all patients were investigated. Four patients with unintentional complications after rhinoplasty operations are presented and the related literature was reviewed. Cases 1 and 2: These patients included a 26-year-old woman and a 30-year-old man who developed herpes simplex virus (HSV) infections after a primary septorhinoplasty. Case 3: This was a 25-year-old woman who developed periorbital emphysema after a primary rhinoplasty operation. Case 4: This was a 22-year-old woman who developed a second-degree burn on the nasal dorsum. All patients healed without sequel or scars. Many unexpected complications have been reported in the literature. Some of these complications include bleeding disorders, allergic reactions, dermatitis, visual loss, gastric bleeding, benign paroxysmal positional vertigo, false aneurysm after rhinoplasty, pneumocephalus, Tapia's syndrome, cavernous sinus syndrome, and skin reactions to prolene. Meticulous patient histories, consistent surgical routines, careful radiologic examinations, and frequent patient visits can help surgeons control these types of complications. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
BibTeX: @article{Keles2016, author = {Keleş, Musa Kemal and Aksakal, İbrahim Alper and Park, Tae Hwan and Yağmur, Çağlayan and Küçüker, İsmail}, title = {Unintentional Complications After Uneventful Rhinoplasty Operations: Case Reports and a Review of the Literature.}, journal = {Aesthetic plastic surgery}, year = {2016}, volume = {40}, issue = {1}, pages = {54--61}, doi = {https://doi.org/10.1007/s00266-015-0594-5}, keywords = {Adult; Female; Humans; Male; Postoperative Complications, etiology; Rhinoplasty; Young Adult; Complication; Rhinoplasty; Septorhinoplasty; Uneventful}, pmid = {26684836} }
Babic, B.B., Jesic, S.D., Milovanovic, J.D. and Arsovic, N.A.	Unintentional conversion of benign paroxysmal positional vertigo caused by repositioning procedures for canalithiasis: transitional BPPV. [Abstract] [BibTeX]	2014	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 271(5), pp. 967-973	article	DOI
Abstract: BPPV when diagnosed before any repositioning procedure is called primary BPPV. Primary BPPV canalithiasis treatment with repositioning procedures sometimes results in unintentional conversion of BPPV form: transitional BPPV. Objectives were to find transitional BPPV forms, how they influence relative rate of canal involvement and how to be treated. This study is a retrospective case review performed at an ambulatory, tertiary referral center. Participants were 189 consecutive BPPV patients. Main outcome measures were detection of transitional BPPV, outcome of repositioning procedures for transitional canalithiasis BPPV and spontaneous recovery for transitional cupulolithiasis BPPV. Canal distribution of primary BPPV was: posterior canal (Pc): 85.7% (162/189), horizontal canal (Hc): 11.6% (22/189), anterior canal (Ac): 2.6% (5/189); taken together with transitional BPPV it was: Pc: 71.3% (164/230), Hc: 26.5% (61/230), Ac: 2.2% (5/230). Transitional BPPV forms were: Hc canalithiasis 58% (24/41), Hc cupulolithiasis 37% (15/41) and common crux reentry 5% (2/41). Treated with barbecue maneuver transitional Hc canalithiasis cases either resolved in 58% (14/24) or transitioned further to transitional Hc cupulolithiasis in 42% (10/24). In follow-up of transitional Hc cupulolithiasis we confirmed spontaneous recovery in 14/15 cases in less than 2 days. The most frequent transitional BPPV form was Hc canalithiasis so it raises importance of barbecue maneuver treatment. Second most frequent was transitional Hc cupulolithiasis which very quickly spontaneously recovers and does not require any intervention. The rarest found transitional BPPV form was common crux reentry which is treated by Canalith repositioning procedure. Transitional BPPV taken together with primary BPPV may decrease relative rate of Pc BPPV, considerably increase relative rate of Hc BPPV and negligibly influence relative rate of Ac BPPV. Transitional BPPV forms can be produced by repositioning maneuvers (transitional Hc cupulolithiasis) or by the subsequent controlling positional test (transitional Hc canalithiasis and common crux reentry); underlying mechanisms are discussed.
BibTeX: @article{Babic2014, author = {Babic, Borivoj B and Jesic, Snezana D and Milovanovic, Jovica D and Arsovic, Nenad A}, title = {Unintentional conversion of benign paroxysmal positional vertigo caused by repositioning procedures for canalithiasis: transitional BPPV.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2014}, volume = {271}, issue = {5}, pages = {967--973}, doi = {https://doi.org/10.1007/s00405-013-2494-0}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, diagnosis, physiopathology, therapy; Female; Humans; Male; Middle Aged; Otolithic Membrane, physiopathology; Patient Positioning; Posture, physiology; Remission, Spontaneous; Retrospective Studies; Young Adult}, pmid = {23605245} }
Luo, J., Erbe, C. and Friedland, D.R.	Unique Clinical Language Patterns Among Expert Vestibular Providers Can Predict Vestibular Diagnoses. [Abstract] [BibTeX]	2018	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 39(9), pp. 1163-1171	article	DOI
Abstract: To identify novel language usage by expert providers predictive of specific vestibular conditions. Retrospective chart review and natural language processing. Level IV. Tertiary referral center. Patients seen for vestibular complaint. Natural language processing and machine learning analyses of semantic and syntactic patterns in clinical documentation from vestibular patients. Accuracy of Naïve Bayes predictive models correlating language usage with clinical diagnoses. Natural language analyses on 866 physician-generated histories from vestibular patients found 3,286 unique examples of language usage of which 614 were used 10 or greater times. The top 15 semantic types represented only 11% of all Unified Medical Language System semantic types but covered 86% of language used in vestibular patient histories. Naïve Bayes machine learning algorithms on a subset of 255 notes representing benign paroxysmal positional vertigo, vestibular migraine, anxiety-related dizziness and central dizziness generated strong predictive models showing an average sensitivity rate of 93.4% and a specificity rate of 98.2%. A binary model for assessing whether a subject had a specific diagnosis or not had an average AUC for the receiver operating characteristic curves of .995 across all conditions. These results indicate that expert providers utilize unique language patterns in vestibular notes that are highly conserved. These patterns have strong predictive power toward specific vestibular diagnoses. Such language elements can provide a simple vocabulary to aid nonexpert providers in formulating a differential diagnosis. They can also be incorporated into clinical decision support systems to facilitate accurate vestibular diagnosis in ambulatory settings.
BibTeX: @article{Luo2018, author = {Luo, Jake and Erbe, Christy and Friedland, David R}, title = {Unique Clinical Language Patterns Among Expert Vestibular Providers Can Predict Vestibular Diagnoses.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2018}, volume = {39}, issue = {9}, pages = {1163--1171}, doi = {https://doi.org/10.1097/MAO.0000000000001930}, pmid = {30080764} }
Polensek, S.H. and Tusa, R.	Unnecessary diagnostic tests often obtained for benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2009	Medical science monitor : international medical journal of experimental and clinical research Vol. 15(7), pp. MT89-MT94	article
Abstract: Benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo prompting patients to seek medical treatment. Diagnosis is made by identifying characteristic nystagmus with positional testing (e.g., Dix-Hallpike maneuver) during a clinical examination. Although diagnosis can be accurately made by non-specialists, costly diagnostic tests are frequently obtained. We examined diagnostic tests ordered and use of specialty consultations in the evaluation of patients eventually diagnosed in our clinic with BPPV. We retrospectively reviewed the medical records of 193 consecutive adult patients referred to our otoneurology clinic and subsequently diagnosed with isolated BPPV of the posterior canal from 2003 to 2008. In all cases, symptoms resolved after treatment. One hundred thirty-six patients (71%) underwent at least one test, and no tests were diagnostic. The test most frequently ordered was brain magnetic resonance imaging (n=76), followed by audiogram (n=64), serologic tests (n=42), brain computed tomographic scan (n=32), caloric electronystagmography (n=24), and magnetic resonance angiography (n=23). Internists and otolaryngologists evaluated the same number of patients (n=75) prior to being seen in our clinic, and neurologists saw the next largest group (n=52). Family and emergency physicians evaluated 22 and 16 patients, respectively. The number of diagnostic tests ordered did not significantly vary from 2003 to 2008. Patients with isolated BPPV undergo many tests of no yield despite the definitive test for diagnosis being a bedside maneuver. Increased use of tests for positional nystagmus likely would improve diagnostic yield and decrease costs in evaluating patients with this common disorder.
BibTeX: @article{Polensek2009, author = {Polensek, Sharon Hartman and Tusa, Ronald}, title = {Unnecessary diagnostic tests often obtained for benign paroxysmal positional vertigo.}, journal = {Medical science monitor : international medical journal of experimental and clinical research}, year = {2009}, volume = {15}, issue = {7}, pages = {MT89--MT94}, keywords = {Diagnostic Tests, Routine, methods; Female; Humans; Male; Middle Aged; Referral and Consultation; Time Factors; Vertigo, diagnosis, therapy}, pmid = {19564834} }
Oghalai, J.S., Manolidis, S., Barth, J.L., Stewart, M.G. and Jenkins, H.A.	Unrecognized benign paroxysmal positional vertigo in elderly patients. [Abstract] [BibTeX]	2000	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 122(5), pp. 630-634	article	DOI
Abstract: Balance disorders in elderly patients are associated with an increased risk of falls but are often difficult to diagnose because of comorbid chronic medical problems. We performed a cross-sectional study to determine the prevalence of unrecognized benign paroxysmal positional vertigo (BPPV) and associated lifestyle sequelae in a public, inner-city geriatric population. Dizziness was found in 61% of patients, whereas balance disorders were found in 77% of patients. Nine percent were found to have unrecognized BPPV. Multivariate analysis demonstrated that the presence of a spinning sensation and the absence of a lightheadedness sensation predicted the presence of unrecognized BPPV. Patients with unrecognized BPPV were more likely to have reduced activities of daily living scores, to have sustained a fall in the previous 3 months, and to have depression. These data indicate that unrecognized BPPV is common within the elderly population and has associated morbidity. Further prospective studies are warranted.
BibTeX: @article{Oghalai2000, author = {Oghalai, J S and Manolidis, S and Barth, J L and Stewart, M G and Jenkins, H A}, title = {Unrecognized benign paroxysmal positional vertigo in elderly patients.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2000}, volume = {122}, issue = {5}, pages = {630--634}, doi = {https://doi.org/10.1067/mhn.2000.105415}, keywords = {Accidental Falls; Activities of Daily Living; Aged; Aged, 80 and over; Cross-Sectional Studies; Dizziness, diagnosis; Female; Humans; Male; Middle Aged; Multivariate Analysis; Postural Balance; Prevalence; Sensation Disorders, diagnosis; Vertigo, complications, diagnosis, epidemiology}, pmid = {10793337} }
Richard-Vitton, T. and Viirre, E.	Unsteadiness and drunkenness sensations as a new sub-type of BPPV. [Abstract] [BibTeX]	2011	Revue de laryngologie - otologie - rhinologie Vol. 132(2), pp. 75-80	article
Abstract: Benign Paroxysmal Positional Vertigo (BPPV) represents at least 35% of vertigo cases and perhaps much more. The aim of this study was to review a proposed new type of BPPV which may be detected by using a mechanical assistance in BPPV diagnostic and therapeutic maneuvers. MATERIELS AND METHODS: The prospective study extracted subjects from 465 patients who presented with some positional vertigo or unsteadiness. Only 152 dizzy patients, who presented with positional nystagmus but no true vertigo, were included. The TRV armchair permits rotation of patients wearing infrared video goggles in all semi-circular planes. Treatment effectiveness was defined as absence of symptoms or findings 3 days after the therapy sessions. If not initially successful, repeat therapeutic sessions were performed or patients underwent further vestibular examination and sometime MRI. One hundred nine of the 152 patients demonstrated a low level canalithiasis showing nystagmus. Unusual data were collected: Ninety seven had a lateral canal and 12 had posterior canal conditions. The average of the patients was 62 and they had an average of 1.6 mechanical therapeutic maneuvres to reach the success end-point. Some patients have persistent unsteadiness or drunkenness sensations after being treated by conventional maneuvers for BPPV. Often considered a post-BPPV otolithic syndrome an alternative possibility is BPPV with a very few otoliths in the lateral canal. The therapeutic technique using the mechanical chair permits to improved diagnosis of canalithiasis, especially that involving the horizontal canals. Some mild dizziness, which may be disabling and chronic can be better investigated and treated with mechanical assistance.
BibTeX: @article{Richard-Vitton2011, author = {Richard-Vitton, T and Viirre, E}, title = {Unsteadiness and drunkenness sensations as a new sub-type of BPPV.}, journal = {Revue de laryngologie - otologie - rhinologie}, year = {2011}, volume = {132}, issue = {2}, pages = {75--80}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Electronystagmography; Equipment Design; Female; Gait Disorders, Neurologic, classification, diagnosis, physiopathology, therapy; Humans; Kinesthesis, physiology; Male; Middle Aged; Orientation, physiology; Otolithic Membrane, physiopathology; Patient Positioning; Postural Balance, physiology; Predictive Value of Tests; Prospective Studies; Rotation; Semicircular Canals, physiopathology; Vertigo, classification, diagnosis, therapy; Vestibular Function Tests, instrumentation, methods; Young Adult}, pmid = {22416485} }
BOFFI, A.	UNUSUAL CASES OF POSITIONAL VERTIGO OF THE SO-CALLED BENIGN PAROXYSMAL TYPE. [BibTeX]	1964	The Journal of laryngology and otology Vol. 78, pp. 171-180	article
BibTeX: @article{BOFFI1964, author = {BOFFI, A}, title = {UNUSUAL CASES OF POSITIONAL VERTIGO OF THE SO-CALLED BENIGN PAROXYSMAL TYPE.}, journal = {The Journal of laryngology and otology}, year = {1964}, volume = {78}, pages = {171--180}, keywords = {Audiometry; Diagnosis, Differential; Humans; Multiple Sclerosis; Neuritis; Nystagmus, Pathologic; Vertigo; Vestibular Function Tests; Vestibular Nerve; AUDIOMETRY; DIAGNOSIS, DIFFERENTIAL; MULTIPLE SCLEROSIS; NEURITIS; NYSTAGMUS; VERTIGO; VESTIBULAR FUNCTION TESTS; VESTIBULAR NERVE}, pmid = {14126279} }
Brauer, H.U.	Unusual complications associated with third molar surgery: a systematic review. [Abstract] [BibTeX]	2009	Quintessence international (Berlin, Germany : 1985) Vol. 40(7), pp. 565-572	article
Abstract: Third molar removal is a frequent surgical procedure. Common complications associated with third molar surgery are well-recognized and frequently explained to patients during the process of informed consent. The general dental practitioner, as well as the oral and maxillofacial surgeon, must be familiar with all possible complications. This systematic review serves as a reminder of the unusual complications of this routine procedure. Studies were located using systematic searches in Medline and the Cochrane Library electronic databases, as well as hand searching of key texts, references, and reviews relevant to the field. Key words included third molar, wisdom tooth, complications, unusual, and rare. References from the relevant articles were also double-checked. The review was limited to English- and German-language articles published within the last 18 years. Frequently detected, well-known complications are permanent nerve damage and immediate or late mandibular fractures. Twenty-four other complications were identified in 22 articles. Among these complications were inflammatory processes, abscess formation, and displacement of teeth and instruments. Single case reports describe asphyxial death after postextraction hematoma, life-threatening hemorrhage, brain abscess, epidural abscess, benign paroxysmal positional vertigo, subcutaneous and tissue space emphysema, subdural empyema, and herpes zoster syndrome. To achieve good patient care, it is necessary to realize the variety of possible complications. Rare complications must be recognized early so that adequate therapy can be immediately ensured.
BibTeX: @article{Brauer2009, author = {Brauer, Hans Ulrich}, title = {Unusual complications associated with third molar surgery: a systematic review.}, journal = {Quintessence international (Berlin, Germany : 1985)}, year = {2009}, volume = {40}, issue = {7}, pages = {565--572}, keywords = {Age Factors; Humans; Intraoperative Complications; Molar, Third, surgery; Postoperative Complications; Tooth Extraction}, pmid = {19626231} }
Parnes, L.S.	Update on posterior canal occlusion for benign paroxysmal positional vertigo. [Abstract] [BibTeX]	1996	Otolaryngologic clinics of North America Vol. 29(2), pp. 333-342	article
Abstract: Most, if not all, cases of BPPV appear to result from free-floating posterior semicircular canal endolymph particles. Particle repositioning alleviates symptoms and findings in the vast majority of patients. For the small intractable group of nonresponders, posterior semicircular canal occlusion remains a safe and highly efficacious procedure. This new technique has also paved the way for even newer and most invasive inner ear procedures.
BibTeX: @article{Parnes1996, author = {Parnes, L S}, title = {Update on posterior canal occlusion for benign paroxysmal positional vertigo.}, journal = {Otolaryngologic clinics of North America}, year = {1996}, volume = {29}, issue = {2}, pages = {333--342}, keywords = {Endolymph; Fibrin Tissue Adhesive, therapeutic use; Humans; Otolithic Membrane, pathology; Posture; Semicircular Canals, pathology, surgery; Tissue Adhesives, therapeutic use; Vertigo, diagnosis, pathology, physiopathology, surgery, therapy}, pmid = {8860931} }
Ramos Alcocer, R., Ledezma Rodríguez, J.G., Navas Romero, A., Cardenas Nuñez, J.L., Rodríguez Montoya, V., Deschamps, J.J. and Liviac Ticse, J.A.	Use of betahistine in the treatment of peripheral vertigo. [Abstract] [BibTeX]	2015	Acta oto-laryngologica Vol. 135(12), pp. 1205-1211	article	DOI
Abstract: Clinical studies and meta-analyses demonstrated that betahistine is effective and safe in the treatment of Ménière's disease, BPPV (benign paroxysmal positional vertigo), vestibular neuronitis, and other types of peripheral vertigo. The goal of this paper is to review the pharmacological profile of betahistine and the evidence for its effectiveness and safety in the treatment of peripheral vertigo. Selection criteria for the publications on betahistine included randomized clinical trials that evaluated the effectiveness and safety of betahistine vs placebo or active control in the treatment of peripheral vertigo. Recent meta-analyses were also included. Databases searched included PubMed, the Cochrane Ear, Nose and Throat Disorders Group Trials Register, and ICTRP. The review also presents an update on the mechanisms of action, pharmacodynamics, and pharmacokinetics of betahistine. Efficacy and safety of betahistine has been demonstrated in numerous clinical trials. The precise mechanism of action of betahistine is still not completely understood, but the clinical experience demonstrated the benefit of betahistine in different types of peripheral vertigo. In more than 40 years of clinical use, betahistine has shown an excellent safety profile with the usual dose range from 8-48 mg daily. According to clinical studies, betahistine 48 mg daily during 3 months is an effective and safe option for the treatment of peripheral vertigo.
BibTeX: @article{RamosAlcocer2015, author = {Ramos Alcocer, Rubén and Ledezma Rodríguez, José Gregorio and Navas Romero, Antonio and Cardenas Nuñez, José Luis and Rodríguez Montoya, Vicente and Deschamps, Jose Junior and Liviac Ticse, Jorge Anibal}, title = {Use of betahistine in the treatment of peripheral vertigo.}, journal = {Acta oto-laryngologica}, year = {2015}, volume = {135}, issue = {12}, pages = {1205--1211}, doi = {https://doi.org/10.3109/00016489.2015.1072873}, keywords = {Betahistine, therapeutic use; Histamine Agonists, therapeutic use; Humans; Postural Balance, drug effects; Quality of Life; Vertigo, drug therapy, physiopathology; Vestibule, Labyrinth, drug effects, physiopathology; Ménière’s disease; benign paroxysmal positional vertigo; neuronitis; prevention; treatment; vestibular compensation}, pmid = {26245698} }
Kerber, K.A., Burke, J.F., Skolarus, L.E., Meurer, W.J., Callaghan, B.C., Brown, D.L., Lisabeth, L.D., McLaughlin, T.J., Fendrick, A.M. and Morgenstern, L.B.	Use of BPPV processes in emergency department dizziness presentations: a population-based study. [Abstract] [BibTeX]	2013	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 148(3), pp. 425-430	article	DOI
Abstract: A common cause of dizziness, benign paroxysmal positional vertigo (BPPV), is effectively diagnosed and cured with the Dix-Hallpike test (DHT) and the canalith repositioning maneuver (CRM). We aimed to describe the use of these processes in emergency departments (EDs), assess for trends in use over time, and determine provider level variability in use. Prospective population-based surveillance study. Emergency departments in Nueces County, Texas, from January 15, 2008, to January 14, 2011. Adult patients discharged from EDs with dizziness, vertigo, or imbalance documented at triage. Clinical information was abstracted from source documents. A hierarchical logistic regression model adjusting for patient and provider characteristics was used to estimate trends in DHT use and provider-level variability. A total of 3522 visits for dizziness were identified. A DHT was documented in 137 visits (3.9%). A CRM was documented in 8 visits (0.2%). Among patients diagnosed with BPPV, a DHT was documented in only 21.8% (34 of 156) and a CRM in 3.9% (6 of 156). In the hierarchical model (c-statistic = 0.93), DHT was less likely to be used over time (odds ratio, 0.97; 95% confidence interval, 0.95-0.99), and the provider level explained 50% (intraclass correlation coefficient, 0.50) of the variance in the probability of DHT use. Benign paroxysmal positional vertigo is seldom examined for and, when diagnosed, infrequently treated in this ED population. Use of the DHT is decreasing over time and varies substantially by provider. Implementation research focused on BPPV care may be an opportunity to optimize management in ED dizziness presentations.
BibTeX: @article{Kerber2013, author = {Kerber, Kevin A and Burke, James F and Skolarus, Lesli E and Meurer, William J and Callaghan, Brian C and Brown, Devin L and Lisabeth, Lynda D and McLaughlin, Thomas J and Fendrick, A Mark and Morgenstern, Lewis B}, title = {Use of BPPV processes in emergency department dizziness presentations: a population-based study.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2013}, volume = {148}, issue = {3}, pages = {425--430}, doi = {https://doi.org/10.1177/0194599812471633}, keywords = {Benign Paroxysmal Positional Vertigo; Diagnostic Techniques, Otological; Dizziness, diagnosis; Emergency Medical Services; Female; Humans; Middle Aged; Neurologic Examination, methods; Prospective Studies; Vertigo, diagnosis, therapy}, pmid = {23264119} }
Nuti, D., Biagini, C., Salerni, L., Gaudini, E. and Passàli, G.C.	Use of mammalian inner ear antigens for the diagnosis of autoimmune sudden loss of vestibular function. [Abstract] [BibTeX]	2002	Acta oto-laryngologica. Supplementum(548), pp. 34-37	article
Abstract: It has been postulated that bilateral sensorineural hearing loss (SNHL) may be the result of an ongoing autoimmune process against the inner ear and a pattern of progressive bilateral SNHL linked to an autoimmune inner ear disorder has been reported. Various attempts have been made to develop an assay to confirm the diagnosis of autoimmune inner ear disease. In this study we used a Western blot assay to determine the presence of IgG antibodies directed against a PO antigen (30 kDa) of the guinea pig in the sera of patients affected by sudden loss of vestibular function (SLVF). Ten patients affected by vestibular neuritis were enrolled: eight with unilateral vestibular loss and two with sequential bilateral impairment. We also tested nine patients with sudden unilateral hearing loss, five with benign paroxysmal positional vertigo and six normal subjects. In the present study only one patient, a woman affected by bilateral vestibular impairment, had IgG antibodies against the PO protein. Our results indicate either that the antigen PO is not a valid marker for autoimmune unilateral SLVF or that our patients did not have an immunological basis for their disease. However, we can suggest that bilateral impairment of vestibular function and bilateral progressive SNHL are more likely to be immune-mediated disorders and that PO could be a valid marker for these diseases. As bilateral vestibular neuritis is an uncommon disease, a multicentre study is required to confirm our suggestions.
BibTeX: @article{Nuti2002, author = {Nuti, Daniele and Biagini, Cesare and Salerni, Lorenzo and Gaudini, Elisa and Passàli, Giulio Cesare}, title = {Use of mammalian inner ear antigens for the diagnosis of autoimmune sudden loss of vestibular function.}, journal = {Acta oto-laryngologica. Supplementum}, year = {2002}, issue = {548}, pages = {34--37}, keywords = {Adult; Aged; Autoantigens, analysis; Autoimmune Diseases of the Nervous System, complications, diagnosis, immunology; Biomarkers, blood; Blotting, Western; Female; Hearing Loss, Sensorineural, complications, diagnosis, immunology; Humans; Immunoglobulin G, blood, immunology; Male; Middle Aged; Myelin P0 Protein, blood, immunology; Vestibular Neuronitis, diagnosis, immunology}, pmid = {12211355} }
Sandhu, J.S., Carr, E. and Rea, P.	Use of TissuePatchDural™ in the closure of an iatrogenic fistula following posterior semicircular canal occlusion surgery for intractable benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2010	Journal of surgical case reports Vol. 2010(8), pp. 8	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is a common disorder caused by the dislocation of otoconia most commonly into the posterior canal. The primary symptoms are brief episodes of head-position related vertigo which may be accompanied by nausea and disequilibrium. BPPV is usually managed conservatively with excellent results, however in a small number of cases the symptoms can become persistent and incapacitating. The most common treatment in such cases involves the surgical occlusion of the canal. This procedure carries a small risk of post operative perilymph leakage via an iatrogenic fistula. In this paper we outline a case of a patient who developed a perilymph leak following occlusion surgery for intractable BPPV. We describe a novel surgical method that was used to close the fistula using a synthetic polymer based patch (TissuePatchDural90™), which has not been applied in the field of otology previously.
BibTeX: @article{Sandhu2010, author = {Sandhu, Jaswinder Singh and Carr, Esmond and Rea, Peter}, title = {Use of TissuePatchDural™ in the closure of an iatrogenic fistula following posterior semicircular canal occlusion surgery for intractable benign paroxysmal positional vertigo.}, journal = {Journal of surgical case reports}, year = {2010}, volume = {2010}, issue = {8}, pages = {8}, doi = {https://doi.org/10.1093/jscr/2010.8.8}, pmid = {24946351} }
Whitney, S.L., Marchetti, G.F. and Morris, L.O.	Usefulness of the dizziness handicap inventory in the screening for benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2005	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 26(5), pp. 1027-1033	article
Abstract: The purpose of the study was to determine whether a newly developed subscale of the Dizziness Handicap Inventory (DHI) could assist in the screening of benign paroxysmal positional vertigo (BPPV). Retrospective case review. Tertiary balance referral center. Charts of 383 patients (mean age, 61 yr) with a variety of vestibular diagnoses (peripheral and central) were reviewed. Patients completed the DHI before the onset of physical therapy intervention. A newly developed BPPV subscale developed from current DHI items was computed to determine whether the score could assist the practitioner in identifying individuals with BPPV. Individuals with BPPV had significantly higher mean scores on the newly developed BPPV subscale of the DHI (p < 0.01). The five-item BPPV score was a significant predictor of the likelihood of having BPPV (chi2 = 8.35; p < 0.01). On the two-item BPPV scale, individuals who had a score of 8 of 8 were 4.3 times more likely to have BPPV compared with individuals who had a score of 0. Items on the DHI appear to be helpful in determining the likelihood of an individual having the diagnosis of BPPV.
BibTeX: @article{Whitney2005, author = {Whitney, Susan L and Marchetti, Gregory F and Morris, Laura O}, title = {Usefulness of the dizziness handicap inventory in the screening for benign paroxysmal positional vertigo.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2005}, volume = {26}, issue = {5}, pages = {1027--1033}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Chi-Square Distribution; Disability Evaluation; Female; Humans; Male; Middle Aged; Retrospective Studies; Sensitivity and Specificity; Surveys and Questionnaires; Vertigo, diagnosis; Vestibular Function Tests}, pmid = {16151354} }
Edlow, J.A. and Newman-Toker, D.	Using the Physical Examination to Diagnose Patients with Acute Dizziness and Vertigo. [Abstract] [BibTeX]	2016	The Journal of emergency medicine Vol. 50(4), pp. 617-628	article	DOI
Abstract: Emergency department (ED) patients who present with acute dizziness or vertigo can be challenging to diagnose. Roughly half have general medical disorders that are usually apparent from the context, associated symptoms, or initial laboratory tests. The rest include a mix of common inner ear disorders and uncommon neurologic ones, particularly vertebrobasilar strokes or posterior fossa mass lesions. In these latter cases, misdiagnosis can lead to serious adverse consequences for patients. Our aim was to assist emergency physicians to use the physical examination effectively to make a specific diagnosis in patients with acute dizziness or vertigo. Recent evidence indicates that the physical examination can help physicians accurately discriminate between benign inner ear conditions and dangerous central ones, enabling correct management of peripheral vestibular disease and avoiding dangerous misdiagnoses of central ones. Patients with the acute vestibular syndrome mostly have vestibular neuritis, but some have stroke. Data suggest that focused eye movement examinations, at least when performed by specialists, are more sensitive for detecting early stroke than brain imaging, including diffusion-weighted magnetic resonance imaging. Patients with the triggered episodic vestibular syndrome mostly have benign paroxysmal positional vertigo (BPPV), but some have posterior fossa mass lesions. Specific positional tests to provoke nystagmus can confirm a BPPV diagnosis at the bedside, enabling immediate curative therapy, or indicate the need for imaging. Emergency physicians can effectively use the physical examination to make a specific diagnosis in patients with acute dizziness or vertigo. They must understand the limitations of brain imaging. This may reduce misdiagnosis of serious central causes of dizziness, including posterior circulation stroke and posterior fossa mass lesions, and improve resource utilization.
BibTeX: @article{Edlow2016a, author = {Edlow, Jonathan A and Newman-Toker, David}, title = {Using the Physical Examination to Diagnose Patients with Acute Dizziness and Vertigo.}, journal = {The Journal of emergency medicine}, year = {2016}, volume = {50}, issue = {4}, pages = {617--628}, doi = {https://doi.org/10.1016/j.jemermed.2015.10.040}, keywords = {Acute Disease; Benign Paroxysmal Positional Vertigo, diagnosis; Diagnosis, Differential; Dizziness, diagnosis; Emergency Service, Hospital; Humans; Physical Examination; Stroke, diagnosis; Vestibular Diseases, diagnosis; BPPV; dizziness; misdiagnosis; physical examination; posterior circulation stroke; vertigo}, pmid = {26896289} }
Roberts, R.A., Abrams, H., Sembach, M.K., Lister, J.J., Gans, R.E. and Chisolm, T.H.	Utility measures of health-related quality of life in patients treated for benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2009	Ear and hearing Vol. 30(3), pp. 369-376	article	DOI
Abstract: Comparing the effects of different disorders and interventions on health-related quality of life (HRQoL) is important for healthcare policy and accountability. There are two basic approaches to measure HRQoL: questionnaires derived from psychometrics and preference-based measures or utilities derived from econometrics. While disease-specific HRQoL questionnaires, such as the Dizziness Handicap Inventory (DHI), are important because they focus on the impact of a specific problem and its treatments (i.e., vestibular disorders), economic comparisons of the impacts of diseases/disorders and their treatments are typically based on utility assessment. The utility measures for audiology application (UMAA) were developed to measure utilities for various audiologic conditions using a standard computer. The purpose of this study was to determine if the UMAA provides stable, valid, and sensitive utility measures of the effects of benign paroxysmal positional vertigo (BPPV) and its treatment on HRQoL. It was hypothesized that utilities, as measured by the UMAA, would indicate improvement in HRQoL post-treatment for BPPV comparable to a disease-specific health status measure (DHI). The UMAA incorporates three techniques to measure utility: rating scale, standard gamble, and time tradeoff. A utility is a cardinal measure of strength of preference and is measured on a continuum basis from 0.0 (incapacitating dizziness) to 1.0 (no dizziness). Fifty-two adults with BPPV of the posterior semicircular canal completed the UMAA and DHI before treatment and again post-treatment. A subgroup of 15 participants completed the UMAA on two occasions before treatment to assess test-retest stability and to establish critical difference values. Results from this investigation demonstrate that utilities as measured through the UMAA are stable, valid, and comparable to the DHI. Post-treatment utilities were also significantly higher than pretreatment utilities, indicating that the utilities, as measured through the UMAA, are sensitive to improvement in HRQoL after BPPV treatment. Utilities as measured through the UMAA seem sensitive to changes in HRQoL after treatment of BPPV. Since the UMAA can be used to measure patient preference (i.e., utility), it may be useful for comparison of specific audiologic conditions, such as BPPV, to nonaudiologic conditions, such as cardiovascular disease and kidney disease.
BibTeX: @article{Roberts2009, author = {Roberts, Richard A and Abrams, Harvey and Sembach, Melanie K and Lister, Jennifer J and Gans, Richard E and Chisolm, Theresa Hnath}, title = {Utility measures of health-related quality of life in patients treated for benign paroxysmal positional vertigo.}, journal = {Ear and hearing}, year = {2009}, volume = {30}, issue = {3}, pages = {369--376}, doi = {https://doi.org/10.1097/AUD.0b013e31819f316a}, keywords = {Adult; Audiology; Computers; Health Status; Humans; Patient Satisfaction; Psychometrics, standards; Quality of Life; Reproducibility of Results; Sensitivity and Specificity; Surveys and Questionnaires, standards; Vertigo, psychology}, pmid = {19322083} }
Choi, S., Choi, H.R., Nahm, H., Han, K., Shin, J.E. and Kim, C.-H.	Utility of the bow and lean test in predicting subtype of benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2018	The Laryngoscope Vol. 128(11), pp. 2600-2604	article	DOI
Abstract: To investigate the role of the bow and lean test (BLT) in the diagnosis of benign paroxysmal positional vertigo (BPPV). Retrospective case-control study. Between March 2015 and June 2017, we enrolled 113 patients with posterior semicircular canal (PSCC) BPPV, 74 patients with lateral semicircular canal (LSCC) canalolithiasis, 53 patients with LSCC cupulolithiasis, and 32 patients with light cupula. We retrospectively assessed bowing nystagmus (BN) and leaning nystagmus (LN). In PSCC BPPV, 75% of the patients showed at least one of BN and LN, and direction of nystagmus provoked by a Dix-Hallpike test on the affected side was consistent with that of LN and opposite to that of BN. In LSCC canalolithiasis, 65% (48 of 74) of the patients showed both BN and LN, which were in the same direction in 38 patients (of 48) and in the opposite direction in 10 patients (of 48). The affected side can be determined according to the results of THE BLT in 74% (55 of 74) of LSCC canalolithiasis patients, and among them, the side determined according to the results of head-roll test was discordant with that according to the BLT in 20 of 55 patients (36%). In LSCC cupulopathy (n = 85), both BN and LN were persistent and observed in all cases, but we could not distinguish LSCC cupulolithiasis from light cupula according to nystagmus direction in the BLT. Although a BLT yields better lateralization in LSCC canalolithiasis, it may be more useful in predicting the diagnosis and lateralization of PSCC BPPV than LSCC canalolithiasis. 4 Laryngoscope, 2600-2604, 2018.
BibTeX: @article{Choi2018a, author = {Choi, Seongjun and Choi, Hye Rang and Nahm, Hyunjoo and Han, Kyujin and Shin, Jung Eun and Kim, Chang-Hee}, title = {Utility of the bow and lean test in predicting subtype of benign paroxysmal positional vertigo.}, journal = {The Laryngoscope}, year = {2018}, volume = {128}, issue = {11}, pages = {2600--2604}, doi = {https://doi.org/10.1002/lary.27142}, keywords = {Benign paroxysmal positional vertigo; Dix-Hallpike test; bow and lean test; head-roll test}, pmid = {29481705} }
Singh, N.K. and Barman, A.	Utility of the Frequency Tuning Measure of oVEMP in Differentiating Meniere's Disease from BPPV. [Abstract] [BibTeX]	2016	Journal of the American Academy of Audiology Vol. 27(9), pp. 764-777	article	DOI
Abstract: Utility of frequency tuning of ocular vestibular evoked myogenic potential (oVEMP) for evaluation of utricular function in individuals with Meniere's disease is a recent development. However, there is dearth of studies regarding its utility in differential diagnosis of Meniere's disease from other vestibular pathologies. The present study aimed at investigating the feasibility of frequency tuning of oVEMP in discriminating Meniere's disease from benign paroxysmal positional vertigo (BPPV). Static group comparison. oVEMPs were acquired from 36 individuals, each with unilateral Meniere's disease and unilateral BPPV. Thirty-six age- and gender-matched healthy individuals formed comparison group for each of the two clinical groups. Contralateral oVEMPs were recorded from both ears of all the participants. The responses pertaining to octave and mid-octave frequencies from 250 to 4000 Hz, one frequency presented at a time, were recorded from infra-orbital electrodes (noninverting placed 1 cm below the lower eyelid and inverting 2 cm below the inverting on the cheek) with forehead as ground. Starting intensity was 125 dB peSPL with subsequent reductions in 10-dB steps to arrive at threshold. The stimuli were delivered to the ear at a rate of 5.1 Hz. The frequency corresponding to the largest peak-to-peak amplitude, best threshold, and/or largest peak-to-peak amplitude at thresholds was considered as the tuning frequency. Proportions of ears with frequency tuning at a particular frequency were compared between the groups. The frequency tuning at 1000 Hz was found to exist in a significantly higher proportion of affected ears with Meniere's disease than the comparison group as well as ears with BPPV (p < 0.05). Using a criterion point of frequency tuning at 875 Hz, the sensitivity and specificity for identifying Meniere's disease was found to be 68% and 100%, respectively. The shift in frequency tuning is an efficient parameter for not only discriminating Meniere's disease from healthy individuals but also distinguishing it from BPPV. Therefore, frequency tuning is recommended as a test parameter of oVEMP for identification of Meniere's disease.
BibTeX: @article{Singh2016, author = {Singh, Niraj Kumar and Barman, Animesh}, title = {Utility of the Frequency Tuning Measure of oVEMP in Differentiating Meniere's Disease from BPPV.}, journal = {Journal of the American Academy of Audiology}, year = {2016}, volume = {27}, issue = {9}, pages = {764--777}, doi = {https://doi.org/10.3766/jaaa.15141}, keywords = {Adolescent; Adult; Auditory Threshold; Benign Paroxysmal Positional Vertigo, diagnosis; Case-Control Studies; Diagnosis, Differential; Female; Hearing Tests; Humans; Male; Meniere Disease, diagnosis; Middle Aged; Sensitivity and Specificity; Vestibular Evoked Myogenic Potentials; Vestibule, Labyrinth, physiopathology; Young Adult}, pmid = {27718352} }
von Brevern, M., Schmidt, T., Schönfeld, U., Lempert, T. and Clarke, A.H.	Utricular dysfunction in patients with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2006	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 27(1), pp. 92-96	article
Abstract: The objective of this study was to test the hypothesis that utricular function is impaired in patients with idiopathic benign paroxysmal positional vertigo. Prospective cohort study. Tertiary dizziness clinic and vestibular research laboratory. Twelve patients with unilateral idiopathic benign paroxysmal positional vertigo were examined 1 week and 1 month after successful treatment with positioning maneuvers and compared with 24 healthy subjects. None. Otolith function was assessed with estimation of the subjective visual vertical and analysis of the torsional otolith-ocular reflex. Unilateral stimulation of the utricle was performed on a rotator that allowed eccentric lateral displacement of the patient during earth-vertical rotation with constant velocity. The otolith-ocular reflex was recorded with three-dimensional video-oculography. There was no difference in the estimation of the subjective visual vertical between patients and controls. The peak-to-peak amplitude of the otolith-ocular reflex torsional eye position was smaller in patients than in the control group. The gain of the unilateral otolith-ocular reflex was reduced in patients on both sides on first testing. After several weeks, only the affected labyrinth showed a reduced otolith-ocular reflex gain. Our findings document otolith dysfunction in patients with idiopathic benign paroxysmal positional vertigo possibly secondary to degeneration of the utricular macula. This finding may account for the transient mild imbalance and dizziness that some patients with benign paroxysmal positional vertigo experience even after resolution of positional vertigo.
BibTeX: @article{Brevern2006a, author = {von Brevern, Michael and Schmidt, Tanja and Schönfeld, Uwe and Lempert, Thomas and Clarke, Andrew H}, title = {Utricular dysfunction in patients with benign paroxysmal positional vertigo.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2006}, volume = {27}, issue = {1}, pages = {92--96}, keywords = {Adult; Age Factors; Aged; Aged, 80 and over; Case-Control Studies; Cohort Studies; Female; Humans; Male; Middle Aged; Posture; Prospective Studies; Reflex, Vestibulo-Ocular, physiology; Saccule and Utricle, physiopathology; Vertigo, physiopathology; Vestibular Function Tests}, pmid = {16371853} }
Angeli, S.I., Abouyared, M., Snapp, H. and Jethanamest, D.	Utricular Dysfunction in Refractory Benign Paroxysmal Positional Vertigo. [Abstract] [BibTeX]	2014	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 151(2), pp. 321-327	article	DOI
Abstract: To determine the prevalence of otolith dysfunction in patients with refractory benign paroxysmal positional vertigo (BPPV). Unmatched case control. Tertiary care institution. Patients included were diagnosed with BPPV, failed initial in-office canalith repositioning maneuvers (CRMs), and completed vestibular testing and vestibular rehabilitation (n = 40). Refractory BPPV (n = 19) was defined in patients whose symptoms did not resolve despite vestibular rehabilitation. These patients were compared with a control group of those with nonrefractory BPPV (n = 21) for results of a caloric test, cervical vestibular evoked myogenic potential (cVEMP), and subjective visual vertical (SVV). Forty-six of 251 patients failed initial treatment with in-office CRM. Forty patients met inclusion criteria. There was no significant difference between the cases (refractory BPPV) (n = 19) and controls (nonrefractory BPPV) (n = 21) in terms of age, duration of symptoms, laterality of BPPV, and BPPV symptoms. There was no difference in the prevalence of caloric weakness and cVEMP abnormalities (P > .05), with odds ratios (ORs [95% confidence interval (CI)]) of having abnormal results among cases vs controls of 1.1818 (0.3329-4.1954) and 4.3846 (0.7627-25.2048), for caloric and cVEMP, respectively. Abnormal eccentric SVV was more prevalent in refractory BPPV cases (58%) than in controls (14%) (P < .0072). The OR (95% CI) of having abnormal SVV was 8.25 (1.7967-37.8822) higher among patients with refractory BPPV than those with nonrefractory BPPV. Patients with refractory BPPV are more likely to have abnormal eccentric SVV and thus underlying utricular dysfunction. This finding is important to take into account when designing rehabilitation strategies for patients with BPPV who fail CRM.
BibTeX: @article{Angeli2014, author = {Angeli, Simon I and Abouyared, Marianne and Snapp, Hillary and Jethanamest, Daniel}, title = {Utricular Dysfunction in Refractory Benign Paroxysmal Positional Vertigo.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2014}, volume = {151}, issue = {2}, pages = {321--327}, doi = {https://doi.org/10.1177/0194599814533075}, keywords = {Benign Paroxysmal Positional Vertigo, physiopathology, therapy; Caloric Tests; Case-Control Studies; Female; Humans; Male; Middle Aged; Otolithic Membrane, physiopathology; Physical Therapy Modalities; Saccule and Utricle, physiopathology; Vestibular Evoked Myogenic Potentials; BPPV; otolith dysfunction; refractory benign paroxysmal positional vertigo; saccule; subjective visual vertical; utricle; vertigo; vestibular testing}, pmid = {24769628} }
Anthony, P.F.	Utricular macular ablation for benign paroxysmal positional vertigo. [Abstract] [BibTeX]	1996	Ear, nose, & throat journal Vol. 75(7), pp. 416-421	article
Abstract: Seventeen percent of all vertiginous patients have benign paroxysmal positional vertigo. Treatment can include occlusion of the posterior semicircular canal for control of these positional vertigo symptoms. More recently, use of an argon laser technique to occlude the posterior membranous semicircular canal has been proposed. However, this laser technique was not tolerated by a diabetic patient. This report describes a new technique using the argon laser to ablate the utricular macula in the affected ear in patients with benign paroxysmal positional vertigo. This procedure is done as outpatient surgery under local anesthesia. The procedure successfully resolved benign paroxysmal positional vertigo in 14 patients. Symptoms in these patients improved from 20-100% (median 87%; mean 80%) as measured by the Dizziness Handicap Inventory.
BibTeX: @article{Anthony1996a, author = {Anthony, P F}, title = {Utricular macular ablation for benign paroxysmal positional vertigo.}, journal = {Ear, nose, & throat journal}, year = {1996}, volume = {75}, issue = {7}, pages = {416--421}, keywords = {Adult; Aged; Female; Hearing, physiology; Hearing Loss, Sensorineural, complications; Humans; Male; Middle Aged; Saccule and Utricle, surgery; Severity of Illness Index; Vertigo, complications, surgery}, pmid = {8764702} }
Chen, W., Shu, L., Wang, Q., Pan, H., Wu, J., Fang, J., Sun, X.-H., Zhai, Y., Dong, Y.-R. and Liu, J.-R.	Validation of 5-item and 2-item questionnaires in Chinese version of Dizziness Handicap Inventory for screening objective benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2016	Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology Vol. 37(8), pp. 1241-1246	article	DOI
Abstract: As possible candidate screening instruments for benign paroxysmal positional vertigo (BPPV), studies to validate the Dizziness Handicap Inventory (DHI) sub-scale (5-item and 2-item) and total scores are rare in China. From May 2014 to December 2014, 108(55 with and 53 without BPPV) patients complaining of episodic vertigo in the past week from a vertigo outpatient clinic were enrolled for DHI evaluation, as well as demographic and other clinical data. Objective BPPV was subsequently determined by positional evoking maneuvers under the record of optical Frenzel glasses. Cronbach's coefficient α was used to evaluate the reliability of psychometric scales. The validity of DHI total, 5-item and 2-item questionnaires to screen for BPPV was assessed by receiver operating characteristic (ROC) curves. It revealed that the DHI 5-item questionnaire had good internal consistency (Cronbach's coefficient α = 0.72). Area under the curve of total DHI, 5-item and 2-item scores for discriminating BPPV from those without was 0.678 (95 % CI 0.578-0.778), 0.873(95 % CI 0.807-0.940) and 0.895(95 % CI 0.836-0.953), respectively. It revealed 74.5 % sensitivity and 88.7 % specificity in separating BPPV and those without, with a cutoff value of 12 in the 5-item questionnaire. The corresponding rate of sensitivity and specificity was 78.2 and 88.7 %, respectively, with a cutoff value of 6 in 2-item questionnaire. The present study indicated that both 5-item and 2-item questionnaires in the Chinese version of DHI may be more valid than DHI total score for screening objective BPPV and merit further application in clinical practice in China.
BibTeX: @article{Chen2016a, author = {Chen, Wei and Shu, Liang and Wang, Qian and Pan, Hui and Wu, Jing and Fang, Jie and Sun, Xu-Hong and Zhai, Yu and Dong, You-Rong and Liu, Jian-Ren}, title = {Validation of 5-item and 2-item questionnaires in Chinese version of Dizziness Handicap Inventory for screening objective benign paroxysmal positional vertigo.}, journal = {Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology}, year = {2016}, volume = {37}, issue = {8}, pages = {1241--1246}, doi = {https://doi.org/10.1007/s10072-016-2573-2}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo, complications, diagnosis; China; Disability Evaluation; Dizziness, diagnosis, etiology; Female; Humans; Male; Middle Aged; ROC Curve; Reproducibility of Results; Retrospective Studies; Surveys and Questionnaires; Translating; Benign paroxysmal positional vertigo; Dizziness Handicap Inventory; Osteoporosis; Screening}, pmid = {27071688} }
Koo, J.-W., Moon, I.J., Shim, W.S., Moon, S.Y. and Kim, J.S.	Value of lying-down nystagmus in the lateralization of horizontal semicircular canal benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2006	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 27(3), pp. 367-371	article
Abstract: Horizontal canal benign paroxysmal positional vertigo is characterized by horizontal direction-changing nystagmus induced by lateral head turning in supine position. According to Ewald's second law, the direction of head turning that creates a stronger response represents the affected side in geotropic nystagmus and the healthy side in apogeotropic nystagmus. However, it may not always be possible to lateralize the involved ear only by comparing the intensity of the nystagmus. We studied the values of nystagmus induced by position change from sitting to supine in the lateralization of horizontal canal benign paroxysmal positional vertigo. A retrospective study of 54 patients who had been diagnosed as having horizontal canal benign paroxysmal positional vertigo at the Dizziness Clinic of Seoul National University Bundang Hospital from May 2003 to February 2004 was performed. The directions of the nystagmus induced by lying down were compared with those determined by Ewald's second law. Of the 54 patients, 32 (20 apogeotropic and 12 geotropic) showed horizontal nystagmus induced by lying down. The nystagmus tended to be ipsilesional in apogeotropic patients (80%) and contralesional in their geotropic counterparts (75%). In horizontal canal benign paroxysmal positional vertigo, lying-down nystagmus mostly beats toward the involved ear in the apogeotropic type and directs to the healthy ear in the geotropic type. The direction of lying-down nystagmus may help lateralizing the involved ear in horizontal canal benign paroxysmal positional vertigo.
BibTeX: @article{Koo2006, author = {Koo, Ja-Won and Moon, Il Joon and Shim, Woo Sub and Moon, So Young and Kim, Ji Soo}, title = {Value of lying-down nystagmus in the lateralization of horizontal semicircular canal benign paroxysmal positional vertigo.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2006}, volume = {27}, issue = {3}, pages = {367--371}, keywords = {Adult; Aged; Aged, 80 and over; Electronystagmography; Female; Humans; Labyrinth Diseases, diagnosis, physiopathology; Male; Middle Aged; Nystagmus, Pathologic, physiopathology; Posture; Retrospective Studies; Semicircular Canals, pathology, physiopathology; Supine Position; Vertigo, diagnosis, physiopathology}, pmid = {16639276} }
Macias, J.D., Lambert, K.M., Massingale, S., Ellensohn, A. and Fritz, J.A.	Variables affecting treatment in benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2000	The Laryngoscope Vol. 110(11), pp. 1921-1924	article	DOI
Abstract: To identify variables affecting outcome in patients with benign paroxysmal positional vertigo (BPPV) treated with canalith repositioning maneuvers. Retrospective review of patients at a tertiary vestibular rehabilitation center. Variables identified for statistical analysis included method of diagnosis, age, sex, onset association with trauma, semicircular canal involvement, presence of bilateral disease, treatment visits, and cycles of canalith repositioning maneuvers per treatment visit. Multivariate statistical analysis using Pearson chi2, likelihood ratio, linear-by-linear association, and cross-tabulation tests were performed. Two hundred fifty-nine patients with BPPV who received treatment were identified from 1996 to 1998. Average follow-up time was 16.9 months. 74.8% required one treatment visit, 19.0% required a second treatment visit, and 98.4% were successfully treated after three treatment visits. The remainder required up to seven treatment visits for relief of symptoms. Variables affecting the number of treatment visits included bilateral disease or location of disease other than in the posterior semicircular canal. Patient age, sex, method of diagnosis, and onset association with trauma had no statistically significant impact. Patients with benign paroxysmal positional vertigo not located in a single posterior semicircular canal are more likely to require multiple visits for canalith repositioning.
BibTeX: @article{Macias2000, author = {Macias, J D and Lambert, K M and Massingale, S and Ellensohn, A and Fritz, J A}, title = {Variables affecting treatment in benign paroxysmal positional vertigo.}, journal = {The Laryngoscope}, year = {2000}, volume = {110}, issue = {11}, pages = {1921--1924}, doi = {https://doi.org/10.1097/00005537-200011000-00029}, keywords = {Adult; Age Factors; Aged; Aged, 80 and over; Female; Follow-Up Studies; Humans; Male; Middle Aged; Recurrence; Regression Analysis; Retreatment; Retrospective Studies; Treatment Outcome; Vertigo, therapy}, pmid = {11081611} }
Choung, Y.-H., Park, K., Moon, S.-K., Kim, C.-H. and Ryu, S.J.	Various causes and clinical characteristics in vertigo in children with normal eardrums. [Abstract] [BibTeX]	2003	International journal of pediatric otorhinolaryngology Vol. 67(8), pp. 889-894	article
Abstract: The differential diagnosis of vertigo in children is extensive. Otitis media and middle ear effusion could be the most common causes of vertigo in children, but there are some problems in detecting the other causes for vertigo because they are one of most frequent diseases of childhood. The purpose of this study is to review the clinical characteristics and both the audiological and vestibular findings of vertigo in children with normal eardrums, who do not show otitis media or middle ear effusion, and to assist in making a differential diagnosis of vertigo. The fifty five children (< 16 years old) with vertigo, who visited the Department of Otolaryngology, Ajou University Hospital, Suwon, South Korea between January 1995 and December 2001 were selected for this study. These excluded the patients with abnormal eardrums/tympanograms or those that did not perform questionnaires, audiological, or vestibular evaluations. They were retrospectively analyzed for clinical symptoms, vestibular functions, and differential diagnosis. The most common causes for vertigo in children were migraine in 17 (30.9%) and benign paroxysmal vertigo of childhood (BPVC) in 14 (25.5%). Other less frequent causes included four cases of trauma, two cases each of Meniere's disease, delayed endolymphatic hydrops, benign positional vertigo, and one case only for cerebellopontine angle tumor, seizure, acute vestibular neuritis, juvenile rheumatoid arthritis, leaving ten cases (18.2%) as unclassified. Abnormal findings were noted in 13 (23.6%) in pure tone audiogram, 3 (5.5%) in positioning test, 6 (10.9%) in bithermal caloric test, and 36 (65.5%) in rotation chair test. The vertigo in children with normal eardrums, who did not show otitis media or middle ear effusion, was most commonly caused by migraine and BPVC. These findings have shown to be very different from those with adult vertigo. The evaluation of vertigo in children requires a questionnaire for extensive and complete history taking, audiograms and vestibular function tests. And in selected cases, electroencephalography, hematological evaluation, imaging of the brain or temporal bone should be performed.
BibTeX: @article{Choung2003, author = {Choung, Yun-Hoon and Park, Keehyun and Moon, Sung-Kyun and Kim, Chul-Ho and Ryu, Sang Jun}, title = {Various causes and clinical characteristics in vertigo in children with normal eardrums.}, journal = {International journal of pediatric otorhinolaryngology}, year = {2003}, volume = {67}, issue = {8}, pages = {889--894}, keywords = {Adolescent; Autoimmune Diseases, complications, diagnosis; Child; Child, Preschool; Chronic Disease; Diagnosis, Differential; Electronystagmography; Endolymphatic Hydrops, complications, diagnosis; Female; Humans; Male; Meniere Disease, complications, diagnosis; Migraine Disorders, complications, diagnosis; Neuroma, Acoustic, complications, diagnosis; Otitis Media, complications, diagnosis; Seizures, complications, diagnosis; Tympanic Membrane, physiopathology; Vertigo, etiology, physiopathology; Vestibular Neuronitis, complications, diagnosis}, pmid = {12880669} }
De Reuck, J.	Vascular risk factors in patients with peripheral vestibular disorders. [Abstract] [BibTeX]	2010	Acta neurologica Belgica Vol. 110(4), pp. 303-305	article
Abstract: The present observational retrospective study investigates whether there are differences in vascular risk factors between patients with spontaneous benign paroxysmal positional vertigo (BPPV) and those with Ménière's disease (MD). Out of a series of 1617 consecutive admitted patients, 36 presented isolated recurrent vertiginous events. Twenty patients with BPPV and 16 with MD were compared. In addition to extensive audiovestibular investigations, all patients had a complete cardio-vascular work-up. A computed tomography (CT) and a magnetic resonance imaging (MRI) of the brain were performed in all patients. The vascular risk factors and the CT/MRI findings were compared between the patients with BPPV and MD. Small old cerebral infarcts were observed in 25% of the BPPV and 31.2% of the MD patients, although none of them had a prior history of stroke. All other vascular risk factors tended to be more frequent in the former group although only a statistically significant difference was found for coronary artery disease (P = 0.03). In this pilot study BPPV does not appear to be such a benign condition but can indicate progression of general atherosclerotic disease.
BibTeX: @article{DeReuck2010, author = {De Reuck, J}, title = {Vascular risk factors in patients with peripheral vestibular disorders.}, journal = {Acta neurologica Belgica}, year = {2010}, volume = {110}, issue = {4}, pages = {303--305}, keywords = {Aged; Benign Paroxysmal Positional Vertigo; Cardiovascular Diseases, complications, diagnosis; Electrocardiography, methods; Electroencephalography, methods; Female; Humans; Magnetic Resonance Imaging, methods; Male; Meniere Disease, diagnosis, epidemiology, etiology; Middle Aged; Pilot Projects; Retrospective Studies; Risk Factors; Statistics, Nonparametric; Tomography, X-Ray Computed, methods; Vertigo, diagnosis, epidemiology, etiology; Vestibular Function Tests, methods}, pmid = {21305858} }
Karatas, M.	Vascular vertigo: epidemiology and clinical syndromes. [Abstract] [BibTeX]	2011	The neurologist Vol. 17(1), pp. 1-10	article	DOI
Abstract: vertigo is a common complaint in medicine. The most common causes of vertigo are benign paroxysmal positional vertigo, vestibular neuritis, Meniere's syndrome, and vascular disorders. Vertigo of vascular origin is usually limited to migraine, transient ischemic attacks, and ischemic or hemorrhagic stroke. Vascular causes lead to various central or peripheral vestibular syndromes with vertigo. This study provides an overview of epidemiology and clinical syndromes of vascular vertigo. vertigo is an illusion of movement caused by asymmetrical involvement of the vestibular system by various causes. Migraine is the most frequent vascular disorder that causes vertigo in all age groups. Vertigo may occur in up to 25% of patients with migraine. The lifetime prevalence of migrainous vertigo is almost 1%. Cerebrovascular disorders are estimated to account for 3% to 7% of patients with vertigo. Vestibular paroxysmia has been diagnosed in 1.8% to 4% of cases in various dizziness units. Vasculitic disorders are rare in the general population, but vertigo may be seen in almost up to 50% of patients with different vasculitic syndromes. migraine, cerebrovascular disorders especially involving the vertebrobasilar territory, cardiocirculatory diseases, neurovascular compression of the eighth nerve, and vasculitis are vascular causes of vertigo syndromes.
BibTeX: @article{Karatas2011, author = {Karatas, Mehmet}, title = {Vascular vertigo: epidemiology and clinical syndromes.}, journal = {The neurologist}, year = {2011}, volume = {17}, issue = {1}, pages = {1--10}, doi = {https://doi.org/10.1097/NRL.0b013e3181f09742}, keywords = {Cerebrovascular Disorders, complications; Diagnosis, Differential; Hemorrhage, complications; Humans; Migraine Disorders, complications, prevention & control; Syndrome; Vertigo, epidemiology, etiology, physiopathology}, pmid = {21192184} }
Ferreira, L.M.d.B.M., Ribeiro, K.M.O.B.d.F., Pestana, A., Ribeiro, A.J.d.V. and Costa de Lima, K.	Vector electronystagmography analysis in elderly individuals with dizziness complaint. [Abstract] [BibTeX]	2013	International archives of otorhinolaryngology Vol. 17(4), pp. 380-382	article	DOI
Abstract: Introduction Vector electronystagmography is widely used to evaluate vestibular function; however, elderly patients may show changes not due to vestibular disorders. Aim This study aims to characterize vector electronystagmography tests in the elderly participants in a service station of the Brazilian public health system, the Unified Health System (SUS) in the city of Natal, who presented with dizziness. Methods A cross-sectional and clinical study to characterize the vector electronystagmography in 10 members of an elderly SUS referral center located in the city of Natal with dizziness. Results Of 10 patients interviewed, 9 were women, and just 1 was a man. All complained of dizziness in the last year, and most of them had more than one type of dizziness. The main differential diagnosis was benign paroxysmal positional vertigo. Regarding vector electronystagmography, we found 20% of patients with semispontaneous nystagmus in at least one direction and changes in saccades latency in 100% of patients, with 20% in relation to the accuracy of pendular tracking changes at the frequency of 0.2 Hz, 10% at 0.4 Hz, and 80% at 0.8 Hz, and 10% change in optokinetic gain. No patient had altered caloric test. Conclusion Vector electronystagmography alterations in the elderly do not always indicate disease.
BibTeX: @article{Ferreira2013, author = {Ferreira, Lidiane Maria de Brito Macedo and Ribeiro, Karyna Mirelly O B de Figueiredo and Pestana, André and Ribeiro, Arthur Jorge de Vasconcelos and Costa de Lima, Kenio}, title = {Vector electronystagmography analysis in elderly individuals with dizziness complaint.}, journal = {International archives of otorhinolaryngology}, year = {2013}, volume = {17}, issue = {4}, pages = {380--382}, doi = {https://doi.org/10.1055/s-0033-1353139}, keywords = {aged; dizziness; medical examination}, pmid = {25992040} }
Kanayama, R., Bronstein, A.M., Gresty, M.A. and Brookes, G.B.	Vertical and torsional VOR in posterior canal occlusion. [Abstract] [BibTeX]	1995	Acta oto-laryngologica. Supplementum Vol. 520 Pt 2, pp. 362-365	article
Abstract: The vertical and torsional vestibulo-ocular reflexes (VOR) were investigated in 3 patients with surgical occlusion of the posterior semicircular canal and 1 patient with singular neurectomy, for treatment of refractory paroxysmal positional vertigo. Stimuli comprised sinusoidal oscillation in the coronal ("roll") and sagittal ("pitch") plane as well as in two oblique planes intermediate between pitch in order to stimulate left anterior + right posterior (LARP) and right anterior + left posterior (RALP) canal pairs separately. One case with left side BPPV was investigated pre and post-operatively. Depression of the vertical and torsional VOR gain was seen 1 week postoperatively when the occluded canal was placed in the optimal plane for stimulation at 1 week postoperatively and subsequently gradually recovered. Recordings in other planes suggested that the contralateral posterior canal was also hypofunctioning, a finding which may explain some residual gait unsteadiness in this case. The other 3 cases who were investigated postoperatively all showed a decrease in downward VOR gain in the "on' direction of the operated canal. The data indicate the specificity of the test procedure and underline the prognostic value of comprehensive pre-operative vestibular assessment.
BibTeX: @article{Kanayama1995, author = {Kanayama, R and Bronstein, A M and Gresty, M A and Brookes, G B}, title = {Vertical and torsional VOR in posterior canal occlusion.}, journal = {Acta oto-laryngologica. Supplementum}, year = {1995}, volume = {520 Pt 2}, pages = {362--365}, keywords = {Adult; Female; Follow-Up Studies; Functional Laterality, physiology; Humans; Kinesthesis, physiology; Male; Meniere Disease, etiology, physiopathology, surgery; Middle Aged; Orientation, physiology; Postoperative Complications, diagnosis, physiopathology; Postural Balance, physiology; Reflex, Vestibulo-Ocular, physiology; Semicircular Canals, physiopathology, surgery; Treatment Outcome; Vestibular Function Tests, instrumentation}, pmid = {8749162} }
Sekine, K., Imai, T., Morita, M., Nakamae, K., Miura, K., Fujioka, H., Kubo, T., Tamura, K. and Takeda, N.	Vertical canal function in normal subjects and patients with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2004	Acta oto-laryngologica Vol. 124(9), pp. 1046-1052	article	DOI
Abstract: To assess the dynamics of the vertical semicircular canal (VSCC)-ocular reflex in normal subjects and then to compare their gain in VSCC-ocular reflex with that of patients with benign paroxysmal positional vertigo (BPPV). Subjects were sinusoidally rotated around the earth-vertical axis with their head tilted 60 degrees backward and turned 45 degrees to the right or left side from the sagittal plane at frequencies of 0.1, 0.3, 0.5, 0.7 and 1.0 Hz with a maximum angular velocity of 50 degrees/s. Head rotation to the right side on the right anterior semicircular canal (SCC)-left posterior SCC plane or to the left side on the left anterior SCC-right posterior SCC plane stimulated the pair of VSCCs. Eye movements were recorded on a video imaging system with an infrared charge-coupled device camera, using our new technique for analyzing the rotation vector of eye movements in three dimensions. The mean gains in left posterior SCC-ocular reflex in normal subjects ranged from 0.44 at 0.1 Hz to 0.79 at 1.0 Hz, while the mean gains in right anterior SCC-ocular reflex ranged from 0.45 at 0.1 Hz to 0.73 at 1.0 Hz. The mean gains in right posterior SCC-ocular reflex in normal subjects ranged from 0.53 at 0.1 Hz to 0.89 at 1.0 Hz, while the mean gains in left anterior SCC-ocular reflex ranged from 0.53 at 0.1 Hz to 0.88 at 1.0 Hz. Thus, the gains in VSCC-ocular reflex did not differ among the four VSCCs in normal subjects. Similarly, vestibulo-ocular reflex (VOR) gains of the four VSCCs in patients with right- or left-sided BPPV were almost the same at all frequencies compared to those of normal subjects. In patients with BPPV, gains in VOR in the four VSCCs were not changed in comparison with those of normal subjects. It is suggested that the mass of free-floating otoconial debris associated with canalolithiasis was too small compared to that of the endolymph to change the canal dynamics.
BibTeX: @article{Sekine2004, author = {Sekine, Kazunori and Imai, Takao and Morita, Masahiro and Nakamae, Koji and Miura, Katsuyoshi and Fujioka, Hiromu and Kubo, Takeshi and Tamura, Koichi and Takeda, Noriaki}, title = {Vertical canal function in normal subjects and patients with benign paroxysmal positional vertigo.}, journal = {Acta oto-laryngologica}, year = {2004}, volume = {124}, issue = {9}, pages = {1046--1052}, doi = {https://doi.org/10.1080/00016480410018061}, keywords = {Adult; Aged; Aged, 80 and over; Caloric Tests, methods; Diagnostic Imaging, methods; Eye Movements; Female; Humans; Lithiasis, complications; Male; Middle Aged; Nystagmus, Physiologic, physiology; Rotation; Semicircular Canals, physiology; Vertigo, physiopathology}, pmid = {15513548} }
Yetiser, S. and Ince, D.	Vertical nystagmus during the seated-supine positional (straight head-hanging) test in patients with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2014	The Journal of laryngology and otology Vol. 128(8), pp. 674-678	article	DOI
Abstract: This study describes the clinical features of up-beating vertical nystagmus observed during the seated-supine positional (straight head-hanging) test in patients with benign paroxysmal positional vertigo. A total of 190 patients with benign paroxysmal positional vertigo symptoms who had presented between 2009 and 2012 were enrolled for this retrospective case series. Twelve patients with positional up-beating vertical nystagmus, as confirmed by video-nystagmography during the seated-supine positional test, were selected. The incidence and duration of symptoms of multiple canal benign paroxysmal positional vertigo were significantly lower compared with the other types of benign paroxysmal positional vertigo (p = 0.029 and p = 0.048 respectively). Trauma was the leading aetiological factor in those patients (p = 0.012). The average number of therapeutic manoeuvres required for the relief of symptoms in patients with multiple canal involvement was significantly higher than in the other groups (p = 0.041). In patients with benign paroxysmal positional vertigo, the presence of vertical up-beating nystagmus while lying down is a unique peripheral sign and could indicate multiple canal involvement. Therefore, the seated-supine positional test should always be included in the test battery.
BibTeX: @article{Yetiser2014, author = {Yetiser, S and Ince, D}, title = {Vertical nystagmus during the seated-supine positional (straight head-hanging) test in patients with benign paroxysmal positional vertigo.}, journal = {The Journal of laryngology and otology}, year = {2014}, volume = {128}, issue = {8}, pages = {674--678}, doi = {https://doi.org/10.1017/S0022215114001480}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, physiopathology; Supine Position; Vertigo, complications; Video Recording}, pmid = {25051458} }
Iida, M., Hitouji, K. and Takahashi, M.	Vertical semicircular canal function: a study in patients with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2001	Acta oto-laryngologica. Supplementum Vol. 545, pp. 35-37	article
Abstract: A pendular rotation test in a head-tilted position (60 degrees backwards and rotated 45 degrees to either the right or left) was performed in 7 patients with benign paroxysmal positional vertigo (BPPV). Patients were rotated 360 degrees at a frequency of 0.1 Hz (maximum speed 114 degrees/s). The excitability of vertical semicircular canals was evaluated using this test procedure. Using an infrared CCD camera and a PC, evoked nystagmus was analyzed in order to determine the morbidity of BPPV. A statistically significant difference (p < 0.05) was found in the maximal slow-phase eye velocity between nystagmus from the anterior semicircular canal and nystagmus from the posterior semicircular canal. The excitability of the posterior semicircular canal in the affected ear was lower than that of the anterior semicircular canal. However, when vertigo and nystagmus disappeared, the difference in excitability was improved. The present results indicate some functional deterioration of the posterior semicircular canal in BPPV cases, suggesting the participation of both mechanical (dumping by mass) and organic (peripheral end organ) factors in causing morbidity.
BibTeX: @article{Iida2001, author = {Iida, M and Hitouji, K and Takahashi, M}, title = {Vertical semicircular canal function: a study in patients with benign paroxysmal positional vertigo.}, journal = {Acta oto-laryngologica. Supplementum}, year = {2001}, volume = {545}, pages = {35--37}, keywords = {Adult; Eye Movements, physiology; Humans; Male; Nystagmus, Pathologic, diagnosis, physiopathology; Semicircular Canals, physiopathology; Vertigo, diagnosis, physiopathology}, pmid = {11677738} }
Silva, C.N.d., Ribeiro, K.M.O.B.d.F., Freitas, R.V.d.M., Ferreira, L.M.d.B.M. and Guerra, R.O.	Vertiginous Symptoms and Objective Measures of Postural Balance in Elderly People with Benign Paroxysmal Positional Vertigo Submitted to the Epley Maneuver. [Abstract] [BibTeX]	2016	International archives of otorhinolaryngology Vol. 20(1), pp. 61-68	article	DOI
Abstract: Introduction Benign Paroxysmal Positional Vertigo (BPPV) is one of the most common and treatable causes of peripheral vestibular vertigo in adults. Its incidence increases with age, eventually leading to disability and a decreased quality of life. Objective The research aims to assess short-term effects of Otolith Repositioning Maneuver (ORM) on dizziness symptoms, quality of life, and postural balance in elderly people with Benign Paroxysmal Positional Vertigo. Methods A quasi-experimental study, which evaluated 14 elderly people that underwent the Otolith Repositioning Maneuver and reevaluation after one week. The authors performed statistical analysis by descriptive analysis of central tendency and dispersion; for pre- and post-treatment conditions, the authors used the Wilcoxon test. Results All aspects of the Dizziness Handicap Inventory (physical, functional, emotional, and total scores) as well as the Visual Analogue Scale (VAS) decreased after therapy (p < 0.05 and p = 0.001, respectively). However, more than half of the elderly participants did not achieve negative Dix-Hallpike. Regarding static and dynamic balance, there were significant differences in some parameters of the modified Clinical Test of Sensory Interaction and Balance, Limits of Stability and gait assessment measured by the Dizziness Gait Index (p < 0.05). Conclusion Results reveal clinical and functional benefits in elderly people with Benign Paroxysmal Positional Vertigo submitted to Otolith Repositioning Maneuver. However, most of the participants did not overcome Benign Paroxysmal Positional Vertigo and not all aspects of postural balance improved. Therefore, a longer follow-up period and a multidisciplinary team are required to establish comprehensive care for elderly patients with dizziness complaints.
BibTeX: @article{Silva2016, author = {Silva, Camila Nicácio da and Ribeiro, Karyna Myrelly O B de Figueiredo and Freitas, Raysa Vanessa de Medeiros and Ferreira, Lidiane Maria de Britho Macedo and Guerra, Ricardo Oliveira}, title = {Vertiginous Symptoms and Objective Measures of Postural Balance in Elderly People with Benign Paroxysmal Positional Vertigo Submitted to the Epley Maneuver.}, journal = {International archives of otorhinolaryngology}, year = {2016}, volume = {20}, issue = {1}, pages = {61--68}, doi = {https://doi.org/10.1055/s-0035-1565915}, keywords = {aged; postural balance; rehabilitation; vestibular diseases}, pmid = {26722348} }
Ferrari, S., Monzani, D., Baraldi, S., Simoni, E., Prati, G., Forghieri, M., Rigatelli, M., Genovese, E. and Pingani, L.	Vertigo "in the pink": The impact of female gender on psychiatric-psychosomatic comorbidity in benign paroxysmal positional vertigo patients. [Abstract] [BibTeX]	2014	Psychosomatics Vol. 55(3), pp. 280-288	article	DOI
Abstract: Comorbidity between vestibular and psychiatric disorders in predisposed individuals is underestimated, untreated, and may result in chronicization and poor quality of life. There are few studies concerning the type and the prevalence of psychiatric-psychosomatic distress in patients with benign paroxysmal positional vertigo (BPPV). The aim of this study was to evaluate psychiatric-psychosomatic comorbidities, in particular anxiety, depression, somatization symptoms, and alexithymia, in a group of BPPV patients compared with healthy subjects, and according to gender. Case-control study comparing 92 BPPV patients recruited at the ENT Unit of Modena General Hospital between November 2007 and December 2010, and 141 healthy controls. The Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Diagnostic Criteria for Psychosomatic Research (DCPR), Brief Symptom Inventory (BSI), and Toronto Alexithymia Scale (TAS-20) were used to perform psychometric assessment. BPPV patients scored higher than controls, with statistical significance, at BDI, BSI somatization, anxiety, and phobic anxiety subscales, and STAI state anxiety; a larger proportion of BPPV patients suffered from clinically significant BDI depressive symptomatology; DCPR disease phobia, functional somatic symptoms secondary to a psychiatric disorder, and demoralization were more common among BPPV subjects. High levels of symptomatology were still found among BPPV female patients, but not among males, even after controlling for symptom severity. Affective symptomatology, such as depression, demoralization, phobia and anxiety, and somatization, were significantly prevalent in BPPV patients, and female gender may be a predisposing factor.
BibTeX: @article{Ferrari2014, author = {Ferrari, Silvia and Monzani, Daniele and Baraldi, Sara and Simoni, Elena and Prati, Giada and Forghieri, Matilde and Rigatelli, Marco and Genovese, Elisabetta and Pingani, Luca}, title = {Vertigo "in the pink": The impact of female gender on psychiatric-psychosomatic comorbidity in benign paroxysmal positional vertigo patients.}, journal = {Psychosomatics}, year = {2014}, volume = {55}, issue = {3}, pages = {280--288}, doi = {https://doi.org/10.1016/j.psym.2013.02.005}, keywords = {Adult; Affective Symptoms, epidemiology; Aged; Benign Paroxysmal Positional Vertigo, epidemiology; Case-Control Studies; Comorbidity; Depression, epidemiology; Female; Humans; Male; Middle Aged; Phobic Disorders, epidemiology; Psychophysiologic Disorders, epidemiology; Sex Factors; Somatoform Disorders, epidemiology; Young Adult}, pmid = {23756120} }
Fernández, L., Breinbauer, H.A. and Delano, P.H.	Vertigo and Dizziness in the Elderly. [Abstract] [BibTeX]	2015	Frontiers in neurology Vol. 6, pp. 144	article	DOI
Abstract: The prevalence of vertigo and dizziness in people aged more than 60 years reaches 30%, and due to aging of world population, the number of patients is rapidly increasing. The presence of dizziness in the elderly is a strong predictor of falls, which is the leading cause of accidental death in people older than 65 years. Balance disorders in the elderly constitute a major public health problem, and require an adequate diagnosis and management by trained physicians. In the elderly, common causes of vertigo may manifest differently, as patients tend to report less rotatory vertigo and more non-specific dizziness and instability than younger patients, making diagnosis more complex. In this mini review, age-related degenerative processes that affect balance are presented. Diagnostic and therapeutic approaches oriented to the specific impaired system, including visual, proprioceptive, and vestibular pathways, are proposed. In addition, presbystasis - the loss of vestibular and balance functions associated with aging - benign paroxysmal positional vertigo, and stroke (in acute syndromes) should always be considered.
BibTeX: @article{Fernandez2015, author = {Fernández, Lara and Breinbauer, Hayo A and Delano, Paul Hinckley}, title = {Vertigo and Dizziness in the Elderly.}, journal = {Frontiers in neurology}, year = {2015}, volume = {6}, pages = {144}, doi = {https://doi.org/10.3389/fneur.2015.00144}, keywords = {aging; dizziness; elderly; falls; presbystasis; vertigo}, pmid = {26167157} }
Kerber, K.A.	Vertigo and dizziness in the emergency department. [Abstract] [BibTeX]	2009	Emergency medicine clinics of North America Vol. 27(1), pp. 39-50, viii	article	DOI
Abstract: Understanding three peripheral vestibular disorders--vestibular neuritis, benign paroxysmal positional vertigo, and Meniere's disease--is the key to the evaluation and management of vertigo and dizziness presentations in the emergency department. Each of these benign disorders is a common cause of a broad category of dizziness presentation. In addition, each of these disorders has characteristic features that allow for a bedside diagnosis. An effective strategy for "ruling-out" a serious disorder, such as stroke, is "ruling-in" a peripheral vestibular disorder. In this article a focus is on the key features of these disorders.
BibTeX: @article{Kerber2009, author = {Kerber, Kevin A}, title = {Vertigo and dizziness in the emergency department.}, journal = {Emergency medicine clinics of North America}, year = {2009}, volume = {27}, issue = {1}, pages = {39--50, viii}, doi = {https://doi.org/10.1016/j.emc.2008.09.002}, keywords = {Dizziness, etiology, therapy; Emergency Service, Hospital; Humans; Meniere Disease, diagnosis; Neurologic Examination; Nystagmus, Pathologic; Vertigo, diagnosis; Vestibular Neuronitis, diagnosis}, pmid = {19218018} }
Neuhauser, H. and Lempert, T.	Vertigo and dizziness related to migraine: a diagnostic challenge. [Abstract] [BibTeX]	2004	Cephalalgia : an international journal of headache Vol. 24(2), pp. 83-91	article	DOI
Abstract: Vertigo and dizziness can be related to migraine in various ways: causally, statistically or, quite frequently, just by chance. Migrainous vertigo (MV) is a vestibular syndrome caused by migraine and presents with attacks of spontaneous or positional vertigo lasting seconds to days and migrainous symptoms during the attack. MV is the most common cause of spontaneous recurrent vertigo and is presently not included in the International Headache Society classification of migraine. Benign paroxysmal positional vertigo (BPPV) and Ménière's disease (MD) are statistically related to migraine, but the possible pathogenetic links have not been established. Moreover, migraineurs suffer from motion sickness more often than controls. Persistent cerebellar symptoms may develop in the course of familial hemiplegic migraine. Dizziness may also be due to orthostatic hypotension, anxiety disorders or major depression which all have an increased prevalence in patients with migraine.
BibTeX: @article{Neuhauser2004, author = {Neuhauser, H and Lempert, T}, title = {Vertigo and dizziness related to migraine: a diagnostic challenge.}, journal = {Cephalalgia : an international journal of headache}, year = {2004}, volume = {24}, issue = {2}, pages = {83--91}, doi = {https://doi.org/10.1111/j.1468-2982.2004.00662.x}, keywords = {Diagnosis, Differential; Dizziness, diagnosis, etiology, physiopathology; Female; Humans; Male; Meniere Disease, complications; Migraine Disorders, complications, diagnosis, physiopathology; Vertigo, diagnosis, etiology, physiopathology}, pmid = {14728703} }
Ludman, H.	Vertigo and imbalance. [BibTeX]	2014	BMJ (Clinical research ed.) Vol. 348, pp. g283	article	DOI
BibTeX: @article{Ludman2014, author = {Ludman, Harold}, title = {Vertigo and imbalance.}, journal = {BMJ (Clinical research ed.)}, year = {2014}, volume = {348}, pages = {g283}, doi = {https://doi.org/10.1136/bmj.g283}, keywords = {Benign Paroxysmal Positional Vertigo, complications, diagnosis; Diagnosis, Differential; Humans; Meniere Disease, complications, diagnosis; Postural Balance, physiology; Vertigo, etiology, physiopathology; Vestibular Diseases, complications, diagnosis}, pmid = {24452766} }
Alpini, D., Caputo, D., Pugnetti, L., Giuliano, D.A. and Cesarani, A.	Vertigo and multiple sclerosis: aspects of differential diagnosis. [Abstract] [BibTeX]	2001	Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology Vol. 22 Suppl 2, pp. S84-S87	article
Abstract: Equilibrium disorders caused by involvement of brainstem and cerebellar structures are common in patients with multiple sclerosis (MS), but peripheral conditions such as benign paroxysmal positional vertigo (BPPV) can be sometimes confused with those of a central origin. Therefore, an accurate otoneurologic investigation paying attention to differential diagnosis aspects should be performed in these subjects. Among available diagnostic tools, electro-oculography, posturography and vestibular evoked myogenic potentials (VEMPs) are especially suited to assess vestibulo-oculomotor and vestibulospinal systems. This paper briefly describes the most recent otoneurologic diagnostic strategies for MS patients and the results of initial clinical experiences, and finally provides suggestions for differentiating MS-related vestibular disorders from other common otoneurological conditions.
BibTeX: @article{Alpini2001, author = {Alpini, D and Caputo, D and Pugnetti, L and Giuliano, D A and Cesarani, A}, title = {Vertigo and multiple sclerosis: aspects of differential diagnosis.}, journal = {Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology}, year = {2001}, volume = {22 Suppl 2}, pages = {S84--S87}, keywords = {Ataxia, etiology; Diagnosis, Differential; Diagnostic Techniques, Neurological; Diagnostic Techniques, Otological; Electromyography; Evoked Potentials, Auditory, Brain Stem; Humans; Multiple Sclerosis, complications, diagnosis; Vertigo, etiology}, pmid = {11794485} }
Yu-Wai-Man, P., Gorman, G., Bateman, D.E., Leigh, R.J. and Chinnery, P.F.	Vertigo and vestibular abnormalities in spinocerebellar ataxia type 6. [Abstract] [BibTeX]	2009	Journal of neurology Vol. 256(1), pp. 78-82	article	DOI
Abstract: Spinocerebellar ataxia type 6 (SCA6) is a calcium channelopathy due to a pathological CAG repeat expansion in CACNL1A4. Patients frequently describe paroxysmal vertigo early in the disease course, but it is not clear whether this is central or labyrinthine in origin. To address this issue we studied 21 SCA6 patients. Symptoms of vertigo were defined using a structured questionnaire. Signs were recorded during a standardised bed-side vestibular examination that included systematic positional testing with Frenzel goggles.Brief, recurrent attacks of vertigo occurred in 13 patients, usually preceding the onset of ataxia. Nystagmus was observed behind Frenzel goggles in 14 patients, and was induced either during positional testing, or head shaking in 20 patients. Only one patient had findings typical of benign paroxysmal positional vertigo (BPPV). Combined downbeat and horizontal gaze-evoked nystagmus ("side-pocket") was the most common form, occurring most commonly in supine and head-hanging positions, and following horizontal head-shaking. Nystagmus beating away from the ground (apogeotropic) occurred in 9 patients as they lay on their side.In conclusion, vertigo and abnormalities on bedside vestibular examination are common in SCA6, with forms of nystagmus typical of cerebellar, rather than labyrinthine, disease. These findings demonstrate phenotypic overlap between SCA6 and episodic ataxia type 2, which are both due to mutations in CACNL1A4.
BibTeX: @article{Yu-Wai-Man2009, author = {Yu-Wai-Man, Patrick and Gorman, Grainne and Bateman, David E and Leigh, R John and Chinnery, Patrick F}, title = {Vertigo and vestibular abnormalities in spinocerebellar ataxia type 6.}, journal = {Journal of neurology}, year = {2009}, volume = {256}, issue = {1}, pages = {78--82}, doi = {https://doi.org/10.1007/s00415-009-0068-2}, keywords = {Aged; Aged, 80 and over; Calcium Channels, genetics; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, diagnosis, physiopathology; Phenotype; Spinocerebellar Ataxias, diagnosis, physiopathology; Trinucleotide Repeat Expansion; Vertigo, diagnosis, physiopathology; Vestibular Function Tests, methods}, pmid = {19224313} }
Murdin, L., Davies, R.A. and Bronstein, A.M.	Vertigo as a migraine trigger. [Abstract] [BibTeX]	2009	Neurology Vol. 73(8), pp. 638-642	article	DOI
Abstract: It is reported in some individual patients that vestibular stimuli can trigger migraine attacks. This study used a case-control design to examine systematically the hypothesis that vertigo induced by vestibular stimulation (rotation/caloric testing) can act as a specific migraine trigger. A total of 123 new patients attending neuro-otology or neurology clinics were studied with questionnaires and physician interview to ascertain migraine history according to International Headache Society criteria. A total of 79 who underwent rotation/caloric vestibular testing (test group) were compared with 44 control patients in whom no such testing was carried out (control group). The principal outcome measure was the occurrence of a migraine attack within 24 hours of exposure to vestibular stimulation. Of those participants with a past history of migraines, 19/39 (49%) of the test group experienced a migraine in the study time window, compared with 1/21 (5%) of the control group. Binary logistic regression analysis confirmed that vestibular testing was associated (p < 0.05) with migraine attacks. The results indicate that induced vertigo can act as a migraine trigger, a finding with implications for the diagnosis of patients with episodic vertigo and migraine headache. While such patients may well have basilar migraine or migrainous vertigo, alternatively, another disorder causing episodic vertigo (e.g., benign paroxysmal positional vertigo or Ménière disease) may be triggering migraine headaches.
BibTeX: @article{Murdin2009, author = {Murdin, Louisa and Davies, Rosalyn A and Bronstein, Adolfo M}, title = {Vertigo as a migraine trigger.}, journal = {Neurology}, year = {2009}, volume = {73}, issue = {8}, pages = {638--642}, doi = {https://doi.org/10.1212/WNL.0b013e3181b38a04}, keywords = {Adolescent; Adult; Aged; Case-Control Studies; Female; Humans; Male; Middle Aged; Migraine Disorders, diagnosis, etiology, physiopathology; Vertigo, complications, diagnosis, physiopathology; Young Adult}, pmid = {19704084} }
Lempert, T., Neuhauser, H. and Daroff, R.B.	Vertigo as a symptom of migraine. [Abstract] [BibTeX]	2009	Annals of the New York Academy of Sciences Vol. 1164, pp. 242-251	article	DOI
Abstract: Migraine and vertigo are common disorders, affecting about 14% and 10%, respectively, of the general population. If migraine and vertigo were unrelated, the expected comorbidity would be 1%, whereas recent epidemiological studies indicate that 3.2% of the population have both migraine and vertigo. The excess comorbidity may be attributed to two factors: 1) vertigo syndromes (including Menière's disease, benign paroxysmal positional vertigo, and anxiety-related dizziness) that are more common in migraineurs than in controls and 2) vestibular migraine (VM) (vertigo as a symptom of migraine.) VM presents with attacks of spontaneous or positional vertigo lasting seconds to days. Headaches are often absent during acute attacks, but other migrainous features such as photophobia or auras, may be present. Like migraine headaches, VM triggers include stress, sleep deprivation, and hormonal changes. During acute attacks, there may be central spontaneous or positional nystagmus and, less commonly, unilateral vestibular hypofunction. In the symptom-free interval, vestibular testing shows mostly minor and nonspecific findings. The pathogenesis of VM is uncertain, but migraine mechanisms may interfere with the vestibular system at the labyrinth, brainstem, and cerebral cortex. Treatment includes vestibular suppressants for acute attacks and migraine prophylaxis for patients with frequent recurrences. However, treatment efficacy has not been validated by properly controlled clinical trials. VM does not fit into the 2004 International Headache Society Classification, in which "basilar-type migraine" must have at least two posterior circulation manifestations; isolated vertigo would not satisfy this criterion.
BibTeX: @article{Lempert2009, author = {Lempert, Thomas and Neuhauser, Hannelore and Daroff, Robert B}, title = {Vertigo as a symptom of migraine.}, journal = {Annals of the New York Academy of Sciences}, year = {2009}, volume = {1164}, pages = {242--251}, doi = {https://doi.org/10.1111/j.1749-6632.2009.03852.x}, keywords = {Humans; Migraine Disorders, diagnosis, epidemiology, physiopathology; Prevalence; Vertigo, epidemiology, physiopathology}, pmid = {19645907} }
Fyrmpas, G., Barkoulas, E., Haidich, A.B. and Tsalighopoulos, M.	Vertigo during the Epley maneuver and success rate in patients with BPPV. [Abstract] [BibTeX]	2013	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 270(10), pp. 2621-2625	article	DOI
Abstract: To investigate whether reported vertigo during the Epley maneuver predicts therapeutic success in patients with benign paroxysmal positioning vertigo of the posterior semicircular canal (pc-BPPV). Fifty consecutive adult patients with pc-BPPV, based on a positive Dix-Hallpike test (DHT), were treated with the Epley maneuver and retested after 2 days. Patients were asked to report the presence of vertigo upon assuming each of the four positions of the maneuver. Thirty seven patients (74 %) were treated successfully in one session. Twenty out of 23 patients who reported vertigo at turning the head to the opposite side (2nd position) had a negative DHT on follow-up. These patients had a higher chance of a successful outcome compared to patients who did not report vertigo in the 2nd position (Odds ratio 5.3, 95 % CI: 1.3-22.2, p = 0.022). Report of vertigo at the other positions was not associated with the outcome. Report of vertigo at the second position of a single modified Epley maneuver is associated with therapeutic success.
BibTeX: @article{Fyrmpas2013, author = {Fyrmpas, Georgios and Barkoulas, Eustathios and Haidich, Anna Bettina and Tsalighopoulos, Miltiadis}, title = {Vertigo during the Epley maneuver and success rate in patients with BPPV.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2013}, volume = {270}, issue = {10}, pages = {2621--2625}, doi = {https://doi.org/10.1007/s00405-012-2292-0}, keywords = {Aged; Benign Paroxysmal Positional Vertigo; Cohort Studies; Female; Humans; Male; Middle Aged; Otolithic Membrane, physiopathology; Patient Positioning, methods; Semicircular Canals, physiopathology; Treatment Outcome; Vertigo, physiopathology, therapy}, pmid = {23203243} }
Erbek, S.H., Erbek, S.S., Yilmaz, I., Topal, O., Ozgirgin, N., Ozluoglu, L.N. and Alehan, F.	Vertigo in childhood: a clinical experience. [Abstract] [BibTeX]	2006	International journal of pediatric otorhinolaryngology Vol. 70(9), pp. 1547-1554	article	DOI
Abstract: Vertigo in childhood is a complaint consisting of a wide spectrum of diagnoses. The aim of this study was to evaluate pediatric patients with vertigo with normal eardrum and middle ear findings and discuss the differential diagnoses. Patient records of 50 children under 18 years of age with vertigo as the chief complaint, examined at the Baskent University, Research and Application Centers at Konya and Adana otorhinolaryngology clinics between May 2003 and October 2005 were retrospectively reviewed. The questionnaires, laboratory tests including blood samples, audiological and vestibular tests, and final diagnoses were analyzed. Patients with perforated eardrums, otitis media with effusion, and acute upper respiratory tract infections were not included in the study. The study group consisted of 50 patients (33 females, 66%; 17 males, 34%), between 4 and 17 years of age (mean age, 11.5+/-3.9 years). Severe sensorineural hearing loss was present in one patient unilaterally (2%) and one patient bilaterally (2%). Bilateral low-frequency sensorineural hearing loss was present in one patient (2%). Electronystagmography revealed central vestibular abnormalities in three patients (6%). Canal paresis was established in six patients (12%). The Dix-Hallpike test was positive in six patients (12%). The most frequent cause of vertigo was migraine, occurring in 34% of patients (n=17). Other less-frequent etiologies of vertigo were benign paroxysmal vertigo (n=6; 12%), benign paroxysmal positional vertigo (n=6; 12%), psychogenic vertigo (n=5; 10%), epilepsy (n=3; 6%), metabolic disorders (n=3; 6%), vestibular neuritis (n=2; 4%), Meniere's disease (n=1; 2%), perilymphatic fistula (n=1; 2%), amblyopia (n=1; 2%), and unclassifiable (n=5; 10%). Migraine was found to be the most frequent presenting diagnosis in childhood vertigo, although several peripheral vestibular disorders also were diagnosed. Evaluation of vertigo in childhood should begin with a thorough neuro-otologic evaluation and include other relevant multidisciplinary team members as needed to avoid unnecessary effort and cost.
BibTeX: @article{Erbek2006, author = {Erbek, Seyra H and Erbek, Selim S and Yilmaz, Ismail and Topal, Ozgul and Ozgirgin, Nuri and Ozluoglu, Levent N and Alehan, Fusun}, title = {Vertigo in childhood: a clinical experience.}, journal = {International journal of pediatric otorhinolaryngology}, year = {2006}, volume = {70}, issue = {9}, pages = {1547--1554}, doi = {https://doi.org/10.1016/j.ijporl.2006.04.001}, keywords = {Adolescent; Child; Child, Preschool; Female; Humans; Male; Retrospective Studies; Vertigo, diagnosis}, pmid = {16730074} }
Dispenza, F. and De Stefano, A.	Vertigo in childhood: a methodological approach. [Abstract] [BibTeX]	2012	Bratislavske lekarske listy Vol. 113(4), pp. 256-259	article
Abstract: Children complaints dizziness merit meticulous evaluation to differentially diagnose a vestibular disease. A syndrome mimicking certain classic signs and symptoms of adult vestibular disorders may be presents in children, such as benign paroxysmal positional vertigo, usually associated with aging. Benign paroxysmal vertigo, in which migraine is a manifestation, with sudden onset of dizziness is a rare peripheral vestibular disorder that is commonly ignored or misdiagnosed. This review covers the development of the diagnosis, evaluation and treatment approaches of vertigo of childhood, a valid support for physician that approach dizzy children (Ref. 25). Full Text in PDF www.elis.sk.
BibTeX: @article{Dispenza2012, author = {Dispenza, F and De Stefano, A}, title = {Vertigo in childhood: a methodological approach.}, journal = {Bratislavske lekarske listy}, year = {2012}, volume = {113}, issue = {4}, pages = {256--259}, keywords = {Benign Paroxysmal Positional Vertigo; Child; Humans; Vertigo, diagnosis, etiology}, pmid = {22502763} }
Frohman, E.M., Zhang, H., Dewey, R.B., Hawker, K.S., Racke, M.K. and Frohman, T.C.	Vertigo in MS: utility of positional and particle repositioning maneuvers. [Abstract] [BibTeX]	2000	Neurology Vol. 55(10), pp. 1566-1569	article
Abstract: A 4-year experience with new-onset vertigo in a university-based MS population was retrospectively reviewed. Of 1,153 patients with MS, 25 could be clinically evaluated during the vertiginous episode. Of these, 13 (52%) were diagnosed with benign paroxysmal positioning vertigo and eight (32%) had acute MS exacerbations with corresponding lesions within the brainstem. All patients diagnosed with benign paroxysmal positioning vertigo were treated successfully with particle repositioning maneuvers.
BibTeX: @article{Frohman2000, author = {Frohman, E M and Zhang, H and Dewey, R B and Hawker, K S and Racke, M K and Frohman, T C}, title = {Vertigo in MS: utility of positional and particle repositioning maneuvers.}, journal = {Neurology}, year = {2000}, volume = {55}, issue = {10}, pages = {1566--1569}, keywords = {Adult; Female; Humans; Male; Multiple Sclerosis, diagnosis, physiopathology; Posture; Vertigo, physiopathology, therapy}, pmid = {11094117} }
Baloh	Vertigo in Older People. [Abstract] [BibTeX]	2000	Current treatment options in neurology Vol. 2(1), pp. 81-89	article
Abstract: When possible, treatment should be directed at the underlying cause of vertigo. The particle repositioning maneuver is a simple curative bedside treatment for benign paroxysmal positional vertigo. Symptomatic therapy using antivertiginous drugs can be used with specific treatments or when no specific treatment is available. Surgery has a limited role in the treatment of vertigo and should be considered only when the diagnosis and pathophysiology are clear. Vestibular rehabilitation helps the patient compensate for a fixed vestibular deficit.
BibTeX: @article{Baloh2000, author = {Baloh}, title = {Vertigo in Older People.}, journal = {Current treatment options in neurology}, year = {2000}, volume = {2}, issue = {1}, pages = {81--89}, pmid = {11096739} }
Kentala, E. and Pyykkö, I.	Vertigo in patients with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2000	Acta oto-laryngologica. Supplementum Vol. 543, pp. 20-22	article
Abstract: We retrieved information on 59 patients, 19 men and 40 women, with benign paroxysmal positional vertigo (BPPV) from the database of the otoneurologic expert system (ONE). The original number of patients was greater, but we excluded all those with hearing loss of any origin. The patients filled in a questionnaire concerning their symptoms, earlier diseases, accidents and tobacco and alcohol use. This information was then integrated with results of audiometric, otoneurologic and imaging studies. The mean age at onset of symptoms was 44 years. Most patients had had vertiginous spells for < 1 year. None of the patients had hearing loss. Tinnitus was experienced by 32% of patients, and these patients experienced more anxiety than the others [r(53) = 0.40, p < 0.01]. The mean duration of the vertigo attacks ranged from a few seconds to 5 min, and they were fairly mild (26%) or moderate (41%) in intensity. The attacks were perceived as more intense if vertigo was rotational [r(54) = 0.60, p < 0.01] or if it was accompanied by nausea [r(58) = 0.42, p < 0.01]. Patients with headache had more intense attacks [r(58) = 0.36, p < 0.01]. The vertigo attacks occurred in spells; patients had several attacks a week (23%) or during the course of 1 day (52%). The vertigo was rotational in 80% of patients, and 47% experienced a floating sensation. The floating vertigo was most often provoked by pressure changes [r(54) = 0.41, p < 0.01] or changes in visual surroundings [r(54) = 0.52, p < 0.01].
BibTeX: @article{Kentala2000, author = {Kentala, E and Pyykkö, I}, title = {Vertigo in patients with benign paroxysmal positional vertigo.}, journal = {Acta oto-laryngologica. Supplementum}, year = {2000}, volume = {543}, pages = {20--22}, keywords = {Adult; Aged; Female; Headache, diagnosis, epidemiology; Humans; Male; Middle Aged; Posture, physiology; Severity of Illness Index; Surveys and Questionnaires; Time Factors; Tinnitus, diagnosis, epidemiology; Vertigo, diagnosis, epidemiology}, pmid = {10908965} }
Sahyouni, R., Moshtaghi, O., Haidar, Y.M., Mahboubi, H., Moshtaghi, A., Lin, H.W. and Djalilian, H.R.	Vertigo in Vestibular Schwannoma Patients Due to Other Pathologies. [Abstract] [BibTeX]	2017	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 38(10), pp. e457-e459	article	DOI
Abstract: To report findings from a cohort of vestibular schwannoma (VS) patients presenting with vertigo from a secondary comorbid vestibular disorder; and to discuss management strategies for this subset of patients presenting with both episodic vertigo and VS. All VS patients who presented with vertigo as the primary symptom from 2012 to 2015 and endorsing no other major complaints were examined. Treatment with migraine lifestyle and prophylactic therapy, or Epley maneuver. Resolution of vertigo following medical treatment alone. Of the nine patients studied, seven (78%) suffered from vestibular migraine, and two (22%) experienced benign positional vertigo. All patients experienced complete resolution of symptoms after treatment. As a result of symptomatic improvement, seven patients (78%) avoided surgery in favor of observation, while two patients (22%) underwent radiosurgery due to continued tumor growth and other nonvertigo symptoms. VS patients can sometimes present with a history of recurrent episodic vertigo. The etiology of the vertigo could be due to the tumor itself or may be due to an underlying comorbidity such as vestibular migraine or benign positional vertigo. VS patients presenting with vertigo should undergo a standard vertigo history and examination to identify other potential causes of vertigo. Most VS patients in our cohort avoided intervention and had resolution of their vertigo.
BibTeX: @article{Sahyouni2017, author = {Sahyouni, Ronald and Moshtaghi, Omid and Haidar, Yarah M and Mahboubi, Hossein and Moshtaghi, Afsheen and Lin, Harrison W and Djalilian, Hamid R}, title = {Vertigo in Vestibular Schwannoma Patients Due to Other Pathologies.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2017}, volume = {38}, issue = {10}, pages = {e457--e459}, doi = {https://doi.org/10.1097/MAO.0000000000001567}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo, etiology, surgery; Cohort Studies; Female; Humans; Life Style; Male; Middle Aged; Migraine Disorders, etiology; Neuroma, Acoustic, complications, surgery; Otologic Surgical Procedures; Recurrence; Retrospective Studies; Vertigo, etiology, prevention & control, surgery; Vestibular Neuronitis, etiology, surgery; Watchful Waiting}, pmid = {28891872} }
Albera, A., Boldreghini, M., Canale, A., Albera, R. and Gervasio, C.F.	Vertigo returning to the sitting position after the Semont manoeuvre. Is it a prognostic symptom? [Abstract] [BibTeX]	2018	Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale Vol. 38(2), pp. 145-150	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV) is a frequent benign vestibular condition usually managed with particle repositioning manoeuvres, such as Semont manoeuvre (SM). Since few authors have described prognostic aspects of liberatory manoeuvres, the purpose of the present study was to investigate the possibility of considering vertigo in the final sitting position of the SM as a prognostic symptom in the outcome of posterior BPPV. One hundred and thirteen patients with diagnosis of unilateral posterior BPPV were taking into account in our retrospective cohort study: 41 men and 72 women, aged 22 to 85 years. All were submitted to one repositioning SM and afterwards controlled 3 to 5 days later by means of an additional Dix-Hallpike manoeuvre. The main outcomes investigated were the occurrence of Ny and vertigo in the different phases of the SM, as well as their characteristics in relation to outcome of the disease. Among all patients, 75 (66%) presented both orthotropic Ny and vertigo in the second SM position and 72% obtained a complete resolution of the disease after the liberatory manoeuvre. Contrarily, 17 subjects (15%) manifested vertigo in the final sitting position of the SM and among these, only 7 (41%) completely recovered from BPPV. According to our data, in case of sudden vertigo returning to the final sitting position of the SM, the failure rate of the liberatory manoeuvre was higher, even though not statistically significant: therefore, it can be considered as a negative prognostic factor of posterior BPPV after SM.
BibTeX: @article{Albera2018, author = {Albera, A and Boldreghini, M and Canale, A and Albera, R and Gervasio, C F}, title = {Vertigo returning to the sitting position after the Semont manoeuvre. Is it a prognostic symptom?}, journal = {Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale}, year = {2018}, volume = {38}, issue = {2}, pages = {145--150}, doi = {https://doi.org/10.14639/0392-100X-1815}, keywords = {BPPV; BPPV outcomes; Positional vertigo; Semont manoeuvre •Semont prognostic factors}, pmid = {29967559} }
Thakar, A., Anjaneyulu, C. and Deka, R.C.	Vertigo syndromes and mechanisms in migraine. [Abstract] [BibTeX]	2001	The Journal of laryngology and otology Vol. 115(10), pp. 782-787	article
Abstract: This paper attempts to define and categorize the vertigo associated with migraine. A retrospective chart review of 344 cases of vertigo identified 19 cases with headaches characteristic of migraine as per strictly defined criteria (International Headache Society, 1988). Four distinct types of vertiginous syndromes were noted. The commonest syndrome (Group I) manifested transient episodes of imbalance with additional momentary subjective rotary vertigo worsened by movement. The attacks lasted a few hours and evaluation in the inter-episode interval demonstrated no vestibular deficit. Group II manifested transient objective rotatory vertigo of from 10 minutes to a few hours but no demonstrable permanent vestibular deficit. Group III displayed symptoms and signs characteristic of benign paroxysmal positional vertigo (BPPV) and Group IV manifested a permanent unilateral labyrinthine weakness. Causation of vertigo by migraine was implied in 10 of 19 cases where the headache and vertigo occurred simultaneously and in two other cases where the vertigo improved with anti-migraine prophylactic treatment. Four distinct and characteristic vertigo syndromes have been noted with migraine. Their spectrum ranges from a transient reversible dysfunction to a more permanent destruction, and includes involvement of both the peripheral and the central vestibular systems.
BibTeX: @article{Thakar2001, author = {Thakar, A and Anjaneyulu, C and Deka, R C}, title = {Vertigo syndromes and mechanisms in migraine.}, journal = {The Journal of laryngology and otology}, year = {2001}, volume = {115}, issue = {10}, pages = {782--787}, keywords = {Adolescent; Adult; Aged; Female; Humans; Ischemia, complications; Labyrinth Diseases, complications; Male; Middle Aged; Migraine Disorders, complications, diagnosis, therapy; Motion; Retrospective Studies; Sound; Syndrome; Vertigo, etiology, therapy; Vestibular Diseases, complications}, pmid = {11667987} }
Tevzadze, N. and Shakarishvili, R.	Vertigo syndromes associated with earthquake in Georgia. [Abstract] [BibTeX]	2007	Georgian medical news(148-149), pp. 36-39	article
Abstract: Georgia experienced strong earthquake, after this event the amount of patients with vestibular symptoms increased. Study evaluates 60 outpatients (51 females, 9 males) aged from 18 to 85 years old who applied at outpatient clinics with vestibular complaints in the initial weeks following the earthquake. BPPV and PPV are the most common causes of vertigo. "Idiopathic" BPPV is the cause of BPPV in 50-70% of cases. Head trauma, vestibular neuritis, Meniere disease, migraine are the most common causes of "secondary" BPPV. (PPV) syndrome characterized by dizziness, subjective disturbance of balance and by perception of illusory body perturbations, usually triggered by perceptual stimulus. PPV frequently associated with anxiety symptoms in patients with obsessive-compulsive type personality. The study revealed "Idiopathic" BPPV in 49 cases and "secondary" types BPPV in 11 cases. 37 previously documented histories of BPPV patients had features typical for posterior semisercircular canal BPPV and 23 patients experienced subjective disturbance symptoms like BPPV, but there were no abnormal responses in their vestibular testing. It is assumed that earthquake could manifest psychogenic vertigo with panic attacks, anxiety, agoraphobia, PPV and could provoke a transition from organic vertigo to PPV. It is concluded that psychological stress play an important role in occurring "secondary" BPPV, earthquake may trigger exacerbation of "secondary" BPPV and could be provoked factor to developing psychogenic vertigo, mostly PPV.
BibTeX: @article{Tevzadze2007a, author = {Tevzadze, N and Shakarishvili, R}, title = {Vertigo syndromes associated with earthquake in Georgia.}, journal = {Georgian medical news}, year = {2007}, issue = {148-149}, pages = {36--39}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Disasters; Female; Georgia (Republic); Humans; Male; Middle Aged; Vertigo, diagnosis, etiology}, pmid = {17921541} }
Uneri, A. and Polat, S.	Vertigo, dizziness and imbalance in the elderly. [Abstract] [BibTeX]	2008	The Journal of laryngology and otology Vol. 122(5), pp. 466-469	article	DOI
Abstract: The aim of this retrospective analysis was to evaluate the diagnosis of vertigo, dizziness and imbalance in elderly patients in two tertiary neurotology clinics. Six hundred and seventy-seven patients aged over 65 years were assessed by the same senior author, and 601 patients were enrolled in the study. The most frequent diagnoses were benign paroxysmal positional vertigo (42.43 per cent), idiopathic vestibulopathy (20.29 per cent), migraine vestibulopathy (13.15 per cent), Ménière's disease (12.47 per cent) and acute vestibular attack (6.49 per cent). This retrospective study showed that 93.5 per cent of the elderly patients studied had been diagnosed with peripheral vertigo. The majority of patients had been classified as having benign paroxysmal positional vertigo, idiopathic vestibulopathy or migraine vestibulopathy.
BibTeX: @article{Uneri2008, author = {Uneri, A and Polat, S}, title = {Vertigo, dizziness and imbalance in the elderly.}, journal = {The Journal of laryngology and otology}, year = {2008}, volume = {122}, issue = {5}, pages = {466--469}, doi = {https://doi.org/10.1017/S0022215107000424}, keywords = {Aged; Aged, 80 and over; Diagnosis, Differential; Dizziness, diagnosis; Epidemiologic Methods; Female; Humans; Male; Meniere Disease, diagnosis; Postural Balance, physiology; Sensation Disorders, diagnosis; Vertigo, diagnosis}, pmid = {17850686} }
Packer, P.	Vertigo: assessment and management. [Abstract] [BibTeX]	1994	Australian family physician Vol. 23(11), pp. 2121-2127	article
Abstract: Elucidation of the cause of vertigo must consist of an adequate history to see if a clinical entity such as BPPV or Meniere's Disease can be recognised, and a general physical examination with emphasis on: The ear--discharge, perforation, fistula sign and hearing. Vestibular system--nystagmus and Romberg test with past pointing and positional testing. CNS--cranial nerves, cerebellar signs and gait. CVS--BP and bruits in neck and cardiac irregularities. Audiogram, ENG and CT or MRI. The specific treatment must be supplemented by sympathetic, symptomatic therapy and reassurance that the condition is not a mystery but clearly defined. The probable cause and lines of treatment available can be explained.
BibTeX: @article{Packer1994, author = {Packer, P}, title = {Vertigo: assessment and management.}, journal = {Australian family physician}, year = {1994}, volume = {23}, issue = {11}, pages = {2121--2127}, keywords = {Humans; Labyrinth Diseases, complications; Meniere Disease, complications, therapy; Vertigo, etiology, therapy}, pmid = {7864767} }
Neuhauser, H.K. and Lempert, T.	Vertigo: epidemiologic aspects. [Abstract] [BibTeX]	2009	Seminars in neurology Vol. 29(5), pp. 473-481	article	DOI
Abstract: Vertigo is a frequent symptom in the general population with a 12-month prevalence of 5% and an incidence of 1.4% in adults. Its prevalence rises with age and is about two to three times higher in women than in men. The epidemiology of vertigo and underlying specific vestibular disorders is still an underdeveloped field despite its usefulness for clinical decision making and its potential for improving patient care. In this article, the authors give an overview on the epidemiology of vertigo as a symptom and of four specific vestibular disorders: benign paroxysmal positional vertigo (BPPV), vestibular migraine, Ménière's disease, and vestibular neuritis.
BibTeX: @article{Neuhauser2009, author = {Neuhauser, Hannelore K and Lempert, Thomas}, title = {Vertigo: epidemiologic aspects.}, journal = {Seminars in neurology}, year = {2009}, volume = {29}, issue = {5}, pages = {473--481}, doi = {https://doi.org/10.1055/s-0029-1241043}, keywords = {Humans; Meniere Disease, epidemiology; Migraine Disorders, epidemiology; Vertigo, epidemiology; Vestibular Neuronitis, epidemiology}, pmid = {19834858} }
Zanni, G.R. and Wick, J.Y.	Vertigo: few new spins on a common problem. [Abstract] [BibTeX]	2006	The Consultant pharmacist : the journal of the American Society of Consultant Pharmacists Vol. 21(9), pp. 680-696	article
Abstract: Vertigo is a common balance deregulation symptom among elders. Its etiology may be peripheral vestibular disease or a central vestibular disorder. Symptom onset, severity, and duration are distinguishing characteristics. The majority of peripheral vestibular disorders include benign paroxysmal positional vertigo, vestibular neuronitis, Meniere's disease, and perilymph fistula. Medication regimen review is necessary to identify possible drug-induced etiology. Treatment options include pharmacotherapy, canalith repositioning procedures, surgery, vestibular rehabilitation therapy, and dietary interventions.
BibTeX: @article{Zanni2006, author = {Zanni, Guido R and Wick, Jeannette Y}, title = {Vertigo: few new spins on a common problem.}, journal = {The Consultant pharmacist : the journal of the American Society of Consultant Pharmacists}, year = {2006}, volume = {21}, issue = {9}, pages = {680--696}, keywords = {Diet; Drug-Related Side Effects and Adverse Reactions; Ear, Inner, pathology; Ear, Middle, pathology; Fistula, complications; Humans; Meniere Disease, complications; Vertigo, diagnosis, etiology, therapy; Vestibular Neuronitis, complications}, pmid = {17069465} }
Baloh, R.W.	Vertigo. [Abstract] [BibTeX]	1998	Lancet (London, England) Vol. 352(9143), pp. 1841-1846	article	DOI
Abstract: Vertigo is a subtype of dizziness, which results from an imbalance within the vestibular system. This seminar focuses on three common presentations of vertigo: prolonged spontaneous vertigo, recurrent attacks of vertigo, and positional vertigo. The patient's history is usually the key to differentiation of peripheral and central causes of vertigo. The most common cause of vertigo, benign paroxysmal positional vertigo, can be cured with a simple positional manoeuvre. Other common causes of vertigo include vestibular neuritis, Ménière's syndrome, migraine, and vertebrobasilar insufficiency. Treatment should be directed at the underlying cause whenever possible, but antivertiginous and antiemetic drugs can suppress symptoms when a specific cause cannot be found. These drugs are generally not indicated for long-term daily use, however, since they may interfere with the normal compensation process.
BibTeX: @article{Baloh1998, author = {Baloh, R W}, title = {Vertigo.}, journal = {Lancet (London, England)}, year = {1998}, volume = {352}, issue = {9143}, pages = {1841--1846}, doi = {https://doi.org/10.1016/S0140-6736(98)05430-0}, keywords = {Humans; Recurrence; Vertigo, etiology, physiopathology, therapy}, pmid = {9851400} }
Collard, M. and Chevalier, Y.	Vertigo. [Abstract] [BibTeX]	1994	Current opinion in neurology Vol. 7(1), pp. 88-92	article
Abstract: Vertigo is one of the most frequent reasons for consultation in daily medical practice. Recent studies show that vertigo involves considerable social costs before being managed efficiently, as it is often incorrectly diagnosed. Sometimes a psychiatric symptom, the original causes are vestibular in Ménière's disease, vestibular neuritis, and benign positional vertigo. Ménière's disease to some extent resembles that of progressive autoimmune deafness. Soon, perhaps, the target of the long-suspected immune reactions will be identified and specific treatments will be developed for the rapidly progressing forms. Benign paroxysmal positional vertigo is certainly a favorite of practitioners because the treatment is so simple. Not all vertigos are so easily cured, and surgery must sometimes be performed. In most cases, retrolabyrinthine vestibular neurectomy, with its acceptable risks, is the operation of choice. New diagnostic techniques, such as dynamic posturography, are interesting, but their use is not as yet clear.
BibTeX: @article{Collard1994, author = {Collard, M and Chevalier, Y}, title = {Vertigo.}, journal = {Current opinion in neurology}, year = {1994}, volume = {7}, issue = {1}, pages = {88--92}, keywords = {Cranial Nerve Diseases, etiology; Diagnosis, Differential; Humans; Meniere Disease, etiology; Vertebrobasilar Insufficiency, etiology; Vertigo, etiology; Vestibular Function Tests; Vestibular Nerve}, pmid = {8173685} }
Ismail, H.M.	Vertigo. A neurobiological review. [Abstract] [BibTeX]	2004	Neurosciences (Riyadh, Saudi Arabia) Vol. 9(4), pp. 243-246	article
Abstract: Dizziness is one of the most common presenting symptoms in clinical practice. Yet, the meaning of this symptom is patient-dependent and can span from true vertigo due to vestibular dysfunction to syncope or vertebro-basilar stroke. This review addresses the neurobiological background of vertigo and the most common syndrome of benign paroxysmal positional vertigo, with an outline of the approach towards localization and management of the acute vertiginous patient.
BibTeX: @article{Ismail2004, author = {Ismail, Hassan M}, title = {Vertigo. A neurobiological review.}, journal = {Neurosciences (Riyadh, Saudi Arabia)}, year = {2004}, volume = {9}, issue = {4}, pages = {243--246}, pmid = {23377241} }
Ekvall Hansson, E. and Magnusson, M.	Vestibular asymmetry predicts falls among elderly patients with multi-sensory dizziness. [Abstract] [BibTeX]	2013	BMC geriatrics Vol. 13, pp. 77	article	DOI
Abstract: Dizziness is the most common symptom in elderly patients and has been identified as a risk factor for falls. While BPPV is the most common cause of dizziness among elderly, multisensory deficits is the second, with visual, vestibular and proprioceptive reduced function. Asymmetric vestibular function is overrepresented in elderly persons with hip fractures and wrist fractures and can be accessed for screening. In this prospective study with one year observation period, 55 patients (41 women, 14 men), 65 to 90 years old (median 80, interquartile range 11) with multisensory dizziness were included. Headshake test were pathologic in 24 patients, which substantially increased the risk of falls (OR 3.4). Thirteen of the 21 patients who had fallen (p = 0.03), and all 6 patients who sustained three falls or more (p = 0.04), had vestibular asymmetry. No other measure could predict the risk of falls (OR 0.55-1.71). Signs of vestibular asymmetry among elderly with multisensory dizziness could predict falls. Hence, it seems important to address fall-prevention programs to such a group of patients. Simple bedside tests of vestibular asymmetry might be a possibility to screen for one risk factor for falls among elderly.
BibTeX: @article{EkvallHansson2013, author = {Ekvall Hansson, Eva and Magnusson, Måns}, title = {Vestibular asymmetry predicts falls among elderly patients with multi-sensory dizziness.}, journal = {BMC geriatrics}, year = {2013}, volume = {13}, pages = {77}, doi = {https://doi.org/10.1186/1471-2318-13-77}, keywords = {Accidental Falls, prevention & control; Aged; Aged, 80 and over; Dizziness, diagnosis, epidemiology; Female; Follow-Up Studies; Humans; Male; Predictive Value of Tests; Prospective Studies; Risk Factors; Single-Blind Method; Sweden, epidemiology; Vestibule, Labyrinth, physiology}, pmid = {23875891} }
Belafsky, P., Gianoli, G., Soileau, J., Moore, D. and Davidowitz, S.	Vestibular autorotation testing in patients with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2000	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 122(2), pp. 163-167	article	DOI
Abstract: The current gold standard for diagnosis of benign paroxysmal positional vertigo (BPPV) is the Dix-Hallpike maneuver. However, because of fatigability, the Dix-Hallpike is often falsely normal. The objective of this study was to evaluate the utility of vestibular autorotation testing in the diagnosis of BPPV. The charts of 210 patients at a tertiary referral center for vertiginous disorders were reviewed. All patients underwent clinical evaluation, Dix-Hallpike testing, audiometry, electronystagmography, and vestibular autorotation testing. The vestibular autorotation results of patients with BPPV were compared with the findings in patients with non-BPPV vestibular disorders. The sensitivity and specificity of vestibular autorotation testing in diagnosing BPPV were calculated. Ninety-one patients (42.9%) had BPPV, 76 patients (36.2%) had vertigo of uncertain cause, 28 (13.3%) had unilateral vestibular hypofunction, 9 patients (4.3%) had Meniere's disease, and 2 patients (1.0%) had perilymphatic fistula. Patients with BPPV were 3.32 times more likely to have a normal horizontal gain (95% CI = 1.54-7.19). A normal horizontal gain is 85% sensitive but only 36% specific for BPPV. Patients with BPPV were 1.9 times more likely to have vertical phase lead (95% CI = 0.95-3.93). Patients with BPPV were 2.20 times more likely to have both normal horizontal gain and vertical phase lead (95% CI = 1.03-4.69) The sensitivity of the combination of normal horizontal gain and vertical phase lead on vestibular autorotation testing is 87% specific but only 25% sensitive in the diagnosis of BPPV. A normal horizontal gain or vertical phase lead on vestibular autorotation testing in a vertiginous patient is suggestive of but not exclusive to a diagnosis of BPPV. The combination of a normal horizontal gain and vertical phase lead on vestibular autorotation testing is highly suggestive of the diagnosis of BPPV. Adjuvant use of these parameters in vestibular autorotation testing may prove to be helpful in the diagnosis of BPPV.
BibTeX: @article{Belafsky2000, author = {Belafsky, P and Gianoli, G and Soileau, J and Moore, D and Davidowitz, S}, title = {Vestibular autorotation testing in patients with benign paroxysmal positional vertigo.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2000}, volume = {122}, issue = {2}, pages = {163--167}, doi = {https://doi.org/10.1016/S0194-5998(00)70233-6}, keywords = {Electrooculography; Female; Fistula, complications, diagnosis; Humans; Labyrinth Diseases, complications, diagnosis; Male; Meniere Disease, complications, diagnosis; Middle Aged; Rotation; Sensitivity and Specificity; Vertigo, diagnosis, etiology; Vestibular Diseases, complications, diagnosis; Vestibular Function Tests}, pmid = {10652384} }
Deveze, A., Bernard-Demanze, L., Xavier, F., Lavieille, J.-P. and Elziere, M.	Vestibular compensation and vestibular rehabilitation. Current concepts and new trends. [Abstract] [BibTeX]	2014	Neurophysiologie clinique = Clinical neurophysiology Vol. 44(1), pp. 49-57	article	DOI
Abstract: The aim of this review is to present the current knowledge of the mechanisms underlying the vestibular compensation and demonstrating how the vestibular rehabilitation is conducted to help the recovery of balance function. Vestibular rehabilitation is based on improving the natural phenomenon called vestibular compensation that occurs after acute vestibular disturbance or chronic and gradual misbalance. Central compensation implies three main mechanisms namely adaptation, substitution and habituation. The compensation, aided by the rehabilitation aimed to compensate and/or to correct the underused or misused of the visual, proprioceptive and vestibular inputs involved in the postural control. As the strategy of equilibration is not corrected, the patient is incompletely cured and remains with inappropriate balance control with its significance on the risk of fall and impact on quality of life. The vestibular rehabilitation helps to correct inappropriate strategy of equilibrium or to accelerate a good but slow compensation phenomenon. Nowadays, new tools are more and more employed for the diagnosis of vestibular deficit (that may include various sources of impairment), the assessment of postural deficit, the control of the appropriate strategy as well to facilitate the efficiency of the rehabilitation especially in elderly people.
BibTeX: @article{Deveze2014, author = {Deveze, A and Bernard-Demanze, L and Xavier, F and Lavieille, J-P and Elziere, M}, title = {Vestibular compensation and vestibular rehabilitation. Current concepts and new trends.}, journal = {Neurophysiologie clinique = Clinical neurophysiology}, year = {2014}, volume = {44}, issue = {1}, pages = {49--57}, doi = {https://doi.org/10.1016/j.neucli.2013.10.138}, keywords = {Adaptation, Physiological; Exercise Therapy; Humans; Postural Balance; Vestibular Diseases, rehabilitation; BPPV; Compensation vestibulaire; Control postural; Dépendance visuelle; Postural control; Rééducation vestibulaire; Vertige paroxystique; Vestibular compensation; Vestibular rehabilitation; Visual dependency}, pmid = {24502905} }
Akin, F.W., Murnane, O.D., Hall, C.D. and Riska, K.M.	Vestibular consequences of mild traumatic brain injury and blast exposure: a review. [Abstract] [BibTeX]	2017	Brain injury Vol. 31(9), pp. 1188-1194	article	DOI
Abstract: The purpose of this article is to review relevant literature on the effect of mild traumatic brain injury (mTBI) and blast injury on the vestibular system. Dizziness and imbalance are common sequelae associated with mTBI, and in some individuals, these symptoms may last for six months or longer. In war-related injuries, mTBI is often associated with blast exposure. The causes of dizziness or imbalance following mTBI and blast injuries have been linked to white matter abnormalities, diffuse axonal injury in the brain, and central and peripheral vestibular system damage. There is some evidence that the otolith organs may be more vulnerable to damage from blast exposure or mTBI than the horizontal semicircular canals. In addition, benign paroxysmal positional vertigo (BPPV) is a common vestibular disorder following head injury that is treated effectively with canalith repositioning therapy. Treatment for (non-BPPV) mTBI-related vestibular dysfunction has focused on the use of vestibular rehabilitation (VR) augmented with additional rehabilitation methods and medication. New treatment approaches may be necessary for effective otolith organ pathway recovery in addition to traditional VR for horizontal semicircular canal (vestibulo-ocular reflex) recovery.
BibTeX: @article{Akin2017, author = {Akin, Faith W and Murnane, Owen D and Hall, Courtney D and Riska, Kristal M}, title = {Vestibular consequences of mild traumatic brain injury and blast exposure: a review.}, journal = {Brain injury}, year = {2017}, volume = {31}, issue = {9}, pages = {1188--1194}, doi = {https://doi.org/10.1080/02699052.2017.1288928}, keywords = {Blast Injuries, complications, physiopathology, therapy; Brain Concussion, complications, physiopathology, therapy; Dizziness, etiology, physiopathology, therapy; Humans; Postural Balance, physiology; Vestibular Diseases, etiology, physiopathology, therapy; Vestibule, Labyrinth, physiopathology; Mild brain injury; balance; concussion}, pmid = {28981340} }
Park, H.M., Jung, S.W. and Rhee, C.K.	Vestibular diagnosis as prognostic indicator in sudden hearing loss with vertigo. [Abstract] [BibTeX]	2001	Acta oto-laryngologica. Supplementum Vol. 545, pp. 80-83	article
Abstract: The majority of episodes of sudden hearing loss are caused by inner ear disorders, often accompanied by vertigo. The patterns of hearing loss usually influence the prognosis. The purpose of this study was to analyze vestibular diagnoses in sudden hearing loss with vertigo, and to correlate them with the recovery of hearing loss. The clinical records of 125 patients with sudden hearing loss were reviewed. Various vestibular evaluations were performed in 36 patients with vertigo. The vertigo in these patients was classified as normal, unilateral hypofunction, directional preponderance, benign paroxysmal positional vertigo (BPPV), non-specific or irritative. The initial and final pure-tone audiograms of these patients were compared. The distribution of vestibular diagnoses was unilateral hypofunction in 30.6% of patients, BPPV in 25.7%, normal in 19.4%, non-specific in 11.1%, directional preponderance in 8.3% and irritative in 8.3%. The recovery of hearing in patients with vertigo was significantly worse than in those without vertigo. The recovery of hearing in patients with spinning vertigo did not differ from that of patients with non-spinning vertigo. The recovery of hearing was worst in the BPPV group, especially in the high frequency range, followed by the unilateral hypofunction group, who showed hearing thresholds between those in the BPPV group and those in the normal vestibular function test group. This study suggests that the diagnostic classification of vestibulopathy is a useful prognostic indicator of hearing recovery in sudden hearing loss with vertigo. We conclude that otolithic and semicircular canal involvement may cause poor hearing results, especially in the high frequency range.
BibTeX: @article{Park2001, author = {Park, H M and Jung, S W and Rhee, C K}, title = {Vestibular diagnosis as prognostic indicator in sudden hearing loss with vertigo.}, journal = {Acta oto-laryngologica. Supplementum}, year = {2001}, volume = {545}, pages = {80--83}, keywords = {Adult; Audiometry, Pure-Tone; Auditory Threshold, physiology; Female; Hearing Disorders, complications, diagnosis, physiopathology; Humans; Male; Middle Aged; Prognosis; Recovery of Function; Severity of Illness Index; Vertigo, complications, diagnosis, physiopathology; Vestibular Function Tests; Vestibule, Labyrinth, physiopathology}, pmid = {11677749} }
Somefun, O.A., Giwa, O.S., Bamgboye, B.A., Okeke-Igbokwe, I.I. and Azeez, A.A.A.	Vestibular disorders among adults in a tertiary hospital in Lagos, Nigeria. [Abstract] [BibTeX]	2010	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 267(10), pp. 1515-1521	article	DOI
Abstract: Dizziness is not an uncommon complaint in the Otolaryngological clinics among other symptoms. To a large number of practitioners, the treatment of dizziness remains the same irrespective of the etiology, i.e., anti-vertiginous drugs. The objective of this study was to document the evaluation, causes and treatment of vestibular disorders among our patients. The design includes descriptive prospective study conducted in the Oto-rhino-laryngology and Orthopedic Clinics of Lagos University Teaching Hospital, Lagos and Nigerian Army Audiological Centre, 68 Nigerian Army Reference Hospital, Yaba, Lagos, Nigeria. Adult patients referred to the audiology clinic for dizziness had detailed history obtained by using structured questionnaire. General physical and neuro-otological examinations were done. Clinical diagnoses were made on standardized criteria. The patients had hearing evaluation, videonystagmography (VNG) evaluation using infrared videonystagmography system. X-ray of the cervical spine and computerized tomogram scan of internal auditory meatus and brain when indicated were done. A total of 102 patients were seen with age range between 21 and 90 years. Thirty patients (29.4%) recorded average duration of episode of vertiginous attacks in seconds, 69 (67.6%) recorded within minutes to hours and 3 (2.9%) with no definite pattern. Clinical signs on neuro-otological examination were elicited on 39 (38.2%) of the patients while on VNG the vestibular subtest mainly caloric test was abnormal unilaterally and bilaterally in 47 (46.1%) while with the oculomotor subtests, smooth pursuit tests were abnormal in 5 (6.9%), saccade tests were abnormal in 8 (7.8%) and OPK were abnormal in 9 (8.8%). Peripheral vestibular disorders are common of which benign paroxysmal positional vertigo (BPPV) was seen in 29 (28.4%), Meniere's disease in 22 (21.6%), recurrent vestibulopathy in 20 (19.6%), cervical vertigo in 18 (17.6%), psychogenic vertigo in 2 (2%), vestibular schwannoma, barotraumas and drug-induced vertigo in 1 (1%), respectively, central vestibular disorders of vascular origin 2 (2%), vertebrobasilar insufficiency in 1 (1%), post-traumatic vertigo in 3 (3%) and unknown in 2 (2%). In conclusion, peripheral vestibular disorders are common of which BPPV is the most prevalent. Pre-referral anti-vertiginous medication is common among general practitioners. The practising ORL/Head neck surgeon and orthopedic surgeons must be conversant with the tools of diagnosis, differential diagnosis and treatment.
BibTeX: @article{Somefun2010, author = {Somefun, O A and Giwa, O S and Bamgboye, B A and Okeke-Igbokwe, I Irene and Azeez, A A Abdul}, title = {Vestibular disorders among adults in a tertiary hospital in Lagos, Nigeria.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2010}, volume = {267}, issue = {10}, pages = {1515--1521}, doi = {https://doi.org/10.1007/s00405-010-1272-5}, keywords = {Adult; Age Distribution; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Cohort Studies; Female; Hearing Loss, diagnosis, epidemiology, therapy; Hospitalization; Humans; Male; Middle Aged; Nigeria; Risk Factors; Severity of Illness Index; Vertigo, diagnosis, epidemiology, therapy; Vestibular Diseases, diagnosis, epidemiology, therapy; Young Adult}, pmid = {20464409} }
Roberts, J.C., Cohen, H.S. and Sangi-Haghpeykar, H.	Vestibular disorders and dual task performance: impairment when walking a straight path. [Abstract] [BibTeX]	2011	Journal of vestibular research : equilibrium & orientation Vol. 21(3), pp. 167-174	article	DOI
Abstract: Locomotion is impaired in some people with vestibular disorders. Performance on cognitive tasks is also impaired in many people with vestibular disorders. The goal of this study was to determine if patients with vestibular disorders have decreased ability to complete a dual task performance involving a cognitive task, an additional motor task or both tasks, combined along a linear path. Subjects were normal, had benign paroxysmal positional vertigo, or had various vestibular disorders that caused unilateral weakness. They were asked to walk 7.62 m in a straight line with eyes open or closed, without extra tasks, and while nodding the head, naming things, and both nodding and naming. The patients walked significantly slower than controls, especially when performing the cognitive task. Patients had greater ataxia and began veering sooner than normals. The subjects' veering increased significantly with the addition of cognitive tasks. The patient groups did not differ significantly from each other. The changes in velocity did not affect the veering. These data suggest that patients with vestibular disorders are impaired in their ability to complete a linear path when cognitive tasks are added.
BibTeX: @article{Roberts2011, author = {Roberts, Jess C and Cohen, Helen S and Sangi-Haghpeykar, Haleh}, title = {Vestibular disorders and dual task performance: impairment when walking a straight path.}, journal = {Journal of vestibular research : equilibrium & orientation}, year = {2011}, volume = {21}, issue = {3}, pages = {167--174}, doi = {https://doi.org/10.3233/VES-2011-0415}, keywords = {Aged; Benign Paroxysmal Positional Vertigo; Cognition, physiology; Gait; Humans; Locomotion; Task Performance and Analysis; Vertigo, physiopathology; Vestibular Diseases, physiopathology; Walking}, pmid = {21558642} }
Mucha, A., Fedor, S. and DeMarco, D.	Vestibular dysfunction and concussion. [Abstract] [BibTeX]	2018	Handbook of clinical neurology Vol. 158, pp. 135-144	article	DOI
Abstract: The assessment and treatment of sport-related concussion (SRC) often requires a multifaceted approach. Vestibular dysfunction represents an important profile of symptoms and pathology following SRC, with high prevalence and association with prolonged recovery. Signs and symptoms of vestibular dysfunction may include dizziness, vertigo, disequilibrium, nausea, and visual impairment. Identifying the central and peripheral vestibular mechanisms responsible for pathology can aid in management of SRC. The most common vestibular disturbances after SRC include benign paroxysmal positional vertigo, vestibulo-ocular reflex impairment, visual motion sensitivity, and balance impairment. A variety of evidence-based screening and assessment tools can help to identify the various types of vestibular pathology in SRC. When vestibular dysfunction is identified, there is emerging support for applying targeted vestibular rehabilitation to manage this condition.
BibTeX: @article{Mucha2018, author = {Mucha, Anne and Fedor, Sheri and DeMarco, Danielle}, title = {Vestibular dysfunction and concussion.}, journal = {Handbook of clinical neurology}, year = {2018}, volume = {158}, pages = {135--144}, doi = {https://doi.org/10.1016/B978-0-444-63954-7.00014-8}, keywords = {balance; concussion; dizziness; migraine; rehabilitation; vestibular}, pmid = {30482341} }
Micarelli, A., Candidi, M., Viziano, A. and Alessandrini, M.	Vestibular dysfunction, beyond benign paroxysmal positional vertigo, affects mental rotations: Comment on "Visual dependence and spatial orientation in benign paroxysmal positional vertigo". [BibTeX]	2018	Journal of vestibular research : equilibrium & orientation Vol. 28(3-4), pp. 365-366	article	DOI
BibTeX: @article{Micarelli2018, author = {Micarelli, Alessandro and Candidi, Matteo and Viziano, Andrea and Alessandrini, Marco}, title = {Vestibular dysfunction, beyond benign paroxysmal positional vertigo, affects mental rotations: Comment on "Visual dependence and spatial orientation in benign paroxysmal positional vertigo".}, journal = {Journal of vestibular research : equilibrium & orientation}, year = {2018}, volume = {28}, issue = {3-4}, pages = {365--366}, doi = {https://doi.org/10.3233/VES-180640}, pmid = {30282384} }
Agrawal, Y., Ward, B.K. and Minor, L.B.	Vestibular dysfunction: prevalence, impact and need for targeted treatment. [BibTeX]	2013	Journal of vestibular research : equilibrium & orientation Vol. 23(3), pp. 113-117	article	DOI
BibTeX: @article{Agrawal2013, author = {Agrawal, Yuri and Ward, Bryan K and Minor, Lloyd B}, title = {Vestibular dysfunction: prevalence, impact and need for targeted treatment.}, journal = {Journal of vestibular research : equilibrium & orientation}, year = {2013}, volume = {23}, issue = {3}, pages = {113--117}, doi = {https://doi.org/10.3233/VES-130498}, keywords = {Accidental Falls; Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Dizziness, epidemiology; Female; Humans; Incidence; Male; Meniere Disease, psychology; Middle Aged; Prevalence; Quality of Life; Temporal Bone, pathology; United States, epidemiology; Vertigo, epidemiology; Vestibular Diseases, complications, epidemiology, psychology}, pmid = {24177344} }
Maria da Silva Lira-Batista, M., Schaffeln Dorigueto, R. and Freitas Ganança, C.	Vestibular evoked myogenic potentials and digital vectoelectro-nystagmography's study in patients with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2013	International archives of otorhinolaryngology Vol. 17(2), pp. 147-156	article	DOI
Abstract: Benign Paroxysmal Positional Vertigo (BPPV) is a very common vestibular disorder characterized by brief but intense attacks of rotatory vertigo triggered by simple rapid movement of the head. The integrity of the vestibular pathways can be assessed using tests such as digital vectoelectronystagmography (VENG) and vestibular evoked myogenic potentials (VEMP). This study aimed to determine the VEMP findings with respect to latency, amplitude, and waveform peak to peak and the results of the oculomotor and vestibular components of VENG in patients with BPPV. Although this otoneurological condition is quite common, little is known of the associated VEMP and VENG changes, making it important to research and describe these results. We examined the records of 4438 patients and selected 35 charts after applying the inclusion and exclusion criteria. Of these, 26 patients were women and 9 men. The average age at diagnosis was 52.7 years, and the most prevalent physiological cause, accounting for 97.3% of cases, was ductolithiasis. There was a statistically significant association between normal hearing and mild contralateral sensorineural hearing loss. The results of the oculomotor tests were within the normal reference ranges for all subjects. Patients with BPPV exhibited symmetrical function of the semicircular canals in their synergistic pairs (p < 0.001). The caloric test showed statistically normal responses from the lateral canals. The waveforms of all patients were adequate, but the VEMP results for the data-crossing maneuver with positive positioning showed a trend toward a relationship for the left ear Lp13. There was also a trend towards an association between normal reflexes in the caloric test and the inter-peak VEMP of the left ear. It can be concluded that although there are some differences between the average levels of the VENG and VEMP results, these differences were not statistically significant. In conclusion, the results of audiologic assessment, hearing thresholds, positioning maneuvers, and caloric tests have no effect on the quantitative results of VEMP. Additional research is warranted to establish the relationships among VENG, VEMP, and BPPV, especially as concerns the oculomotor tests.
BibTeX: @article{MariadaSilvaLira-Batista2013, author = {Maria da Silva Lira-Batista, Marta and Schaffeln Dorigueto, Ricardo and Freitas Ganança, Cristina}, title = {Vestibular evoked myogenic potentials and digital vectoelectro-nystagmography's study in patients with benign paroxysmal positional vertigo.}, journal = {International archives of otorhinolaryngology}, year = {2013}, volume = {17}, issue = {2}, pages = {147--156}, doi = {https://doi.org/10.7162/S1809-97772013000200006}, keywords = {Vertigo; Vestibular Diseases; Vestibular Evoked Myogenic Potentials; Vestibular Function Tests}, pmid = {25992006} }
Akkuzu, G., Akkuzu, B. and Ozluoglu, L.N.	Vestibular evoked myogenic potentials in benign paroxysmal positional vertigo and Meniere's disease. [Abstract] [BibTeX]	2006	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 263(6), pp. 510-517	article	DOI
Abstract: The objective was to investigate vestibular evoked myogenic potentials (VEMP) in benign paroxysmal positional vertigo (BPPV) and Meniere's disease, and to determine if this type of testing is valuable for assessing the vestibular system. A prospective controlled clinical study was designed in a tertiary referral center setting. The 62 participants included 17 healthy controls and 45 other subjects selected from patients who presented with the complaint of vertigo (25 diagnosed with BPPV and 20 diagnosed with Meniere's disease). The main outcome measures of VEMP were recorded in all subjects and findings in each patient group were compared with control findings. The VEMP for the 30 affected ears in the 25 BPPV patients revealed prolonged latencies in eight ears and decreased amplitude in one ear (nine abnormal ears; 30% of total). The recordings for the 20 affected ears in the Meniere's disease patients revealed four ears with no response, six ears with prolonged latencies (ten abnormal ears; 50% of total). Only two (5.9%) of the 34 control ears had abnormal VEMP. The rate of VEMP abnormalities in the control ears was significantly lower than the corresponding rates in the affected BPPV ears and the affected Meniere's ears that were studied (P=0.012 and P<0.001, respectively). The results suggest that testing of VEMP is a promising method for diagnosing and following patients with BPPV paroxysmal positional vertigo and Meniere's disease. Further investigations with this method in other neurotologic pathologies might also be informative.
BibTeX: @article{Akkuzu2006, author = {Akkuzu, Güzin and Akkuzu, Babur and Ozluoglu, Levent N}, title = {Vestibular evoked myogenic potentials in benign paroxysmal positional vertigo and Meniere's disease.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2006}, volume = {263}, issue = {6}, pages = {510--517}, doi = {https://doi.org/10.1007/s00405-005-0002-x}, keywords = {Adult; Aged; Aged, 80 and over; Evoked Potentials, Auditory; Female; Humans; Male; Meniere Disease, physiopathology; Middle Aged; Prospective Studies; Vertigo, physiopathology; Vestibular Function Tests, methods; Vestibule, Labyrinth, innervation, physiopathology}, pmid = {16482459} }
Hong, S.M., Park, D.C., Yeo, S.G. and Cha, C.I.	Vestibular evoked myogenic potentials in patients with benign paroxysmal positional vertigo involving each semicircular canal. [Abstract] [BibTeX]	2008	American journal of otolaryngology Vol. 29(3), pp. 184-187	article	DOI
Abstract: We have investigated vestibular evoked myogenic potentials (VEMPs) as a function of age and the involvement of each of the 3 semicircular canals in patients with benign paroxysmal positional vertigo (BPPV). We performed prospective assessment from January 2005 to September 2006. Vestibular evoked myogenic potential was measured in 53 patients with BPPV and 84 healthy subjects, with the latter subdivided by patient age. The subgroup of healthy subjects older than 60 years showed significantly more prolonged p13 and n23 latencies and lower amplitude than the other 2 subgroups. Of the 53 patients with BPPV, 13 (24.5%) showed abnormal VEMP responses on the affected side when compared with their age-related control subgroup. There was no correlation between VEMP findings and the affected semicircular canal. Patients with BPPV may show abnormal VEMP findings, irrespective of the involved semicircular canal, and age was associated with VEMP results suggesting degeneration of the maculae of the saccule.
BibTeX: @article{Hong2008b, author = {Hong, Seok Min and Park, Dong Choon and Yeo, Seung Geun and Cha, Chang Il}, title = {Vestibular evoked myogenic potentials in patients with benign paroxysmal positional vertigo involving each semicircular canal.}, journal = {American journal of otolaryngology}, year = {2008}, volume = {29}, issue = {3}, pages = {184--187}, doi = {https://doi.org/10.1016/j.amjoto.2007.07.004}, keywords = {Adult; Aged; Aged, 80 and over; Diagnosis, Differential; Electromyography, methods; Evoked Potentials, Auditory, physiology; Female; Humans; Male; Middle Aged; Muscle Contraction, physiology; Neck Muscles, innervation, physiopathology; Retrospective Studies; Semicircular Canals, innervation, physiopathology; Severity of Illness Index; Vertigo, diagnosis, physiopathology; Vestibular Function Tests, methods; Young Adult}, pmid = {18439953} }
Korres, S., Gkoritsa, E., Giannakakou-Razelou, D., Yiotakis, I., Riga, M. and Nikolpoulos, T.P.	Vestibular evoked myogenic potentials in patients with BPPV. [Abstract] [BibTeX]	2011	Medical science monitor : international medical journal of experimental and clinical research Vol. 17(1), pp. CR42-CR47	article
Abstract: The probable cause of Benign Paroxysmal Positional Vertigo (BPPV) is a degeneration of the oto lithic organs (utricle and saccule). The aim of the study is to find possible alterations in Vestibular Evoked Myogenic Potentials (VEMP) recordings in BPPV patients, because the saccule is part of the VEMP pathway. 27 BPPV patients (24 unilateral and 3 bilateral) aged 20 to 70 years and 30 healthy age matched controls. BPPV was diagnosed by the upbeating geotropic nystagmus found in the supine position with the head overextended towards one side. The subjects were investigated with pure tone audiometry, bi-thermal caloric test with electronystagmographic (ENG) recording, and VEMP recording. P1 latency and N1 latency did not present any statistical difference between control ears and affected ears of the BPPV population. The percentage of abnormal VEMP in the BPPV population was statistically higher than in the control ears (p < 0.005). No significant relationship could be shown between the occurrence of Canal Paresis and abnormal VEMP. No relationship was found between the side (right or left ear) where BPPV appeared clinically and the side where abnormal VEMP was registered. BPPV is a clinical entity associated with increased occurrence of abnormal VEMP recordings, possibly due to degeneration of the saccular macula, which is part of the neural VEMP pathway.
BibTeX: @article{Korres2011b, author = {Korres, Stavros and Gkoritsa, Eleni and Giannakakou-Razelou, Dimitra and Yiotakis, Ioannis and Riga, Maria and Nikolpoulos, Thomas P}, title = {Vestibular evoked myogenic potentials in patients with BPPV.}, journal = {Medical science monitor : international medical journal of experimental and clinical research}, year = {2011}, volume = {17}, issue = {1}, pages = {CR42--CR47}, keywords = {Adult; Aged; Audiometry, Pure-Tone; Benign Paroxysmal Positional Vertigo; Electronystagmography; Female; Humans; Male; Middle Aged; Saccule and Utricle, pathology; Vertigo, physiopathology; Vestibular Evoked Myogenic Potentials, physiology}, pmid = {21169909} }
Norré, M.E., Forrez, G. and Beckers, A.	Vestibular habituation training and posturography in benign paroxysmal positioning vertigo. [Abstract] [BibTeX]	1987	ORL; journal for oto-rhino-laryngology and its related specialties Vol. 49(1), pp. 22-25	article	DOI
Abstract: A number of cases with typical positioning vertigo (BPPV) show a unilateral vestibular hypofunction (UVH) by caloric testing. However, treatment by habituation exercises (VHT) improves vertigo independently of the presence of UVH. Moreover, VHT has no influence upon the results of caloric and rotation tests. These findings prove the independence of the pathogenetic mechanisms of the peripheral vestibular disturbances UVH and BPPV.
BibTeX: @article{Norre1987b, author = {Norré, M E and Forrez, G and Beckers, A}, title = {Vestibular habituation training and posturography in benign paroxysmal positioning vertigo.}, journal = {ORL; journal for oto-rhino-laryngology and its related specialties}, year = {1987}, volume = {49}, issue = {1}, pages = {22--25}, doi = {https://doi.org/10.1159/000275902}, keywords = {Caloric Tests; Habituation, Psychophysiologic; Humans; Labyrinth Diseases, complications, diagnosis; Posture; Vertigo, complications, therapy; Vestibule, Labyrinth, physiopathology}, pmid = {3494220} }
Rauch, S.D.	Vestibular histopathology of the human temporal bone. What can we learn? [Abstract] [BibTeX]	2001	Annals of the New York Academy of Sciences Vol. 942, pp. 25-33	article
Abstract: Histologic sections of the human temporal bone display snapshots of the entire lifetime integrated into the moment the bone enters fixative. The bulk of the literature on vestibular histopathology is anecdotal and descriptive in nature, rather than quantitative. This is because the means of describing and measuring patients' vestibular symptoms are poorly developed, and the complex geometry of the vestibular labyrinth complicates efforts to study it in serial histologic sections. Histopathologic findings in the common peripheral vestibulopathies, including Meniere's syndrome, benign paroxysmal positional vertigo, viral labyrinthitis, vestibular neuronitis, and ototoxicity, have all been described. A new quantitative method for assessment of vestibular otopathology using Nomarski optics has recently been reported. It has been successfully applied to create a normative database of age-related changes in the vestibular hair cell populations which, in turn, has been used to study the effects of aminoglycoside ototoxicity and Meniere's syndrome. These data provide the first meaningful opportunity to make structure-function correlations between vestibular function testing and temporal bone pathology in humans. Wider clinical application of vestibular function testing and postmortem temporal bone donation should be promoted by all investigators interested in accumulating the resources necessary to gain a deeper understanding of the human vestibular system in health and disease.
BibTeX: @article{Rauch2001, author = {Rauch, S D}, title = {Vestibular histopathology of the human temporal bone. What can we learn?}, journal = {Annals of the New York Academy of Sciences}, year = {2001}, volume = {942}, pages = {25--33}, keywords = {Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Temporal Bone, pathology; Vestibular Diseases, chemically induced, etiology, pathology}, pmid = {11710467} }
Ahearn, D.J. and Umapathy, D.	Vestibular impairment in older people frequently contributes to dizziness as part of a geriatric syndrome. [Abstract] [BibTeX]	2015	Clinical medicine (London, England) Vol. 15(1), pp. 25-30	article	DOI
Abstract: Research to identify whether dizziness is a geriatric syndrome has largely overlooked often treatable vestibular causes. To ascertain the degree to which vestibular and other causes of dizziness interact in older people, an eight-month retrospective case-note review was undertaken in patients aged ≥: 65 years referred with dizziness or imbalance to an audiovestibular medicine clinic. Of 41 patients aged 65-93 years old, 15 (37%) had multiple symptom triggers, 23 (56%) had recent dizziness-related falls, 24 (59%) and 10 (24%) had peripheral and central vestibular causes for dizziness respectively, whereas 6 (15%) had both. Sixteen (39%) had benign paroxysmal positional vertigo, of which 13 (32%) had an additional peripheral vestibular impairment. Twenty-six (63%) had other (general medical/cardiac) causes; of these 13 (50%) also had vestibular causes. Polypharmacy, orthostatic hypotension, psychotropic drug use and anxiety were common contributory factors. Vestibular causes of dizziness contribute to a multifactorial geriatric syndrome. All patients with dizziness and falls should have a vestibular assessment (especially peripheral) to improve quality of life and reduce falls.
BibTeX: @article{Ahearn2015, author = {Ahearn, David J and Umapathy, Dolores}, title = {Vestibular impairment in older people frequently contributes to dizziness as part of a geriatric syndrome.}, journal = {Clinical medicine (London, England)}, year = {2015}, volume = {15}, issue = {1}, pages = {25--30}, doi = {https://doi.org/10.7861/clinmedicine.15-1-25}, keywords = {Aged; Aged, 80 and over; Aging; Dizziness, epidemiology, etiology, physiopathology; Female; Geriatrics; Humans; Male; Vertigo; Vestibular Diseases, complications, epidemiology, physiopathology; dizziness; geriatric syndrome; older people; vestibular impairment}, pmid = {25650194} }
Song, J.-J., Hong, S.K., Lee, S.Y., Park, S.J., Kang, S.I., An, Y.-H., Jang, J.H., Kim, J.S. and Koo, J.-W.	Vestibular Manifestations in Subjects With Enlarged Vestibular Aqueduct. [Abstract] [BibTeX]	2018	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 39(6), pp. e461-e467	article	DOI
Abstract: To describe the results of a thorough evaluation in a large series of patients with an enlarged vestibular aqueduct (EVA), focusing on vestibular manifestations with etiological considerations. Retrospective chart review of patients with EVA. Tertiary referral center. A total of 22 EVA patients with a median age of 8 years (6 mo-35 yr) who underwent both audiovestibular and radiologic examinations. Patient demographics, radiologic findings, audiologic results, vestibular symptoms, findings of neurotologic examinations, and laboratory evaluations were collected and analyzed. Standard descriptive statistics were used to summarize patient characteristics. Subjects who had a history of vertigo attack were categorized as "vestibulopathy group," while subjects without any history of vertigo as "non-vestibulopathy group." Of the 41 ears included, 37 (90.2%) had hearing loss on initial audiometric evaluations. Among the 22 patients, 14 (63.6%) complained of dizziness. Of the 14 vertiginous patients, seven had recurrent episodes, five had a history of single attack, and two presented with postural imbalances. There were no significant differences between vestibulopathy and non-vestibulopathy groups with regard to the relationship between the development of vestibular symptoms and aqueductal size, hearing threshold, or age at first visit. Four of the 22 (18.2%) patients developed secondary benign paroxysmal positional vertigo (BPPV) and all patients complained of simultaneous decreases in hearing. Our results demonstrate that patients may develop vestibular symptoms during their clinical course, and all patients with an enlarged vestibular aqueduct should be cautioned regarding the potential development of vestibular pathology. Moreover, the non-negligible incidence of secondary BPPV mandates positional tests when evaluating EVA patients with vertigo.
BibTeX: @article{Song2018, author = {Song, Jae-Jin and Hong, Sung Kwang and Lee, Sang Yeon and Park, Sung Joon and Kang, Seong Il and An, Yong-Hwi and Jang, Jeong Hun and Kim, Ji Soo and Koo, Ja-Won}, title = {Vestibular Manifestations in Subjects With Enlarged Vestibular Aqueduct.}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2018}, volume = {39}, issue = {6}, pages = {e461--e467}, doi = {https://doi.org/10.1097/MAO.0000000000001817}, pmid = {29664869} }
Furman, J.M. and Balaban, C.D.	Vestibular migraine. [Abstract] [BibTeX]	2015	Annals of the New York Academy of Sciences Vol. 1343, pp. 90-96	article	DOI
Abstract: Vestibular migraine is now considered a distinct diagnostic entity by both the Barany Society and the International Headache Society. The recognition of vestibular migraine as a diagnostic entity required decades and was presaged by several reports indicating that a large proportion of patients with migraine headaches have vestibular symptoms and that a large proportion of patients with undiagnosed episodic vestibular symptoms have migraine headache. Despite the availability of diagnostic criteria for vestibular migraine, challenges to diagnosis include variability in terms of the character of dizziness, the presence or absence of clearly defined attacks, the duration of attacks, and the temporal association between headache or other migrainous features and vestibular symptoms. Also, symptoms of vestibular migraine often overlap with symptoms of other causes of dizziness, especially Ménière's disease and benign paroxysmal positional vertigo (BPPV). This article will discuss the demographics, epidemiology, clinical manifestations, physical examination findings, laboratory testing, comorbidities, treatment options, and pathophysiology of vestibular migraine. Future research in the field of vestibular migraine should include both clinical and basic science efforts to better understand the pathophysiology of this condition. Controlled treatment trials for vestibular migraine are desperately needed.
BibTeX: @article{Furman2015, author = {Furman, Joseph M and Balaban, Carey D}, title = {Vestibular migraine.}, journal = {Annals of the New York Academy of Sciences}, year = {2015}, volume = {1343}, pages = {90--96}, doi = {https://doi.org/10.1111/nyas.12645}, keywords = {Humans; Migraine Disorders, diagnosis; Surveys and Questionnaires; Vestibular Diseases, diagnosis; Vestibule, Labyrinth, physiopathology; dizziness; headache; imbalance; migraine; vertigo; vestibular}, pmid = {25728541} }
Strupp, M., Versino, M. and Brandt, T.	Vestibular migraine. [Abstract] [BibTeX]	2010	Handbook of clinical neurology Vol. 97, pp. 755-771	article	DOI
Abstract: Vestibular migraine is a chameleon among the episodic vertigo syndromes because considerable variation characterizes its clinical manifestation. The attacks may last from seconds to days. About one-third of patients presents with monosymptomatic attacks of vertigo or dizziness without headache or other migrainous symptoms. During attacks most patients show spontaneous or positional nystagmus and in the attack-free interval minor ocular motor and vestibular deficits. Women are significantly more often affected than men. Symptoms may begin at any time in life, with the highest prevalence in young adults and between the ages of 60 and 70. Over the last 10 years vestibular migraine has evolved into a medical entity in dizziness units. It is the most common cause of spontaneous recurrent episodic vertigo and accounts for approximately 10% of patients with vertigo and dizziness. Its broad spectrum poses a diagnostic problem of how to rule out Menière's disease or vestibular paroxysmia. Vestibular migraine should be included in the International Headache Classification of Headache Disorders (ICHD) as a subcategory of migraine. It should, however, be kept separate and distinct from basilar-type migraine and benign paroxysmal vertigo of childhood. We prefer the term "vestibular migraine" to "migrainous vertigo," because the latter may also refer to various vestibular and non-vestibular symptoms. Antimigrainous medication to treat the single attack and to prevent recurring attacks appears to be effective, but the published evidence is weak. A randomized, double-blind, placebo-controlled study is required to evaluate medical treatment of this condition.
BibTeX: @article{Strupp2010, author = {Strupp, Michael and Versino, Maurizio and Brandt, Thomas}, title = {Vestibular migraine.}, journal = {Handbook of clinical neurology}, year = {2010}, volume = {97}, pages = {755--771}, doi = {https://doi.org/10.1016/S0072-9752(10)97062-0}, keywords = {Dizziness, diagnosis; Double-Blind Method; Headache; Humans; Migraine Disorders, therapy; Vertigo}, pmid = {20816468} }
Pulec, J.L. and Patterson, M.J.	Vestibular nerve pathology in cases of intractable vertigo: an electronmicroscopic study. [Abstract] [BibTeX]	1997	The American journal of otology Vol. 18(4), pp. 475-483	article
Abstract: This study aimed to determine the absence or presence and the nature of pathology of the vestibular nerve in case of intractable vertigo. This was a prospective study. The study was performed at a private practice tertiary referral center. There-were 42 patients with intractable vertigo in the study. All patients received thorough diagnostic examinations and surgical excision of the vestibular nerves. Segments of the superior and inferior vestibular nerves were surgically removed, preserved in glutaraldehyde, examined by electronmicroscopy, and the findings were correlated with the clinical diagnosis. A variety of different types of pathologic lesions were identified, including axon and supporting cell degeneration, herpes zoster virus, other viruses, results of bacterial infection, and regrowth of nerve after surgical resection. The vestibular nerves were found to be histologically normal in lesions primarily involving the end organ such as most early Meniere's disease cases, benign paroxysmal postural vertigo (BPPV), and mild labyrinthine concussion. Vestibular nerve degeneration was seen with advanced Meniere's disease, severe labyrinthine concussion, and with vascular loops in the internal auditory canal. Herpes zoster involves Scarpa ganglion in herpes zoster oticus. Viruses were found in the nuclei of vestibular nerve cells in a patient with delayed hydrops. Regrowth of the vestibular nerve after surgical resection was confirmed in three cases.
BibTeX: @article{Pulec1997, author = {Pulec, J L and Patterson, M J}, title = {Vestibular nerve pathology in cases of intractable vertigo: an electronmicroscopic study.}, journal = {The American journal of otology}, year = {1997}, volume = {18}, issue = {4}, pages = {475--483}, keywords = {Adult; Aged; Axons, ultrastructure; Cranial Nerve Diseases, complications, diagnosis, virology; Demyelinating Diseases; Female; Humans; Male; Meniere Disease, complications; Microscopy, Electron; Middle Aged; Nerve Degeneration; Otitis Media with Effusion, complications; Prospective Studies; Vertigo, surgery; Vestibular Nerve, surgery, ultrastructure}, pmid = {9233489} }
Ryu, J.H.	Vestibular neuritis: an overview using a classical case. [Abstract] [BibTeX]	1993	Acta oto-laryngologica. Supplementum Vol. 503, pp. 25-30	article
Abstract: Although acute unilateral and/or bilateral vestibular paralysis, known as vestibular neuronitis, is the second most common cause of vertigo (the most common is benign paroxysmal positional vertigo (BPPV), it is fraught with controversies. The clinical symptoms and methods of treatment of vestibular neuronitis are well defined; however, the etiology and pathophysiology of this disorder are still sketchy. Furthermore, there are no specific diagnostic tests available, and unfortunately, there are no animal models for this disorder. The purpose of this paper is to present an overview of those controversies using a classical case of vestibular neuronitis.
BibTeX: @article{Ryu1993, author = {Ryu, J H}, title = {Vestibular neuritis: an overview using a classical case.}, journal = {Acta oto-laryngologica. Supplementum}, year = {1993}, volume = {503}, pages = {25--30}, keywords = {Adult; Caloric Tests; Diagnosis, Differential; Electronystagmography; Female; Follow-Up Studies; Humans; Meniere Disease, diagnosis, etiology, physiopathology; Neuritis, diagnosis, etiology, physiopathology; Neurologic Examination; Vestibular Nerve, physiopathology; Vestibulocochlear Nerve Diseases, diagnosis, etiology, physiopathology}, pmid = {8470495} }
Mandalà, M., Santoro, G.P., Awrey, J. and Nuti, D.	Vestibular neuritis: recurrence and incidence of secondary benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2010	Acta oto-laryngologica Vol. 130(5), pp. 565-567	article	DOI
Abstract: Recurrence of vestibular neuritis (VN) is a rare event in long-term follow-up. The incidence of benign paroxysmal positional vertigo (BPPV) in VN patients represents a quite common outcome. To our knowledge, this study represents the only long-term longitudinal study on recurrence of VN and incidence of secondary BPPV in VN. To study a large number of VN patients longitudinally to identify the recurrence rate of VN and incidence of BPPV, other peripheral vestibular disorders, sudden hearing loss or Bell's palsy. This prospective cohort study assessed a VN patient-based clinic population. All patients received a complete bedside clinical examination and caloric irrigation. Long-term (range 4-6 years, mean 4.9 years) longitudinal follow-up examination of 51 VN patients demonstrated a low recurrence rate (1/51 patients, 2.0%). With recurrence, VN affected the same ear after 6 months and caused less severe symptoms. BPPV appears to be more frequent (5/51 patients, 9.8%) in VN patients than in the general population, consistently affecting the posterior canal of the same ear. BPPV occurrence after VN predominantly affects VN patients who did not fully recover from the disease. Moreover, BPPV after VN appears to be more difficult to treat than idiopathic BPPV.
BibTeX: @article{Mandala2010, author = {Mandalà, Marco and Santoro, Giovanni Paolo and Awrey, Julianne and Nuti, Daniele}, title = {Vestibular neuritis: recurrence and incidence of secondary benign paroxysmal positional vertigo.}, journal = {Acta oto-laryngologica}, year = {2010}, volume = {130}, issue = {5}, pages = {565--567}, doi = {https://doi.org/10.3109/00016480903311278}, keywords = {Adult; Aged; Bell Palsy, epidemiology; Female; Hearing Loss, Sudden, epidemiology; Humans; Incidence; Italy, epidemiology; Male; Middle Aged; Prospective Studies; Recurrence; Vertigo, epidemiology; Vestibular Neuronitis, epidemiology}, pmid = {19883173} }
Shirabe, S.	Vestibular neuronitis in childhood. [Abstract] [BibTeX]	1988	Acta oto-laryngologica. Supplementum Vol. 458, pp. 120-122	article
Abstract: Over a 14-year period commencing in 1973, we followed 177 children less than 12 years old suffering from vertigo and/or disequilibrium. In 35 of 177 patients, the vertigo-like condition was due to peripheral causes: 10 sudden deafness, six vestibular neuronitis, three benign paroxysmal positional vertigo and three Meniere's disease. In this paper, two cases of pediatric vestibular neuronitis will be reported in detail. All six patients with vestibular neuronitis were boys, and the affected sides were equally distributed in the group. The patients recovered within two to four weeks, a prognosis which is better than that observed in adults. With regard to directional nystagmus, the gaze was bilateral in five patients and vertical in two. They showed neuro-otologic findings that suggest not only unilateral dysfunction but also bilateral disorders or partial lesions on the central vestibular system. Consequently, in the hope that the study of vertigo in childhood may provide additional clues to the pathogenesis of the disease in adults, we would like to consider two cases of pediatric cases of vestibular neuronitis.
BibTeX: @article{Shirabe1988, author = {Shirabe, S}, title = {Vestibular neuronitis in childhood.}, journal = {Acta oto-laryngologica. Supplementum}, year = {1988}, volume = {458}, pages = {120--122}, keywords = {Child; Humans; Male; Neuritis, complications; Postural Balance; Vertigo, etiology; Vestibular Nerve; Vestibulocochlear Nerve Diseases, complications}, pmid = {3245418} }
Strupp, M., Lopez-Escamez, J.A., Kim, J.-S., Straumann, D., Jen, J.C., Carey, J., Bisdorff, A. and Brandt, T.	Vestibular paroxysmia: Diagnostic criteria. [Abstract] [BibTeX]	2016	Journal of vestibular research : equilibrium & orientation Vol. 26(5-6), pp. 409-415	article	DOI
Abstract: This paper describes the diagnostic criteria for vestibular paroxysmia (VP) as defined by the Classification Committee of the Bárány Society. The diagnosis of VP is mainly based on the patient history and requires: A) at least ten attacks of spontaneous spinning or non-spinning vertigo; B) duration less than 1 minute; C) stereotyped phenomenology in a particular patient; D) response to a treatment with carbamazepine/oxcarbazepine; and F) not better accounted for by another diagnosis. Probable VP is defined as follows: A) at least five attacks of spinning or non-spinning vertigo; B) duration less than 5 minutes; C) spontaneous occurrence or provoked by certain head-movements; D) stereotyped phenomenology in a particular patient; E) not better accounted for by another diagnosis.Ephaptic discharges in the proximal part of the 8th cranial nerve, which is covered by oligodendrocytes, are the assumed mechanism. Important differential diagnoses are Menière's disease, vestibular migraine, benign paroxysmal positional vertigo, epileptic vestibular aura, paroxysmal brainstem attacks (in multiple sclerosis or after brainstem stroke), superior canal dehiscence syndrome, perilymph fistula, transient ischemic attacks and panic attacks. Current areas of uncertainty in the diagnosis of VP are: a) MRI findings of vascular compression which are not diagnostic of the disease or predictive for the affected side because they are also observed in about 30% of healthy asymptomatic subjects; and b) response to treatment with carbamazepine/oxcarbazepine supports the diagnosis but there are so far no randomized controlled trials for treatment of VP.
BibTeX: @article{Strupp2016, author = {Strupp, Michael and Lopez-Escamez, Jose A and Kim, Ji-Soo and Straumann, Dominik and Jen, Joanna C and Carey, John and Bisdorff, Alexandre and Brandt, Thomas}, title = {Vestibular paroxysmia: Diagnostic criteria.}, journal = {Journal of vestibular research : equilibrium & orientation}, year = {2016}, volume = {26}, issue = {5-6}, pages = {409--415}, doi = {https://doi.org/10.3233/VES-160589}, keywords = {Benign Paroxysmal Positional Vertigo, complications, diagnosis, therapy; Carbamazepine, analogs & derivatives, therapeutic use; Diagnosis, Differential; Female; Head Movements; Humans; Magnetic Resonance Imaging; Male; Otologic Surgical Procedures; Oxcarbazepine; Prevalence; Vertigo, diagnosis, etiology; Vestibular Diseases, complications, diagnosis, drug therapy; Vestibular Function Tests; Vestibulocochlear Nerve, physiopathology; ICVD; Vertigo; attacks; dizziness; neurovascular compression}, pmid = {28262641} }
Bronstein, A.M.	Vestibular reflexes and positional manoeuvres. [Abstract] [BibTeX]	2003	Journal of neurology, neurosurgery, and psychiatry Vol. 74(3), pp. 289-293	article
Abstract: Dizziness and vertigo are some of the more frequently encountered symptoms in neurology clinics. In turn, one of the most common causes of vertigo is benign paroxysmal positional vertigo (BPPV), accounting for a quarter of all patients with dizziness and vertigo. Reviewing the value of the positional manoeuvres available is relevant, particularly in the light of the efficient treatments available for BPPV. In this article I will deal with positional manoeuvres first, and then with how vestibulo-ocular reflexes (VOR) can be tested in the clinic. I will not discuss VOR suppression assessment.
BibTeX: @article{Bronstein2003, author = {Bronstein, A M}, title = {Vestibular reflexes and positional manoeuvres.}, journal = {Journal of neurology, neurosurgery, and psychiatry}, year = {2003}, volume = {74}, issue = {3}, pages = {289--293}, keywords = {Fixation, Ocular, physiology; Fundus Oculi; Head, physiology; Humans; Movement, physiology; Nystagmus, Pathologic, physiopathology; Ophthalmoscopy, methods; Posture, physiology; Reflex, Vestibulo-Ocular, physiology; Vertigo, diagnosis, physiopathology; Visual Acuity, physiology}, pmid = {12588910} }
Hillier, S.L. and Hollohan, V.	Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. [Abstract] [BibTeX]	2007	The Cochrane database of systematic reviews(4), pp. CD005397	article	DOI
Abstract: Unilateral peripheral vestibular dysfunction (UPVD) can occur as a result of disease, trauma or post-operatively. The dysfunction is characterized by complaints of dizziness, visual or gaze disturbances and balance impairment. Current management includes medication, physical manoeuvres and exercise regimes, the latter known collectively as vestibular rehabilitation (VR). To assess the effectiveness of vestibular rehabilitation in the adult, community dwelling population of people with symptomatic unilateral peripheral vestibular dysfunction. The search included the Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library Issue 1 2007, MEDLINE (1950 to 2007) and EMBASE (1974 to 2007). The date of the last search was March 2007. Randomised trials of adults living in the community, diagnosed with symptomatic unilateral peripheral vestibular dysfunction. Comparisons sought were: Vestibular rehabilitation versus control (placebo etc.). Vestibular rehabilitation versus other treatment (non-vestibular rehabilitation e.g. pharmacological). Vestibular rehabilitation versus another form of vestibular rehabilitation. Outcome measures that were considered included: frequency and severity of dizziness or visual disturbance; changes in balance impairment, function or quality of life; measure/s of physiological status with known functional correlation. Both authors independently extracted data and assessed trials for quality. Thirty-two trials were identified and eleven were excluded because of mixed/unclear vestibular pathology, leaving twenty-one trials in the review. Included studies addressed the effectiveness of vestibular rehabilitation against control/sham interventions, non-vestibular rehabilitation interventions or other forms of vestibular rehabilitation, by comparing the subjects in each group who had significant resolution of symptoms and/or improved function. Individual and pooled data showed a statistically significant effect in favour of the vestibular rehabilitation over control or no intervention. The exception to this was when movement based vestibular rehabilitation was compared to physical manoeuvres for benign paroxysmal positional vertigo, where the latter was shown to be superior in cure rate in the short term. There were no reported adverse effects. There is moderate to strong evidence that vestibular rehabilitation is a safe, effective management for unilateral peripheral vestibular dysfunction, based on a number of high quality randomised controlled trials. There is moderate evidence that vestibular rehabilitation provides a resolution of symptoms in the medium term. However there is evidence that for the specific diagnostic group of benign paroxysmal positional vertigo, physical (repositioning) manoeuvres are more effective in the short term than exercise based vestibular rehabilitation. There is insufficient evidence to discriminate between differing forms of vestibular rehabilitation.
BibTeX: @article{Hillier2007, author = {Hillier, S L and Hollohan, V}, title = {Vestibular rehabilitation for unilateral peripheral vestibular dysfunction.}, journal = {The Cochrane database of systematic reviews}, year = {2007}, issue = {4}, pages = {CD005397}, doi = {https://doi.org/10.1002/14651858.CD005397.pub2}, keywords = {Dizziness, rehabilitation; Exercise Movement Techniques; Humans; Postural Balance; Randomized Controlled Trials as Topic; Sensation Disorders, rehabilitation; Vertigo, rehabilitation; Vestibular Diseases, physiopathology, rehabilitation; Vestibule, Labyrinth, physiopathology}, pmid = {17943853} }
Hillier, S.L. and McDonnell, M.	Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. [Abstract] [BibTeX]	2011	The Cochrane database of systematic reviews(2), pp. CD005397	article	DOI
Abstract: This is an update of a Cochrane Review first published in The Cochrane Library in Issue 4, 2007.Unilateral peripheral vestibular dysfunction (UPVD) can occur as a result of disease, trauma or postoperatively. The dysfunction is characterised by complaints of dizziness, visual or gaze disturbances and balance impairment. Current management includes medication, physical manoeuvres and exercise regimes, the latter known collectively as vestibular rehabilitation (VR). To assess the effectiveness of vestibular rehabilitation in the adult, community-dwelling population of people with symptomatic unilateral peripheral vestibular dysfunction. We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ISRCTN and additional sources for published and unpublished trials. The most recent search was 1 July 2010, following a previous search in March 2007. Randomised trials of adults living in the community, diagnosed with symptomatic unilateral peripheral vestibular dysfunction. We sought comparisons of VR versus control (placebo etc.), other treatment (non-VR, e.g. pharmacological) or another form of VR. We considered the outcome measures of frequency and severity of dizziness or visual disturbance; changes in balance impairment, function or quality of life; and measure/s of physiological status with known functional correlation. Both authors independently extracted data and assessed trials for risk of bias. We included 27 trials, involving 1668 participants, in the review. Trials addressed the effectiveness of VR against control/sham interventions, medical interventions or other forms of VR. Individual and pooled data showed a statistically significant effect in favour of VR over control or no intervention. The exception to this was when movement-based VR was compared to physical manoeuvres for benign paroxysmal positional vertigo (BPPV), where the latter was shown to be superior in cure rate in the short term. There were no reported adverse effects. There is moderate to strong evidence that VR is a safe, effective management for unilateral peripheral vestibular dysfunction, based on a number of high quality randomised controlled trials. There is moderate evidence that VR provides a resolution of symptoms and improvement in functioning in the medium term. However, there is evidence that for the specific diagnostic group of BPPV, physical (repositioning) manoeuvres are more effective in the short term than exercise-based vestibular rehabilitation; although a combination of the two is effective for longer-term functional recovery. There is insufficient evidence to discriminate between differing forms of VR.
BibTeX: @article{Hillier2011, author = {Hillier, Susan L and McDonnell, Michelle}, title = {Vestibular rehabilitation for unilateral peripheral vestibular dysfunction.}, journal = {The Cochrane database of systematic reviews}, year = {2011}, issue = {2}, pages = {CD005397}, doi = {https://doi.org/10.1002/14651858.CD005397.pub3}, keywords = {Adult; Dizziness, rehabilitation; Exercise Movement Techniques; Humans; Postural Balance; Randomized Controlled Trials as Topic; Sensation Disorders, rehabilitation; Vertigo, rehabilitation; Vestibular Diseases, physiopathology, rehabilitation; Vestibule, Labyrinth, physiopathology}, pmid = {21328277} }
McDonnell, M.N. and Hillier, S.L.	Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. [Abstract] [BibTeX]	2015	The Cochrane database of systematic reviews Vol. 1, pp. CD005397	article	DOI
Abstract: This is an update of a Cochrane review first published in The Cochrane Library in Issue 4, 2007 and previously updated in 2011.Unilateral peripheral vestibular dysfunction (UPVD) can occur as a result of disease, trauma or postoperatively. The dysfunction is characterised by complaints of dizziness, visual or gaze disturbances and balance impairment. Current management includes medication, physical manoeuvres and exercise regimes, the latter known collectively as vestibular rehabilitation. To assess the effectiveness of vestibular rehabilitation in the adult, community-dwelling population of people with symptomatic unilateral peripheral vestibular dysfunction. We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ISRCTN and additional sources for published and unpublished trials. The most recent search was 18 January 2014. Randomised controlled trials of adults living in the community, diagnosed with symptomatic unilateral peripheral vestibular dysfunction. We sought comparisons of vestibular rehabilitation versus control (e.g. placebo), other treatment (non-vestibular rehabilitation, e.g. pharmacological) or another form of vestibular rehabilitation. Our primary outcome measure was change in the specified symptomatology (for example, proportion with dizziness resolved, frequency or severity of dizziness). Secondary outcomes were measures of function, quality of life and/or measure(s) of physiological status, where reproducibility has been confirmed and shown to be relevant or related to health status (for example, posturography), and adverse effects We used the standard methodological procedures expected by The Cochrane Collaboration. We included 39 studies involving 2441 participants with unilateral peripheral vestibular disorders in the review. Trials addressed the effectiveness of vestibular rehabilitation against control/sham interventions, medical interventions or other forms of vestibular rehabilitation. Non-blinding of outcome assessors and selective reporting were threats that may have biased the results in 25% of studies, but otherwise there was a low risk of selection or attrition bias.Individual and pooled analyses of the primary outcome, frequency of dizziness, showed a statistically significant effect in favour of vestibular rehabilitation over control or no intervention (odds ratio (OR) 2.67, 95% confidence interval (CI) 1.85 to 3.86; four studies, 565 participants). Secondary outcomes measures related to levels of activity or participation measured, for example, with the Dizziness Handicap Inventory, which also showed a strong trend towards significant differences between the groups (standardised mean difference (SMD) -0.83, 95% CI -1.02 to -0.64). The exception to this was when movement-based vestibular rehabilitation was compared to physical manoeuvres for benign paroxysmal positional vertigo (BPPV), where the latter was shown to be superior in cure rate in the short term (OR 0.19, 95% CI 0.07 to 0.49). There were no reported adverse effects. There is moderate to strong evidence that vestibular rehabilitation is a safe, effective management for unilateral peripheral vestibular dysfunction, based on a number of high-quality randomised controlled trials. There is moderate evidence that vestibular rehabilitation resolves symptoms and improves functioning in the medium term. However, there is evidence that for the specific diagnostic group of BPPV, physical (repositioning) manoeuvres are more effective in the short term than exercise-based vestibular rehabilitation; although a combination of the two is effective for longer-term functional recovery. There is insufficient evidence to discriminate between differing forms of vestibular rehabilitation.
BibTeX: @article{McDonnell2015, author = {McDonnell, Michelle N and Hillier, Susan L}, title = {Vestibular rehabilitation for unilateral peripheral vestibular dysfunction.}, journal = {The Cochrane database of systematic reviews}, year = {2015}, volume = {1}, pages = {CD005397}, doi = {https://doi.org/10.1002/14651858.CD005397.pub4}, keywords = {Adult; Dizziness, rehabilitation; Exercise Movement Techniques; Humans; Postural Balance; Randomized Controlled Trials as Topic; Sensation Disorders, rehabilitation; Vertigo, rehabilitation; Vestibular Diseases, physiopathology, rehabilitation; Vestibule, Labyrinth, physiopathology}, pmid = {25581507} }
Bressi, F., Vella, P., Casale, M., Moffa, A., Sabatino, L., Lopez, M.A., Carinci, F., Papalia, R., Salvinelli, F. and Sterzi, S.	Vestibular rehabilitation in benign paroxysmal positional vertigo: Reality or fiction? [Abstract] [BibTeX]	2017	International journal of immunopathology and pharmacology Vol. 30(2), pp. 113-122	article	DOI
Abstract: The objective of this article is to systematically review the evidence on the effectiveness of vestibular rehabilitation (VR) in patients with benign paroxysmal positional vertigo (BPPV). Relevant published studies about VR in BPPV were searched in PubMed, Google Scholar and Ovid using various keywords. We included trials that were available in the English language and did not apply publication year or publication status restrictions. Studies based on the VR in other peripheral and/or central balance disorders are excluded. Primary outcome was the effect on vertigo attacks and balance. Of 42 identified trials, only 12 trials fulfilled our inclusion criteria and were included in this review. Three of them investigated the role of VR in patients with BPPV comparing with no treatment, two of them evaluated the efficacy of VR versus medications, seven of them have highlighted the benefits of the VR alone or in combination with canalith repositioning procedure (CRP) compared to CRP alone. The studies differed in type of intervention, type of outcome and follow-up time. VR improves balance control, promoting visual stabilization with head movements, improving vestibular-visual interaction during head movement and expanding static and dynamic posture stability. CRP and VR seem to have a synergic effect in patients with BPPV, especially in elderly patients. VR does not reduce the recurrence rate, but it seems to reduce the unpleasantness. So VR can substitute CRP when spine comorbidities contraindicate CRP and can reduce the uptake of anti-vertigo drugs post CRP. Further studies are needed to confirm these encouraging results.
BibTeX: @article{Bressi2017, author = {Bressi, Federica and Vella, Paola and Casale, Manuele and Moffa, Antonio and Sabatino, Lorenzo and Lopez, Michele Antonio and Carinci, Francesco and Papalia, Rocco and Salvinelli, Fabrizio and Sterzi, Silvia}, title = {Vestibular rehabilitation in benign paroxysmal positional vertigo: Reality or fiction?}, journal = {International journal of immunopathology and pharmacology}, year = {2017}, volume = {30}, issue = {2}, pages = {113--122}, doi = {https://doi.org/10.1177/0394632017709917}, keywords = {Benign Paroxysmal Positional Vertigo, rehabilitation; Humans; Patient Positioning; Posture; Vestibule, Labyrinth; benign paroxysmal positional vertigo; systematic review; vertigo; vestibular rehabilitation}, pmid = {28485653} }
Alrwaily, M. and Whitney, S.L.	Vestibular rehabilitation of older adults with dizziness. [Abstract] [BibTeX]	2011	Otolaryngologic clinics of North America Vol. 44(2), pp. 473-96, x	article	DOI
Abstract: The role of rehabilitation for treatment of older adults with dizziness and balance disorders is reviewed. Theories related to functional recovery from peripheral and central vestibular disorders are presented. Suggestions on which older adults might benefit from vestibular rehabilitation therapy are presented. Promising innovative rehabilitation strategies and technologies that might enhance recovery of the older adult with balance dysfunction are discussed.
BibTeX: @article{Alrwaily2011, author = {Alrwaily, Muhammad and Whitney, Susan L}, title = {Vestibular rehabilitation of older adults with dizziness.}, journal = {Otolaryngologic clinics of North America}, year = {2011}, volume = {44}, issue = {2}, pages = {473--96, x}, doi = {https://doi.org/10.1016/j.otc.2011.01.015}, keywords = {Accidental Falls; Benign Paroxysmal Positional Vertigo; Craniocerebral Trauma, complications; Dizziness, etiology, physiopathology, prevention & control; Humans; Meniere Disease, rehabilitation; Neuroma, Acoustic, surgery; Parkinson Disease, complications, therapy; Physical Therapy Specialty; Reflex, Vestibulo-Ocular; Vertigo, rehabilitation; Vestibular Diseases, complications, physiopathology, rehabilitation; Vestibular Neuronitis, physiopathology}, pmid = {21474018} }
Herdman, S.J., Blatt, P.J. and Schubert, M.C.	Vestibular rehabilitation of patients with vestibular hypofunction or with benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2000	Current opinion in neurology Vol. 13(1), pp. 39-43	article
Abstract: Since the initial introduction of exercises as a treatment for patients with vestibular deficits, there have been numerous clinical reports on the benefits of treatment. Clinical reports, however, are of limited use as a basis for treatment because, without a control group, they offer only interesting descriptions of the patient populations. Fortunately, several prospective, randomized studies on the treatment of patients with vestibular hypofunction or with benign paroxysmal positional vertigo have been published recently, adding to the small number of previous publications. This review will examine the information provided by those studies. Advances in the use of outcome measures, assessment of otolith function and treatment of related balance problems are also presented.
BibTeX: @article{Herdman2000, author = {Herdman, S J and Blatt, P J and Schubert, M C}, title = {Vestibular rehabilitation of patients with vestibular hypofunction or with benign paroxysmal positional vertigo.}, journal = {Current opinion in neurology}, year = {2000}, volume = {13}, issue = {1}, pages = {39--43}, keywords = {Animals; Humans; Vertigo, drug therapy, physiopathology; Vestibular Diseases, drug therapy, physiopathology; Vestibule, Labyrinth, drug effects, physiopathology}, pmid = {10719648} }
Dunlap, P.M., Holmberg, J.M. and Whitney, S.L.	Vestibular rehabilitation: advances in peripheral and central vestibular disorders. [Abstract] [BibTeX]	2019	Current opinion in neurology Vol. 32(1), pp. 137-144	article	DOI
Abstract: Rehabilitation for persons with vertigo and balance disorders is becoming commonplace and the literature is expanding rapidly. The present review highlights recent findings of both peripheral and central vestibular disorders and provides insight into evidence related to new rehabilitative interventions. Risk factors will be reviewed to create a better understanding of patient and clinical characteristics that may effect recovery among persons with vestibular disorders. Clinical practice guidelines have recently been developed for peripheral vestibular hypofunction and updated for benign paroxysmal positional vertigo. Diagnoses such as persistent postural-perceptual dizziness (PPPD) and vestibular migraine are now defined, and there is growing literature supporting the effectiveness of vestibular rehabilitation as a treatment option. As technology advances, virtual reality and other technologies are being used more frequently to augment vestibular rehabilitation. Clinicians now have a better understanding of rehabilitation expectations and whom to refer based on evidence in order to improve functional outcomes for persons living with peripheral and central vestibular disorders. An up-to-date understanding of the evidence related to vestibular rehabilitation can assist the practicing clinician in making better clinical decisions for their patient and hopefully result in optimal functional recovery.
BibTeX: @article{Dunlap2019, author = {Dunlap, Pamela M and Holmberg, Janene M and Whitney, Susan L}, title = {Vestibular rehabilitation: advances in peripheral and central vestibular disorders.}, journal = {Current opinion in neurology}, year = {2019}, volume = {32}, issue = {1}, pages = {137--144}, doi = {https://doi.org/10.1097/WCO.0000000000000632}, pmid = {30461465} }
Cabrera Kang, C.M. and Tusa, R.J.	Vestibular rehabilitation: rationale and indications. [Abstract] [BibTeX]	2013	Seminars in neurology Vol. 33(3), pp. 276-285	article	DOI
Abstract: Treatment options of the patient with dizziness include medication, rehabilitation with physical therapy, surgery, counseling, and reassurance. Here the authors discuss vestibular rehabilitation for patients with benign paroxysmal positional vertigo (BPPV), unilateral vestibular loss or hypofunction, and bilateral vestibular loss/hypofunction. They describe the different mechanisms for recovery with vestibular rehabilitation, the exercises that are used, and which ones are best. An exhaustive literature review on clinical outcomes with the best research publications for BPPV, unilateral vestibular loss/hypofunction, and bilateral vestibular loss/hypofunction is presented. For BPPV, the authors also summarize the evidence-based review practice parameters published in Neurology by Fife et al. (2008) and review all relevant articles published since then.
BibTeX: @article{CabreraKang2013, author = {Cabrera Kang, Christian M and Tusa, Ronald J}, title = {Vestibular rehabilitation: rationale and indications.}, journal = {Seminars in neurology}, year = {2013}, volume = {33}, issue = {3}, pages = {276--285}, doi = {https://doi.org/10.1055/s-0033-1354593}, keywords = {Evidence-Based Medicine; Exercise Therapy; Guidelines as Topic; Humans; Physical Therapy Modalities; Vertigo, rehabilitation; Vestibular Diseases, physiopathology, rehabilitation, therapy}, pmid = {24057831} }
Herdman, S.J.	Vestibular rehabilitation. [Abstract] [BibTeX]	2013	Current opinion in neurology Vol. 26(1), pp. 96-101	article	DOI
Abstract: This review examines the research from 2011 through 2012 on treatment efficacy in two common vestibular disorders - vestibular hypofunction and benign paroxysmal positional vertigo (BPPV). Significant numbers of randomized controlled trials now support the use of specific exercises for the treatment of patients with unilateral peripheral vestibular hypofunction. We do not know if some treatment approaches are more effective than others. There is preliminary evidence that head movement may be the component critical to recovered function and decreased symptoms. Some patient characteristics and initial assessment results appear to predict treatment outcome but the evidence is incomplete. Treatment of posterior canal BPPV canalithiasis is well established. New evidence supports certain treatments for horizontal canal BPPV. Treatments for unilateral vestibular hypofunction and for posterior canal BPPV are effective; however, there are many as yet unanswered questions such as why some patients with vestibular hypofunction do not improve with a course of vestibular exercises. We also do not know what would be the best treatment for anterior canal BPPV or for multiple-canal involvement BPPV.
BibTeX: @article{Herdman2013, author = {Herdman, Susan J}, title = {Vestibular rehabilitation.}, journal = {Current opinion in neurology}, year = {2013}, volume = {26}, issue = {1}, pages = {96--101}, doi = {https://doi.org/10.1097/WCO.0b013e32835c5ec4}, keywords = {Benign Paroxysmal Positional Vertigo; Exercise, physiology; Exercise Therapy, methods; Head Movements, physiology; Humans; Vertigo, rehabilitation; Vestibular Diseases, rehabilitation}, pmid = {23241567} }
Kim, M.-B., Lee, H.S. and Ban, J.H.	Vestibular suppressants after canalith repositioning in benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2014	The Laryngoscope Vol. 124(10), pp. 2400-2403	article	DOI
Abstract: To investigate the characteristics of residual symptoms and to evaluate the effects of adjuvant vestibular suppressants on residual symptoms after successful canalith repositioning procedures (CRPs). Individual randomized controlled trial. One hundred fifty patients with idiopathic benign paroxysmal positional vertigo who achieved successful CRPs on initial visit participated in this study. Dizziness Handicap Inventory (DHI) questionnaires were completed before CRPs. All study populations were divided into three groups after successful CRPs on the initial visit day: the medication (V) group (treated with a vestibular suppressant [dimenhydrinate 50 mg per day]), the placebo (P) group, and the no medication (N) group. One week after successful CRPs, residual symptoms were checked and repeated DHI questionnaires were completed to compare residual symptoms. Among the 138 patients who did not show positional nystagmus at follow-up, 67 (48.5%) complained of residual symptoms. The presence of residual symptoms was more prevalent in the P and N group compared with the V group (P = .035, P = .017, respectively). The most frequent residual symptom was lightheadedness (n = 42). Moreover, in the V group, lightheadedness was significantly reduced compared with the P group (P = .029). However, in the analysis of DHI, total and subscale scores did not differ across the three groups before or after successful CRP. Vestibular suppressants significantly reduced residual symptoms compared to both placebo and no medication after CRP. However, there was no significant reduction in DHI score compared with the control group, suggesting that the residual symptoms could not be evaluated by DHI score alone.
BibTeX: @article{Kim2014a, author = {Kim, Min-Beom and Lee, Hyun S and Ban, Jae H}, title = {Vestibular suppressants after canalith repositioning in benign paroxysmal positional vertigo.}, journal = {The Laryngoscope}, year = {2014}, volume = {124}, issue = {10}, pages = {2400--2403}, doi = {https://doi.org/10.1002/lary.24741}, keywords = {Adult; Aged; Aged, 80 and over; Antiemetics, administration & dosage; Benign Paroxysmal Positional Vertigo, complications, physiopathology, surgery; Dimenhydrinate, administration & dosage; Dizziness, drug therapy, etiology, physiopathology; Dose-Response Relationship, Drug; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nystagmus, Physiologic, physiology; Otologic Surgical Procedures; Patient Positioning; Postoperative Complications; Retrospective Studies; Semicircular Canals, surgery; Surveys and Questionnaires; Treatment Outcome; Vestibular Function Tests; Vestibule, Labyrinth, drug effects, physiopathology; Young Adult; Benign paroxysmal positional vertigo; symptom; treatment; vestibular suppressant}, pmid = {24782447} }
Bisdorff, A.	Vestibular symptoms and history taking. [Abstract] [BibTeX]	2016	Handbook of clinical neurology Vol. 137, pp. 83-90	article	DOI
Abstract: History taking is an essential part in the diagnostic process of vestibular disorders. The approach to focus strongly on the quality of symptoms, like vertigo, dizziness, or unsteadiness, is not that useful as these symptoms often coexist and are all nonspecific, as each of them may arise from vestibular and nonvestibular diseases (like cardiovascular disease) and do not permit to distinguish potentially dangerous from benign causes. Instead, patients should be categorized if they have an acute, episodic, or chronic vestibular syndrome (AVS, EVS, or CVS) to narrow down the spectrum of differential diagnosis. Typical examples of disorders provoking an AVS would be vestibular neuritis or stroke of peripheral or central vestibular structures, of an EVS Menière's disease, benign paroxysmal positional vertigo, or vestibular migraine and of a CVS long-standing uni- or bilateral vestibular failure or cerebellar degeneration. The presence of triggers should be established with a main distinction between positional (change of head orientation with respect to gravity), head motion-induced (time-locked to head motion regardless of direction) and orthostatic position change as the underlying disorders are quite different. Accompanying symptoms also help to orient to the underlying cause, like aural or neurologic symptoms, but also chest pain or dyspnea.
BibTeX: @article{Bisdorff2016, author = {Bisdorff, A}, title = {Vestibular symptoms and history taking.}, journal = {Handbook of clinical neurology}, year = {2016}, volume = {137}, pages = {83--90}, doi = {https://doi.org/10.1016/B978-0-444-63437-5.00006-6}, keywords = {Humans; Medical History Taking, methods; Vestibular Diseases, diagnosis, physiopathology; Menière disease; dizziness; positional vertigo; unsteadiness; vertigo; vestibular migraine; vestibular syndrome}, pmid = {27638064} }
Fujino, A., Tokumasu, K., Okamoto, M., Naganuma, H., Hoshino, I., Arai, M. and Yoneda, S.	Vestibular training for acute unilateral vestibular disturbances: its efficacy in comparison with antivertigo drug. [Abstract] [BibTeX]	1996	Acta oto-laryngologica. Supplementum Vol. 524, pp. 21-26	article
Abstract: We carried out a clinical trial on the treatment of acute unilateral vestibular disturbances (AUVD) without typical Meniere's disease and benign paroxysmal positional vertigo. Two therapy groups were selected: vestibular training (VT) with drug therapy and drug administration alone. After the experimental period of 8 weeks, all patients were classified into two groups depending on the methods of treatment, and the clinical courses of the patients were compared statistically. It was confirmed statistically by global judgments of symptoms and signs that improvement rates were higher in the group treated by VT with medication than the improvement rate in the group with medication alone. It is concluded that VT is effective for early relief from vestibular ataxia.
BibTeX: @article{Fujino1996, author = {Fujino, A and Tokumasu, K and Okamoto, M and Naganuma, H and Hoshino, I and Arai, M and Yoneda, S}, title = {Vestibular training for acute unilateral vestibular disturbances: its efficacy in comparison with antivertigo drug.}, journal = {Acta oto-laryngologica. Supplementum}, year = {1996}, volume = {524}, pages = {21--26}, keywords = {Adult; Ataxia, complications, drug therapy; Betahistine, administration & dosage, therapeutic use; Female; Humans; Male; Middle Aged; Severity of Illness Index; Vertigo, complications, drug therapy}, pmid = {8790757} }
Fujino, A., Tokumasu, K., Yosio, S., Naganuma, H., Yoneda, S. and Nakamura, K.	Vestibular training for benign paroxysmal positional vertigo. Its efficacy in comparison with antivertigo drugs. [Abstract] [BibTeX]	1994	Archives of otolaryngology--head & neck surgery Vol. 120(5), pp. 497-504	article
Abstract: A modified controlled study on treatment effects of vestibular training (VT) for benign paroxysmal positional vertigo was performed. The VT was compared with courses of patients in three different groups: patients treated by medication, by VT, and by VT with medication during 8 weeks. It was statistically confirmed by global judgments of symptoms and signs that improvement rates of positional nystagmus and vertigo were higher in the two groups treated by VT with and without medication than the improvement rate in the medication alone group. In the groups treated by VT, the effects were not influenced by time since onset of disease or by patient age. It is therefore assumed that VT can be used as a first-choice treatment in patients with benign paroxysmal positional vertigo, even in long-term cases or older patients.
BibTeX: @article{Fujino1994, author = {Fujino, A and Tokumasu, K and Yosio, S and Naganuma, H and Yoneda, S and Nakamura, K}, title = {Vestibular training for benign paroxysmal positional vertigo. Its efficacy in comparison with antivertigo drugs.}, journal = {Archives of otolaryngology--head & neck surgery}, year = {1994}, volume = {120}, issue = {5}, pages = {497--504}, keywords = {Adult; Age Factors; Aged; Aged, 80 and over; Betahistine, therapeutic use; Combined Modality Therapy; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic, complications, therapy; Physical Therapy Modalities; Posture; Prospective Studies; Severity of Illness Index; Time Factors; Treatment Outcome; Vertigo, complications, diagnosis, therapy}, pmid = {8172700} }
Maekawa, C., Kitahara, T., Horii, A., Miyabe, J. and Kubo, T.	Vestibular type of Mondini anomalies with BPPV and Meniere's disease-like symptoms. [Abstract] [BibTeX]	2009	Auris, nasus, larynx Vol. 36(2), pp. 218-220	article	DOI
Abstract: An extremely rare case with labyrinthine anomaly with normal hearing was demonstrated. This case firstly showed transient positioning vertigo like benign paroxysmal positional vertigo (BPPV) and subsequently episodic vertigo like Meniere's disease. A 55-year-old male attended our hospital, complaining of transient but persistent positioning vertigo in 2004. The apogeotropic positioning nystagmus was observed in spine position. In 2005, he came to feel episodic vertigo continuously for more than 30min like Meniere's disease. We examined CT scan and 3D-MRI, indicating the hypoplastic lateral semicircular canal (L-SCC) fused together with enlarged vestibule on the left side. We finally diagnosed this case as Mondini anomaly on the left side. The imaging analysis is the most useful for differential diagnosis of Mondini anomalies, because symptoms in these patients are actually various due to the individual inner ear condition. The mechanism of generation of BPPV-like vertigo: the otolith in deformed utricle might be transferred into the fused space with vestibule and L-SCC, resulting in the irrigation of the hypoplastic cupula. The mechanism of generation of Meniere's disease-like vertigo: neuro-otologic findings with furosemide test implied endolymphatic hydrops on the left side. Meniere's disease-like episodic vertigo could be due to subsequently generated endolymphatic hydrops.
BibTeX: @article{Maekawa2009, author = {Maekawa, Chie and Kitahara, Tadashi and Horii, Arata and Miyabe, Junji and Kubo, Takeshi}, title = {Vestibular type of Mondini anomalies with BPPV and Meniere's disease-like symptoms.}, journal = {Auris, nasus, larynx}, year = {2009}, volume = {36}, issue = {2}, pages = {218--220}, doi = {https://doi.org/10.1016/j.anl.2008.04.010}, keywords = {Audiometry, Pure-Tone; Diagnosis, Differential; Diuretics, Osmotic, therapeutic use; Drug Therapy, Combination; Endolymphatic Hydrops, diagnosis, drug therapy; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Isosorbide, therapeutic use; Magnetic Resonance Imaging; Male; Meniere Disease, diagnosis, drug therapy; Middle Aged; Semicircular Canals, abnormalities; Tomography, X-Ray Computed; Vertigo, diagnosis, drug therapy; Vestibule, Labyrinth, abnormalities}, pmid = {18614306} }
Hong, S.M., Kim, S.K., Park, C.H. and Lee, J.H.	Vestibular-evoked myogenic potentials in migrainous vertigo. [Abstract] [BibTeX]	2011	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 144(2), pp. 284-287	article	DOI
Abstract: Patients with migraine headaches have a high prevalence of episodic vertigo, and several studies support the clinical association of migraine and vertigo. Various tests have been conducted in patients with migrainous vertigo; however, only a few studies have been reported on otolith function. The aim of the present study was to increase the understanding of migrainous vertigo pathophysiology by assessing the sacculocollic pathway in patients with migrainous vertigo using vestibular-evoked myogenic potentials testing (VEMPs). Prospective study. Tertiary referral center. VEMP testing was performed in 30 patients with migrainous vertigo and 31 healthy volunteers using 90- and 100-dB tone-pip stimuli. We compared hearing, p13 and n23 latency, VEMP asymmetry, and VEMP formation rate between the patient and control groups. No between-group difference was observed in p13 and n23 latency or VEMP asymmetry. The rate of normal VEMP wave formation in both ears was significantly lower in the patient group compared with that of the control group in response to the 90-dB stimulus. Furthermore, VEMP wave formation was absent in both ears at 100 dB in significantly more patients than in control subjects. The results indicate that patients with migrainous vertigo show abnormal VEMP findings, suggesting that migrainous vertigo might have a lesion at the sacculocollic pathway.
BibTeX: @article{Hong2011, author = {Hong, Seok Min and Kim, Seung Kyun and Park, Chan Hum and Lee, Jun Ho}, title = {Vestibular-evoked myogenic potentials in migrainous vertigo.}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2011}, volume = {144}, issue = {2}, pages = {284--287}, doi = {https://doi.org/10.1177/0194599810391755}, keywords = {Adult; Benign Paroxysmal Positional Vertigo; Female; Humans; Male; Middle Aged; Migraine Disorders, physiopathology; Prospective Studies; Vertigo, physiopathology; Vestibular Evoked Myogenic Potentials, physiology; Vestibular Function Tests, methods; Vestibular Nerve, physiopathology}, pmid = {21493432} }
Fallahnezhad, T., Adel Ghahraman, M., Farahani, S., Hoseinabadi, R. and Jalaie, S.	Vestibulo-Ocular Reflex Abnormalities in Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo: A Pilot Study. [Abstract] [BibTeX]	2017	Iranian journal of otorhinolaryngology Vol. 29(94), pp. 269-274	article
Abstract: Benign paroxysmal positional vertigo (BPPV), involving the semicircular canals, is one of the most common diseases of the inner ear. The video head impulse test (vHIT) is a new test that examines the function of the canals. This study aimed to investigate the vestibulo-ocular reflex (VOR) gain, gain asymmetry and saccades after stimulating all six canals in patients definitively diagnosed with posterior semicircular canal BPPV (PSC-BPPV). Twenty-nine unilateral PSC-BPPV patients with normal oculographic and caloric results were enrolled in this study. vHIT was performed on six canals, and VOR gain, gain asymmetry and saccades were measured. Sixteen (55.17%) patients had abnormal posterior canal VOR gains in the ipsilesional ear. VOR gains in both horizontal canals were within normal limits. Superior canal VOR gains were mostly lower than normal and were not correlated to PSC abnormalities (P>0.05). No corrective saccades could be observed. VOR gain in the direction of the posterior semicircular canal may be reduced in PSC-BPPV patients. Evaluation of PSC-VOR parameters could be beneficial, although superior canal measurements should be interpreted with caution.
BibTeX: @article{Fallahnezhad2017, author = {Fallahnezhad, Tayyebe and Adel Ghahraman, Mansoureh and Farahani, Saeid and Hoseinabadi, Reza and Jalaie, Shohreh}, title = {Vestibulo-Ocular Reflex Abnormalities in Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo: A Pilot Study.}, journal = {Iranian journal of otorhinolaryngology}, year = {2017}, volume = {29}, issue = {94}, pages = {269--274}, keywords = {Benign paroxysmal positional vertigo; Head impulse test; Semicircular canals; Vestibulo-ocular reflex}, pmid = {28955674} }
Perez-Fernandez, N., Martinez-Lopez, M. and Manrique-Huarte, R.	Vestibulo-ocular reflex in patients with superior semicircular canal benign paroxysmal positional vertigo (BPPV). [Abstract] [BibTeX]	2014	Acta oto-laryngologica Vol. 134(5), pp. 485-490	article	DOI
Abstract: The function of all the semicircular canals in patients with idiopathic benign paroxysmal positional vertigo (BPPV) in whom otoconial debris is located in the superior semicircular canal (SSC) is normal. BPPV of SSC is an infrequent entity in which otoconial debris evokes vertigo and nystagmus in the head-hanging position and during anterior flexion of the patient. We studied the vestibulo-ocular reflex (VOR) in 12 patients with this particular type of BPPV. The reflex was evoked by rapid head impulses in the plane of the three semicircular canals in the affected and the normal ear. The reflex was evaluated with a video system that analyzes the head and eye velocity: the gain (the relation between both magnitudes) was the objective measure. The mean gain of VOR was within normal limits for the six semicircular canals and there were no significant differences between the same canals on each side of patients with BPPV in whom canalolithiasis was located in the SSC. However, gain asymmetry was different for each pair of canals.
BibTeX: @article{Perez-Fernandez2014, author = {Perez-Fernandez, Nicolas and Martinez-Lopez, Marta and Manrique-Huarte, Raquel}, title = {Vestibulo-ocular reflex in patients with superior semicircular canal benign paroxysmal positional vertigo (BPPV).}, journal = {Acta oto-laryngologica}, year = {2014}, volume = {134}, issue = {5}, pages = {485--490}, doi = {https://doi.org/10.3109/00016489.2013.871750}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo, physiopathology; Female; Humans; Male; Middle Aged; Reflex, Vestibulo-Ocular; Semicircular Canals, physiopathology}, pmid = {24702228} }
Black, F.O. and Nashner, L.M.	Vestibulo-spinal control differs in patients with reduced versus distorted vestibular function. [Abstract] [BibTeX]	1984	Acta oto-laryngologica. Supplementum Vol. 406, pp. 110-114	article
Abstract: Abnormal vestibular function disrupts a subject's reference to gravity (earth) vertical, and prevents resolution of conflicting or inaccurate visual and somatosensory spatial references. However, errors which patients make when attempting to resolve conflicting visual and somatosensory orientation inputs during upright stance differed markedly in patients with (1) symmetric or asymmetric reduced vestibular function, (2) benign paroxysmal positional nystagmus and vertigo, and (3) a combination of distorted and reduced function. Objective characterization of spatial orientation systems and compensatory strategies under altered sensory conditions is an essential first step toward identifying optimal treatment methods for each of these three types of vestibular deficient patients.
BibTeX: @article{Black1984a, author = {Black, F O and Nashner, L M}, title = {Vestibulo-spinal control differs in patients with reduced versus distorted vestibular function.}, journal = {Acta oto-laryngologica. Supplementum}, year = {1984}, volume = {406}, pages = {110--114}, keywords = {Humans; Labyrinth Diseases, physiopathology; Nystagmus, Pathologic, physiopathology; Posture; Spinal Cord, physiology; Vertigo, physiopathology; Vestibular Function Tests; Vestibular Nerve, physiology; Vestibule, Labyrinth, physiopathology}, pmid = {6332451} }
Hain, T.C., Helminski, J.O., Reis, I.L. and Uddin, M.K.	Vibration does not improve results of the canalith repositioning procedure. [Abstract] [BibTeX]	2000	Archives of otolaryngology--head & neck surgery Vol. 126(5), pp. 617-622	article
Abstract: To determine whether, in patients with benign paroxysmal positional vertigo (BPPV), the canalith repositioning procedure performed with vibration applied over the mastoid bone of the affected ear is more effective in resolving the symptoms and preventing recurrence of BPPV than the procedure performed without vibration. Retrospective case review. Tertiary referral center. Ninety-four patients diagnosed as having BPPV involving the posterior semicircular canal. Patients were assigned to one of 2 treatment groups: the canalith repositioning procedure with vibration (n=44) and with no vibration (n=50). Effectiveness of treatment was determined through clinical reevaluation or reported through a telephone interview 1 week after treatment. Intensity of symptoms was quantified on a scale of 1 to 3 (mild, moderate, or severe); effectiveness of treatment was categorized on a scale of 1 to 4 (cure, much better, better, or no change). Rate of recurrence was determined through later clinical reevaluation or a telephone interview. At 1 week, 57 of the 94 patients were cured and 16 were much better, providing a 78% overall success rate. There was no significant difference in effectiveness of the treatment or the frequency of reoccurrence of BPPV between the vibration and no-vibration groups as determined from the Kaplan-Meier product-limit method and log-rank test. Rate of recurrence was 47% at a maximum follow-up of 5.25 years. Our results suggest that, while the canalith repositioning procedure is effective in the treatment of BPPV, vibration applied during the maneuver does not significantly affect short-term or long-term outcomes.
BibTeX: @article{Hain2000, author = {Hain, T C and Helminski, J O and Reis, I L and Uddin, M K}, title = {Vibration does not improve results of the canalith repositioning procedure.}, journal = {Archives of otolaryngology--head & neck surgery}, year = {2000}, volume = {126}, issue = {5}, pages = {617--622}, keywords = {Adult; Aged; Combined Modality Therapy; Female; Follow-Up Studies; Head Movements, physiology; Humans; Male; Meniere Disease, physiopathology, therapy; Middle Aged; Otolithic Membrane, physiopathology; Recurrence; Retrospective Studies; Semicircular Canals, physiopathology; Treatment Failure; Vibration, therapeutic use}, pmid = {10807329} }
Macias, J.D., Ellensohn, A., Massingale, S. and Gerkin, R.	Vibration with the canalith repositioning maneuver: a prospective randomized study to determine efficacy. [Abstract] [BibTeX]	2004	The Laryngoscope Vol. 114(6), pp. 1011-1014	article	DOI
Abstract: The objective was to determine whether the inclusion of vibration and additional treatment cycles has an effect on short- and long-term success rates in the treatment of benign paroxysmal positional vertigo with the canalith repositioning maneuver. Prospective randomized study of patients treated at a tertiary vestibular rehabilitation center. Variables identified for statistical analysis included patient age, gender, vibration used, and canalith repositioning cycles. Analysis using Student t test, chi2 test, Kaplan-Meier curves with log rank test, and Cox proportional hazards regression was performed. One hundred two patients with benign paroxysmal positional vertigo treated over a 1-year period (August 2001-August 2002) were randomly assigned to receive the canalith repositioning maneuver with or without vibration. Average duration of follow-up was 9.44 months. The single treatment success rate was 93.1%. To relieve symptoms, 29.4% of patients required more than one canalith repositioning cycle. The relapse rate was 30.5%. Thirty-nine patients were assigned to the canalith repositioning group with vibration, and 63 to the canalith repositioning group without vibration. There was no statistical difference in age, gender, initial success rates, or relapse rates between the canalith repositioning groups with and without vibration. On average, patients required 1.38 canalith repositioning cycles for successful treatment. Vibration did not affect the number of canalith repositioning cycles required to convert the Dix-Hallpike test result to normal. The need for additional canalith repositioning cycles had no statistical effect on initial treatment success or relapse rates. Vibration provided no additional benefit in initial treatment success or in reducing long-term relapse rates when included in the canalith repositioning maneuver. Many patients with benign paroxysmal positional vertigo require more than one canalith repositioning cycle at the time of initial treatment to relieve symptoms, but this does not indicate a higher likelihood for recurrence. No variable predicted a higher rate of recurrence.
BibTeX: @article{Macias2004, author = {Macias, John D and Ellensohn, Andrea and Massingale, Shelly and Gerkin, Richard}, title = {Vibration with the canalith repositioning maneuver: a prospective randomized study to determine efficacy.}, journal = {The Laryngoscope}, year = {2004}, volume = {114}, issue = {6}, pages = {1011--1014}, doi = {https://doi.org/10.1097/00005537-200406000-00010}, keywords = {Chi-Square Distribution; Female; Humans; Male; Middle Aged; Posture; Proportional Hazards Models; Prospective Studies; Treatment Outcome; Vertigo, therapy; Vibration, therapeutic use}, pmid = {15179204} }
Hamann, K.F. and Schuster, E.M.	Vibration-induced nystagmus - A sign of unilateral vestibular deficit. [Abstract] [BibTeX]	1999	ORL; journal for oto-rhino-laryngology and its related specialties Vol. 61(2), pp. 74-79	article	DOI
Abstract: Vibrations of 60 Hz and 100 Hz were applied on the mastoid of healthy subjects, patients with unilateral peripheral vestibular lesions, with central lesions of different localizations, and patients with benign paroxysmal positioning vertigo (BPPV). In patients with unilateral peripheral deficit a horizontal nystagmus with a small torsional component beating generally to the not affected side could be observed. This nystagmus did not show adaptation during 40 s. The occurrence was more frequent using 60-Hz stimulations. This vibration-induced nystagmus did never occur in healthy subjects, seldom in patients with central vertigo, and only exceptionally in patients with BPPV. It is concluded that the finding of a vibration-induced nystagmus reflects a side difference of peripheral vestibular excitability.
BibTeX: @article{Hamann1999, author = {Hamann, K F and Schuster, E M}, title = {Vibration-induced nystagmus - A sign of unilateral vestibular deficit.}, journal = {ORL; journal for oto-rhino-laryngology and its related specialties}, year = {1999}, volume = {61}, issue = {2}, pages = {74--79}, doi = {https://doi.org/10.1159/000027645}, keywords = {Humans; Mastoid; Nystagmus, Pathologic, physiopathology; Vertigo, diagnosis, physiopathology; Vestibular Diseases, diagnosis, physiopathology; Vibration}, pmid = {10095196} }
Toupet, M., Ferrary, E. and Grayeli, A.B.	Visual analog scale to assess vertigo and dizziness after repositioning maneuvers for benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2011	Journal of vestibular research : equilibrium & orientation Vol. 21(4), pp. 235-241	article	DOI
Abstract: The aim of this study was to evaluate the value of Visual Analog Scale (VAS) in evaluating vertigo and dizziness in patients with benign paroxysmal positional vertigo (BPPV). 226 adult patients suffering from a BPPV and undergoing repositioning maneuvers were included in this prospective study. Vertigo (V) and dizziness (D) were separately evaluated from day 0 to 5 by VAS. V and D scores decreased both exponentially but with different constants. D scores were not correlated to V suggesting the independency of the ratings. D was related to the dizziness intensity level expressed at interrogation. Both D and V scores were related to patients' global satisfaction. VAS allows differentiating vertigo from dizziness and provides coherent results with other clinical indicators.
BibTeX: @article{Toupet2011, author = {Toupet, Michet and Ferrary, Evelyne and Grayeli, Alexis Bozorg}, title = {Visual analog scale to assess vertigo and dizziness after repositioning maneuvers for benign paroxysmal positional vertigo.}, journal = {Journal of vestibular research : equilibrium & orientation}, year = {2011}, volume = {21}, issue = {4}, pages = {235--241}, doi = {https://doi.org/10.3233/VES-2011-0420}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Dizziness, diagnosis; Female; Humans; Male; Middle Aged; Neurologic Examination, methods; Patient Positioning; Patient Satisfaction; Prospective Studies; Vertigo, diagnosis, therapy}, pmid = {21846956} }
Agarwal, K., Bronstein, A.M., Faldon, M.E., Mandalà, M., Murray, K. and Silove, Y.	Visual dependence and BPPV. [Abstract] [BibTeX]	2012	Journal of neurology Vol. 259(6), pp. 1117-1124	article	DOI
Abstract: The increased visual dependence noted in some vestibular patients may be secondary to their vertigo. We examine whether a single, brief vertigo attack, such as in benign paroxysmal positional vertigo (BPPV), modifies visual dependency. Visual dependency was measured before and after the Hallpike manoeuvre with (a) the Rod and Frame and the Rod and Disc techniques whilst seated and (b) the postural sway induced by visual roll-motion stimulation. Three subject groups were studied: 20 patients with BPPV (history and positive Hallpike manoeuvre; PosH group), 20 control patients (history of BPPV but negative Hallpike manoeuvre; NegH group) and 20 normal controls. Our findings show that while both patient groups showed enhanced visual dependency, the PosH and the normal control group decreased visual dependency on repetition of the visual tasks after the Hallpike manoeuvre. NegH patients differed from PosH patients in that their high visual dependency did not diminish on repetition of the visual stimuli; they scored higher on the situational characteristic questionnaire ('visual vertigo' symptoms) and showed higher incidence of migraine. We conclude that long term vestibular symptoms increase visual dependence but a single BPPV attack does not increase it further. Repetitive visual motion stimulation induces adaptation in visual dependence in peripheral vestibular disorders such as BPPV. A positional form of vestibular migraine may underlie the symptoms of some patients with a history of BPPV but negative Hallpike manoeuvre. The finding that they have non adaptable increased visual dependency may explain visuo-vestibular symptoms in this group and, perhaps more widely, in patients with migraine.
BibTeX: @article{Agarwal2012, author = {Agarwal, K and Bronstein, A M and Faldon, M E and Mandalà, M and Murray, K and Silove, Y}, title = {Visual dependence and BPPV.}, journal = {Journal of neurology}, year = {2012}, volume = {259}, issue = {6}, pages = {1117--1124}, doi = {https://doi.org/10.1007/s00415-011-6311-7}, keywords = {Adult; Aged; Benign Paroxysmal Positional Vertigo; Female; Humans; Male; Middle Aged; Photic Stimulation, methods; Postural Balance, physiology; Random Allocation; Vertigo, diagnosis, physiopathology; Visual Perception, physiology}, pmid = {22113702} }
Nair, M.A., Mulavara, A.P., Bloomberg, J.J., Sangi-Haghpeykar, H. and Cohen, H.S.	Visual dependence and spatial orientation in benign paroxysmal positional vertigo. [Abstract] [BibTeX]	2018	Journal of vestibular research : equilibrium & orientation Vol. 27(5-6), pp. 279-286	article	DOI
Abstract: People with benign paroxysmal positional vertigo (BPPV) probably have otoconial particles displaced from the utricle into the posterior semicircular canal. This unilateral change in the inertial load distributions of the labyrinth may result in visual dependence and may affect balance control. The goal of this study was to explore the interaction between visual dependence and balance control. We compared 23 healthy controls to 17 people with unilateral BPPV on the Clinical Test of Sensory Interaction and Balance on compliant foam with feet together, the Rod-and-Frame Test and a Mental Rotation Test. In controls, but not BPPV subjects, subjects with poor balance scores had significantly greater visual dependence, indicating that reliance on visual cues can affect balance control. BPPV and control subjects did not differ on the mental rotation task overall but BPPV reaction time was greater at greater orietantions, suggesting that this cognitive function was affected by BPPV. The side of impairment was strongly related to the side of perceived bias in the Earth vertical determined by BPPV subjects, indicating the relationship between the effect of asymmetric otolith unloading with simultaneous canal loading on spatial orientation perception.
BibTeX: @article{Nair2018, author = {Nair, Maitreyi A and Mulavara, Ajitkumar P and Bloomberg, Jacob J and Sangi-Haghpeykar, Haleh and Cohen, Helen S}, title = {Visual dependence and spatial orientation in benign paroxysmal positional vertigo.}, journal = {Journal of vestibular research : equilibrium & orientation}, year = {2018}, volume = {27}, issue = {5-6}, pages = {279--286}, doi = {https://doi.org/10.3233/VES-170623}, keywords = {Benign Paroxysmal Positional Vertigo, physiopathology; Female; Humans; Male; Middle Aged; Orientation, Spatial, physiology; Postural Balance, physiology; Semicircular Canals, physiopathology; Space Perception; Vestibular Function Tests; Vision, Ocular, physiology; BPPV; CTSIB; Romberg; balance testing; mental rotation; rod and frame test; screening; vestibular testing; visual dependence}, pmid = {29400684} }
Kishi, M., Sakakibara, R., Yoshida, T., Yamamoto, M., Suzuki, M., Kataoka, M., Tsuyusaki, Y., Tateno, A. and Tateno, F.	Visual Suppression is Impaired in Spinocerebellar Ataxia Type 6 but Preserved in Benign Paroxysmal Positional Vertigo. [Abstract] [BibTeX]	2012	Diagnostics (Basel, Switzerland) Vol. 2(4), pp. 52-56	article	DOI
Abstract: Positional vertigo is a common neurologic emergency and mostly the etiology is peripheral. However, central diseases may mimic peripheral positional vertigo at their initial presentation. We here describe the results of a visual suppression test in six patients with spinocerebellar ataxia type 6 (SCA6), a central positional vertigo, and nine patients with benign paroxysmal positional vertigo (BPPV), the major peripheral positional vertigo. As a result, the visual suppression value of both diseases differed significantly; e.g., 22.5% in SCA6 and 64.3% in BPPV (p < 0.001). There was a positive correlation between the visual suppression value and disease duration, cerebellar atrophy, and CAG repeat length of SCA6 but they were not statistically significant. In conclusion, the present study showed for the first time that visual suppression is impaired in SCA6, a central positional vertigo, but preserved in BPPV, the major peripheral positional vertigo, by directly comparing both groups. The abnormality in the SCA6 group presumably reflects dysfunction in the central visual fixation pathway at the cerebellar flocculus and nodulus. This simple test might aid differential diagnosis of peripheral and central positional vertigo at the earlier stage of disease.
BibTeX: @article{Kishi2012, author = {Kishi, Masahiko and Sakakibara, Ryuji and Yoshida, Tomoe and Yamamoto, Masahiko and Suzuki, Mitsuya and Kataoka, Manabu and Tsuyusaki, Yohei and Tateno, Akihiko and Tateno, Fuyuki}, title = {Visual Suppression is Impaired in Spinocerebellar Ataxia Type 6 but Preserved in Benign Paroxysmal Positional Vertigo.}, journal = {Diagnostics (Basel, Switzerland)}, year = {2012}, volume = {2}, issue = {4}, pages = {52--56}, doi = {https://doi.org/10.3390/diagnostics2040052}, keywords = {benign paroxysmal positional vertigo; flocculus; nodulus; spinocerebellar ataxia 6; visual suppression test}, pmid = {26859398} }
Konijnenberg, J.J. and Kingma, H.	Visuo-vestibular interaction measurements: an alternative for rotation tests with better discriminatory power? [Abstract] [BibTeX]	1995	Acta oto-laryngologica. Supplementum Vol. 520 Pt 1, pp. 194-198	article
Abstract: A vestibular function test is introduced for evaluating visuo-vestibular interaction (VVI), in which a visual target may move asynchronously with a pseudo-randomly oscillating rotatory chair. The results show better discrimination of patients (Meniere's disease, benign paroxysmal positioning vertigo (BPPV), uncompensated peripheral vestibular lesions. whiplash) than do standard tests (torsion swing, velocity step, calorization, smooth pursuit, optokinetics, saccade analysis). For the phase shift, the better performance is shown to stem from improved reproducibility. Signal analysis is done fully automatically, thereby precluding experimenter's bias.
BibTeX: @article{Konijnenberg1995, author = {Konijnenberg, J J and Kingma, H}, title = {Visuo-vestibular interaction measurements: an alternative for rotation tests with better discriminatory power?}, journal = {Acta oto-laryngologica. Supplementum}, year = {1995}, volume = {520 Pt 1}, pages = {194--198}, keywords = {Diagnosis, Differential; Equipment Design; Humans; Meniere Disease, diagnosis, physiopathology; Orientation, physiology; Postural Balance, physiology; Reflex, Vestibulo-Ocular, physiology; Reproducibility of Results; Saccades, physiology; Signal Processing, Computer-Assisted; Vestibular Diseases, diagnosis, physiopathology; Vestibular Function Tests, instrumentation; Vestibular Nerve, physiopathology; Whiplash Injuries, diagnosis, physiopathology}, pmid = {8749117} }
Büki, B., Ecker, M., Jünger, H. and Lundberg, Y.W.	Vitamin D deficiency and benign paroxysmal positioning vertigo. [Abstract] [BibTeX]	2013	Medical hypotheses Vol. 80(2), pp. 201-204	article	DOI
Abstract: Benign paroxysmal positional vertigo is a common cause of disabling vertigo with a high rate of recurrence. Although connections between vitamin D deficiency and osteoporosis, as well as between osteoporosis and benign paroxysmal positional vertigo have been suggested respectively in the literature, we are not aware of any publication linking vitamin D and benign paroxysmal positional vertigo. As a hypothesis, we suggest that there is a relation between insufficient vitamin D level and benign paroxysmal positional vertigo. In order to test this hypothesis, in a small retrospective pilot study, 25-hydroxyvitamin D levels in serum of patients with benign paroxysmal positional vertigo and frequency of recurrence after correction of serum level were assessed retrospectively. Patients with idiopathic positional vertigo had a low average serum level of 25-hydroxyvitamin D (23ng/mL) similar to that of the general Austrian population, which has a high prevalence of hypovitaminosis D. In 4 cases with chronically recurrent severe vertigo episodes, average levels of serum 25-hydroxyvitamin D were even significantly lower than in the other vertigo patients, who had their first episode. Vertigo attacks did not recur after supplementation with vitamin D. We raise the possibility that patients with benign paroxysmal positional vertigo who have low vitamin D levels may benefit from supplementation and suggest further epidemiological investigations to determine the effect of correcting vitamin D deficiency on the recurrence of vertigo. Given the many known benefits of vitamin D, the authors recommend the measurement of vitamin D in patients with benign paroxysmal positional vertigo and supplementation if necessary.
BibTeX: @article{Bueki2013, author = {Büki, Béla and Ecker, Michael and Jünger, Heinz and Lundberg, Yunxia Wang}, title = {Vitamin D deficiency and benign paroxysmal positioning vertigo.}, journal = {Medical hypotheses}, year = {2013}, volume = {80}, issue = {2}, pages = {201--204}, doi = {https://doi.org/10.1016/j.mehy.2012.11.029}, keywords = {Austria, epidemiology; Benign Paroxysmal Positional Vertigo; Dietary Supplements; Humans; Pilot Projects; Prevalence; Recurrence; Retrospective Studies; Vertigo, epidemiology, etiology; Vitamin D, analogs & derivatives, blood; Vitamin D Deficiency, complications, epidemiology}, pmid = {23245911} }
Taneja, M.K. and Taneja, V.	Vitamin d deficiency in e.N.T. Patients. [Abstract] [BibTeX]	2013	Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India Vol. 65(1), pp. 57-60	article	DOI
Abstract: A prospective study to observe the prevalence of deficiency of vitamin D in out patients of otolaryngology clinic at Indian Institute of ear diseases, Muzaffarnagar. The patients attending outpatient of otolaryngology clinic with various complaints and not responding to conventional treatment were advised for assessment of vitamin D [25 (OH)D] level in blood. The age, sex, occupation, colour of skin, chief complaints, obesity, provisional diagnosis, and incidence of sun exposure was noted in all cases. A total of 86 patients were examined, maximum patients were in the age group of 7-15 years. The chief complaints in majority of the patients were sore throat with recurrent upper respiratory tract infection. Only in three patient's vitamin D level was found to be with in normal limits. In rest 83 (96.51 %) it was either deficient 57 (66.28 %) or insufficient 21 (24.42 %). The incidence of vitamin D deficiency is extremely common in Ear Nose Throat disease (E.N.T.) patients. The results of vitamin supplementation were promising in cases of benign paroxysmal positional vertigo with cervical spondylosis and URTI with asthma, empirical supplementation of vitamin D in all E.N.T. patients not responding to conventional treatment is worth trying. At place of sun screen, use of pomegranates and blueberries may be encouraged to prevent sunburn and eliminate Vitamin D deficiency.
BibTeX: @article{Taneja2013, author = {Taneja, M K and Taneja, Vivek}, title = {Vitamin d deficiency in e.N.T. Patients.}, journal = {Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India}, year = {2013}, volume = {65}, issue = {1}, pages = {57--60}, doi = {https://doi.org/10.1007/s12070-012-0603-9}, keywords = {B.P.P.V.; Bronchial asthma; Cervical spondyliosis; E.N.T; URTI; Vitamin D deficiency}, pmid = {24381922} }
Cohen, H.S. and Sangi-Haghpeykar, H.	Walking speed and vestibular disorders in a path integration task. [Abstract] [BibTeX]	2011	Gait & posture Vol. 33(2), pp. 211-213	article	DOI
Abstract: The goal of this study was to determine if parameters of gait are related to the path integration deficits in some people with vestibular disorders. We tested normals, and two groups of vestibularly impaired people, with unilateral benign paroxysmal positional vertigo and with unilateral weakness. Each group had 20 subjects. They walked straight ahead for 7.62 m, with eyes open or closed, to the beat of a metronome at 60 beats/min, 120 beats/min and 176 beats/min. When adjusted for age and sex, normals veered significantly less and walked significantly further before veering than the unilateral weakness group; all groups veered significantly less at 120 beats/min than the slower or faster cadences. Older patients walked slightly but significantly slower than younger patients at the faster speeds. Step length did not differ among diagnostic groups. These data confirm the involvement of vestibular function in path integration, suggest a differentiation by type of vestibular impairment, and suggest some differences by cadence.
BibTeX: @article{Cohen2011, author = {Cohen, Helen S and Sangi-Haghpeykar, Haleh}, title = {Walking speed and vestibular disorders in a path integration task.}, journal = {Gait & posture}, year = {2011}, volume = {33}, issue = {2}, pages = {211--213}, doi = {https://doi.org/10.1016/j.gaitpost.2010.11.007}, keywords = {Female; Humans; Male; Middle Aged; Orientation, physiology; Space Perception, physiology; Vertigo, physiopathology; Vestibular Diseases, physiopathology; Walking, physiology}, pmid = {21131202} }
Rahko, T. and Kotti, V.	Walk-rotate-walk test identifies patients responding to Lempert's maneuver, with benign paroxysmal positional vertigo of the horizontal canal. [Abstract] [BibTeX]	2001	European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Vol. 258(3), pp. 112-115	article
Abstract: Two hundred and fifteen patients were diagnosed and treated for benign paroxysmal positional vertigo of the horizontal canal (BPPV-HC). All patients were tested with conventional positional nystagmus tests lying supine and rotating head for geotropic nystagmus, registered with Frenzels glasses, and in 109 cases with ENG. The walk-rotate-walk (WRW) test, developed by one of us (T.R.) and described in the text, was applied to all patients. The immediate good treatment results with Lempert's maneuver verify the correct diagnosis of BPPV-HC. The WRW test is a more sensitive test for BPPV-HC than earlier positional tests. The unhabituated acute phase of vestibular neuritis shows positive test results and must be eliminated with caloric tests. The WRW test identifies as a dynamic test patients with symptoms of even lesser magnitude, where the compensatory capacity of the equilibrium system suppresses the diagnostic findings with earlier positional horizontal canal tests.
BibTeX: @article{Rahko2001, author = {Rahko, T and Kotti, V}, title = {Walk-rotate-walk test identifies patients responding to Lempert's maneuver, with benign paroxysmal positional vertigo of the horizontal canal.}, journal = {European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery}, year = {2001}, volume = {258}, issue = {3}, pages = {112--115}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Child; Diagnosis, Differential; Electronystagmography; Female; Humans; Locomotion, physiology; Male; Middle Aged; Orientation, physiology; Otolithic Membrane, physiopathology; Postural Balance, physiology; Semicircular Canals, physiopathology; Vertigo, diagnosis, physiopathology, therapy; Vestibular Function Tests; Vestibular Neuronitis, diagnosis, physiopathology, therapy}, pmid = {11374250} }
Karlberg, M., Hall, K., Quickert, N., Hinson, J. and Halmagyi, G.M.	What inner ear diseases cause benign paroxysmal positional vertigo? [Abstract] [BibTeX]	2000	Acta oto-laryngologica Vol. 120(3), pp. 380-385	article
Abstract: Benign paroxysmal positional vertigo (BPPV) originating from the posterior semicircular canal (pSCC) is a common vestibular disorder that is easy to diagnose and usually easy to treat. The majority of patients with BPPV have no known inner ear disease; they have "primary" or "idiopathic" BPPV. However, a minority does have objective evidence of an inner ear disease on the same side as the BPPV and this group has "secondary" or "symptomatic" BPPV. Previous publications differ on the prevalence of secondary BPPV and about the types of inner ear diseases capable of causing it. In order to determine what proportion of patients have secondary as opposed to primary BPPV and which inner ear diseases are capable of causing secondary BPPV, we searched our database for the 10-year period from 1988 to 1997 and found a total of 2847 patients with BPPV. Of these, 81 (3%) had definite pSCC-BPPV secondary to an ipsilateral inner ear disease. Sixteen had Menière's disease, 24 had an acute unilateral peripheral vestibulopathy, 12 had a chronic unilateral peripheral vestibulopathy, 21 had chronic bilateral peripheral vestibulopathy and 8 had unilateral sensorineural hearing loss. It seems that any inner ear disease that detaches otoconia and yet does not totally destroy pSCC function can cause BPPV and that a case can be made for audiometry and caloric testing in all patients with BPPV.
BibTeX: @article{Karlberg2000a, author = {Karlberg, M and Hall, K and Quickert, N and Hinson, J and Halmagyi, G M}, title = {What inner ear diseases cause benign paroxysmal positional vertigo?}, journal = {Acta oto-laryngologica}, year = {2000}, volume = {120}, issue = {3}, pages = {380--385}, keywords = {Acute Disease; Adult; Aged; Aged, 80 and over; Audiometry; Caloric Tests; Chronic Disease; Ear Diseases, complications, diagnosis; Ear, Inner, physiopathology; Female; Hearing Loss, Sensorineural, diagnosis, physiopathology; Humans; Middle Aged; Posture; Semicircular Canals, physiopathology; Vertigo, etiology, physiopathology}, pmid = {10894413} }
Cakir, B.O., Ercan, I., Cakir, Z.A., Civelek, S., Sayin, I. and Turgut, S.	What is the true incidence of horizontal semicircular canal benign paroxysmal positional vertigo? [Abstract] [BibTeX]	2006	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Vol. 134(3), pp. 451-454	article	DOI
Abstract: To assess the correct incidence of horizontal semicircular canal (H-SCC) benign paroxysmal positional vertigo (BPPV). Retrospective assessment of patients with BPPV. All patients with BPPV were included and the rates of involvement of posterior, horizontal, and anterior SCCs were determined. One hundred sixty-nine patients with the diagnosis of BPPV were evaluated. One hundred forty-four patients (85.2%) were found to have posterior SCC (P-SCC) involvement, and there were 20 patients (11.8%) with horizontal SCC (H-SCC) and 2 patients (1.2%) with anterior SCC (A-SCC) involvement. Three patients (1.8%) had simultaneous H-SCC and P-SCC BPPV ipsilaterally. Geotropic nystagmus was seen in 17 out of 23 patients (73.9%) in roll test, and ageotropic nystagmus was seen in the remaining 6 patients (26.1%). H-SCC constitutes 13.6% of all BPPV cases. H-SCC BPPV with geotropic nystagmus is more common. H-SCC BPPV can coexist with ipsilateral P-SCC BPPV. However, in some cases of H-SCC BPPV, Dix-Hallpike maneuver can cause vertigo and horizontal nystagmus. This may be confused with P-SCC BPPV. Therefore, the roll test must be performed in all cases in addition to Dix-Hallpike maneuver and both ears must be evaluated with respect to all SCCs for BPPV. C-4.
BibTeX: @article{Cakir2006b, author = {Cakir, Burak Omür and Ercan, Ibrahim and Cakir, Zeynep Alkan and Civelek, Senol and Sayin, Ibrahim and Turgut, Suat}, title = {What is the true incidence of horizontal semicircular canal benign paroxysmal positional vertigo?}, journal = {Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year = {2006}, volume = {134}, issue = {3}, pages = {451--454}, doi = {https://doi.org/10.1016/j.otohns.2005.07.045}, keywords = {Adult; Aged; Aged, 80 and over; Audiometry, Pure-Tone; Caloric Tests; Electronystagmography; Eye Movements, physiology; Female; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Nystagmus, Physiologic, physiology; Posture; Retrospective Studies; Rotation; Semicircular Canals, physiopathology; Time Factors; Vertigo, classification, physiopathology}, pmid = {16500443} }
Staab, J.P. and Ruckenstein, M.J.	Which comes first? Psychogenic dizziness versus otogenic anxiety. [Abstract] [BibTeX]	2003	The Laryngoscope Vol. 113(10), pp. 1714-1718	article
Abstract: OBJECTIVE To investigate the hypotheses that physical neurotologic conditions may trigger anxiety disorders (otogenic pattern of illness), that psychiatric disorders may produce dizziness (psychogenic pattern), and that risk factors for these syndromes may be identified. STUDY DESIGN Retrospective review of all patients (N = 132) treated at a tertiary care balance center from 1998 to 2002 for psychogenic dizziness with or without physical neurotologic illnesses. METHODS All patients underwent comprehensive neurotologic and psychiatric evaluations with attention to the longitudinal course of symptoms and risk factors for psychopathology. Patients were grouped according to the condition first causing dizziness. Risk factors were compared across groups. RESULTS Three equally prevalent patterns of illness were found: anxiety disorders as the sole cause of dizziness (33% of cases), neurotologic conditions exacerbating preexisting psychiatric disorders (34%), and neurotologic conditions triggering new anxiety or depressive disorders (33%). Panic disorder and agoraphobia were significantly more prevalent than less severe phobias in the first two groups, whereas the opposite pattern existed in the third group (P <.0001). More patients in the first two groups had risk factors for anxiety disorders (P <.05). Depression was not a primary cause of dizziness in any patient. Vestibular neuronitis, benign paroxysmal positional vertigo, and migraine were the most common neurotologic conditions. CONCLUSIONS These data support the hypothesis that physical neurotologic conditions may trigger psychopathology as often as primary anxiety disorders cause dizziness. A third pattern appears to be equally common wherein physical neurotologic conditions exacerbate preexisting psychiatric illnesses. Individuals at risk for anxiety disorders may be more likely to have primary psychopathology.
BibTeX: @article{Staab2003, author = {Staab, Jeffrey P and Ruckenstein, Michael J}, title = {Which comes first? Psychogenic dizziness versus otogenic anxiety.}, journal = {The Laryngoscope}, year = {2003}, volume = {113}, issue = {10}, pages = {1714--1718}, keywords = {Adolescent; Adult; Aged; Aged, 80 and over; Anxiety Disorders, complications, physiopathology; Chronic Disease; Dizziness, etiology, psychology; Female; Humans; Logistic Models; Male; Middle Aged; Risk Factors}, pmid = {14520095} }
Dimitriadis, P.A., Saad, M., Igra, M.S., Mandavia, R., Bowes, C., Hoggard, N. and Ray, J.	White matter lesions in magnetic resonance imaging of the brain in 56 patients with visual vertigo. [Abstract] [BibTeX]	2018	The Journal of laryngology and otology Vol. 132(6), pp. 550-553	article	DOI
Abstract: Visual vertigo is defined as a condition in which there is worsening or triggering of vestibular symptoms in certain visual environments. Previous studies have associated visual vertigo with an increased prevalence of underlying white matter lesions on brain imaging. This study evaluated the magnetic resonance imaging scans of the brain from a cohort of patients with visual vertigo, and compared the outcomes to an age- and gender-matched group of healthy volunteers.Results and conclusionWhite matter lesions were observed in 17.9 per cent of the patient group and in 16.3 per cent of the control group. The prevalence of white matter lesions in the patient group was not too different to that expected based on age.
BibTeX: @article{Dimitriadis2018, author = {Dimitriadis, P A and Saad, M and Igra, M S and Mandavia, R and Bowes, C and Hoggard, N and Ray, J}, title = {White matter lesions in magnetic resonance imaging of the brain in 56 patients with visual vertigo.}, journal = {The Journal of laryngology and otology}, year = {2018}, volume = {132}, issue = {6}, pages = {550--553}, doi = {https://doi.org/10.1017/S0022215118000701}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, diagnostic imaging, epidemiology, physiopathology; Brain, diagnostic imaging; Case-Control Studies; Cohort Studies; Female; Humans; Leukoencephalopathies, diagnostic imaging, epidemiology; Magnetic Resonance Imaging; Male; Meniere Disease, diagnostic imaging, epidemiology, physiopathology; Middle Aged; Migraine Disorders, diagnostic imaging, epidemiology, physiopathology; Prevalence; Severity of Illness Index; Surveys and Questionnaires; Vertigo, diagnostic imaging, epidemiology, physiopathology; Vestibular Neuronitis, diagnostic imaging, epidemiology, physiopathology; Visual Perception; White Matter, diagnostic imaging; Young Adult; Dizziness; Magnetic Resonance Imaging; Vertigo; White Matter}, pmid = {30019667} }
Best, C., Tschan, R., Eckhardt-Henn, A. and Dieterich, M.	Who is at risk for ongoing dizziness and psychological strain after a vestibular disorder? [Abstract] [BibTeX]	2009	Neuroscience Vol. 164(4), pp. 1579-1587	article	DOI
Abstract: Patients with vestibular vertigo syndromes often suffer from anxiety and depression, whereas patients with psychiatric disorders often experience subjective unsteadiness, dizziness, or vertigo. Thus, it has been hypothesized that the vestibular system may be interlinked with the emotion processing systems. The aim of the current study was to evaluate this hypothesis by correlating vestibular and psychiatric symptoms with the course of the disease over 1 year. This interdisciplinary, prospective, longitudinal study included a total of 68 patients with acute vestibular vertigo syndromes. Four subgroups of patients with benign paroxysmal positioning vertigo (BPPV, n=19), acute vestibular neuritis (VN, n=14), vestibular migraine (VM, n=27), or Menière's disease (MD, n=8) were compared. All patients underwent neurological and neuro-otological examinations and filled out standardized self-report inventories including the Vertigo Symptom Scale (VSS), the Vertigo Handicap Questionnaire (VHQ) and the Symptom Checklist 90R (GSI, SCL-90R) at five different times (T0-T4) in the course of 1 year. VM patients experienced significantly more "vertigo and related symptoms" (VSS-VER), "somatic anxiety and autonomic arousal" (VSS-AA), and "vertigo induced handicap" (VHQ) than all other patients (P<0.001-P=0.006). Patients with a positive history of psychiatric disorders had significantly more emotional distress (GSI, SCL-90R), regardless of the specific phenomenology of the four diagnostic subgroups. Finally, fluctuations of vestibular excitability correlated positively with the extent of subjectively perceived vertigo. VM patients are significantly more handicapped by vertigo and related symptoms. They show significantly elevated fluctuations of vestibular excitability, which correlate with the (subjective) severity of vertigo symptoms.
BibTeX: @article{Best2009, author = {Best, C and Tschan, R and Eckhardt-Henn, A and Dieterich, M}, title = {Who is at risk for ongoing dizziness and psychological strain after a vestibular disorder?}, journal = {Neuroscience}, year = {2009}, volume = {164}, issue = {4}, pages = {1579--1587}, doi = {https://doi.org/10.1016/j.neuroscience.2009.09.034}, keywords = {Dizziness, etiology, psychology; Female; Humans; Male; Meniere Disease, complications, psychology; Middle Aged; Migraine Disorders, complications, psychology; Prospective Studies; Stress, Psychological, etiology, psychology; Syndrome; Vertigo, complications, psychology; Vestibular Diseases, complications, psychology; Vestibular Neuronitis, complications, psychology}, pmid = {19828125} }
Zucca, G., Valli, S., Valli, P., Perin, P. and Mira, E.	Why do benign paroxysmal positional vertigo episodes recover spontaneously? [Abstract] [BibTeX]	1998	Journal of vestibular research : equilibrium & orientation Vol. 8(4), pp. 325-329	article
Abstract: It is well known that most episodes of benign paroxysmal positional vertigo (BPPV), even in untreated, recover spontaneously in 2 to 6 weeks. In the present study, we put forward the hypothesis that this is mainly due to the fact that endolymph, owing to its low calcium content (20 microM) is able to dissolve otoconia. To support this, the fate of frog saccular otoconia immersed in normal endolymph (Ca2+ content 20 microM) and in Ca2+-rich endolymphatic fluids (up to 500 microM) was studied by observing the crystals at regular intervals for 3 weeks. The results demonstrated that normal endolymph can dissolve otoconia very rapidly (in about 20 hours). When the endolymphatic Ca2+ content was increased (50 to 200 microM) otoconia dissolution time was slowed down (about 100 to 130 hours, respectively) and completely stopped when the endolymphatic Ca2+ content was of 500 microM. The present results therefore suggest that the major process involved in the spontaneous recovery of BPPV episodes is the capability of the endolymph to dissolve dislodged otoconia.
BibTeX: @article{Zucca1998, author = {Zucca, G and Valli, S and Valli, P and Perin, P and Mira, E}, title = {Why do benign paroxysmal positional vertigo episodes recover spontaneously?}, journal = {Journal of vestibular research : equilibrium & orientation}, year = {1998}, volume = {8}, issue = {4}, pages = {325--329}, keywords = {Animals; Calcium, pharmacology; Endolymph, physiology; Microscopy, Electron, Scanning; Otolithic Membrane, drug effects, metabolism, ultrastructure; Rana esculenta; Vertigo, metabolism, physiopathology}, pmid = {9652482} }
Dagan, E., Wolf, M. and Migirov, L.M.	Why do geriatric patients attend otolaryngology emergency rooms? [Abstract] [BibTeX]	2012	The Israel Medical Association journal : IMAJ Vol. 14(10), pp. 633-636	article
Abstract: With an aging population, health care of the elderly population is becoming increasingly important; however, the principles of geriatric medicine and issues of concern specific to geriatric otolaryngologic patients have not been widely applied. To qualitatively analyze otolaryngological (EN1) emergencies in a geriatric population in an ENT emergency department (ED). In this retrospective study the medical records of patients > or = 65 years of age who attended our ENT-ED between 3 pm and 8 am and who were observed and/or treated by the on-call otorhinolaryngologist at Sheba Medical Center in 2009 were reviewed for age, gender, main complaint, and preliminary diagnosis. Allergic reactions, balance disorders, epistaxis, head/facial trauma and swallowing-related complaints were considered true emergencies. The staff in the ENT-ED examined and treated 1-10 geriatric patients daily (mean 2.35). A total of 597 subjects met the study entry criteria (median age 75 years); 16.6% were > or = 85 years old. There was approximately equal gender representation. More elderly patients presented to the ENT-ED on the weekends (37.9% of the total) compared to weekdays (62.1%). There were 393 patients (65.8%) with true emergencies, of which epistaxis, balance disorders and head and facial trauma were the most common diagnoses (20.1%, 15.75% and 13.7%, respectively), while 46.5% of all vestibulopathy cases involved benign paroxysmal positional vertigo. More than 65% of visits of the elderly presenting to ENT-ED involve true emergencies. This growing population may benefit from the presence of geriatric specialists in emergency departments.
BibTeX: @article{Dagan2012, author = {Dagan, Elad and Wolf, Michael and Migirov, Lela M}, title = {Why do geriatric patients attend otolaryngology emergency rooms?}, journal = {The Israel Medical Association journal : IMAJ}, year = {2012}, volume = {14}, issue = {10}, pages = {633--636}, keywords = {Age Factors; Aged; Emergencies; Emergency Service, Hospital; Female; Humans; Incidence; Israel, epidemiology; Male; Otolaryngology; Otorhinolaryngologic Diseases, epidemiology, therapy; Patient Admission, statistics & numerical data; Retrospective Studies; Risk Factors}, pmid = {23193786} }
Özler, G.S. and Yengil, E.	Why do geriatric patients visit otorhinolaryngology? [Abstract] [BibTeX]	2016	Ear, nose, & throat journal Vol. 95(6), pp. 224-229	article
Abstract: The number and proportion of people more than 65 years old in the population are increasing with the rise in life expectancy. This study was designed to investigate the otolarygologic needs and visits of geriatric patients. We conducted a retrospective study that included all patients ≥65 years of age who visited the otolaryngology department between 8 a.m. and 4 p.m. during 1 year. Age, gender, main complaint, and clinical diagnosis were noted on a chart and analyzed. In 2012, a total of 19,875 patients attended the otolaryngology department between 8 a.m. and 4 p.m., of whom 418 (2.1%) were aged ≥65 years. The most common complaints were ear and hearing disorders (24.2%), epistaxis(15.3%), balance disorders (15.1%), pharyngotonsillar pathologies (14.8%), and head and facial trauma (9.6%). This study shows that the changing patient population will change the type and frequencies of pathologies seen in general otolaryngology practices. Geriatric patients need a targeted approach to their diseases because they have special issues unique to their population.
BibTeX: @article{Oezler2016, author = {Özler, Gül Soylu and Yengil, Erhan}, title = {Why do geriatric patients visit otorhinolaryngology?}, journal = {Ear, nose, & throat journal}, year = {2016}, volume = {95}, issue = {6}, pages = {224--229}, keywords = {Aged; Aged, 80 and over; Ambulatory Care Facilities; Benign Paroxysmal Positional Vertigo, epidemiology; Craniocerebral Trauma, epidemiology; Epistaxis, epidemiology; Facial Injuries, epidemiology; Female; Hearing Disorders, epidemiology; Humans; Male; Middle Aged; Otolaryngology; Otorhinolaryngologic Diseases, epidemiology; Pharyngeal Diseases, epidemiology; Postural Balance; Retrospective Studies; Salivary Gland Diseases, epidemiology; Sensation Disorders, epidemiology; Sinusitis, epidemiology; Tinnitus, epidemiology}, pmid = {27304440} }
Babac, S., Djeric, D., Petrovic-Lazic, M., Arsovic, N. and Mikic, A.	Why do treatment failure and recurrences of benign paroxysmal positional vertigo occur? [Abstract] [BibTeX]	2014	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vol. 35(6), pp. 1105-1110	article	DOI
Abstract: To investigate the potential risk factors associated to the treatment failure and recurrence of benign paroxysmal positional vertigo (BPPV). Prospective cohort study. Tertiary referral center. Four hundred patients with benign paroxysmal positional vertigo, 119 men and 281 women, aged 27 to 88 years. Patients were treated once a week, with only one, appropriate, depending on the affected canal, repositioning maneuver (modified Epley, Semont, barbecue/inverted Gufoni, Kim). The control Dix-Hallpike test and the roll test were performed on 7 days. The treatment outcome and recurrence were evaluated with regard to sex, age, duration of symptoms, etiologic factors, migraines, osteoporosis, vascular risk factors, endocrine diseases, localization of otoconia, and simultaneous involvement of multiple canals. The results indicate that treatment was negatively affected by patients' age, osteoporosis, and head trauma, without them causing recurrent symptoms. The highest number of uncured patients was observed in the 73- to 88-year-old age group (14.8%). The application of more than one maneuver was necessary in 27.5% of cases with primary BPPV and 88.9% with secondary BPPV. The highest treatment success was achieved in the group with BPPV of the posterior semicircular canal (F = 3.668, p = 0.026). The recurrence rate was 15.5%. Potential risk factors associated to the treatment failure were as follows: the age older than 50, secondary BPPV, head trauma, the occurrence of osteoporosis, and localization of otoconia in the anterior semicircular canal. The analyzed factors did not have impact on the recurrence.
BibTeX: @article{Babac2014, author = {Babac, Snezana and Djeric, Dragoslava and Petrovic-Lazic, Mirjana and Arsovic, Nenad and Mikic, Aleksandar}, title = {Why do treatment failure and recurrences of benign paroxysmal positional vertigo occur?}, journal = {Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology}, year = {2014}, volume = {35}, issue = {6}, pages = {1105--1110}, doi = {https://doi.org/10.1097/MAO.0000000000000417}, keywords = {Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo, epidemiology, therapy; Craniocerebral Trauma, epidemiology; Female; Humans; Male; Middle Aged; Osteoporosis, epidemiology; Otolithic Membrane; Posture; Prospective Studies; Recurrence; Risk Factors; Semicircular Canals; Treatment Outcome}, pmid = {24853239} }
Lorin, P., Foubert, F. and Debaty, M.	Why Treat Apogeotropic BPPVs of the Horizontal Canal? About 30 Observations. [Abstract] [BibTeX]	2011	International journal of otolaryngology Vol. 2011, pp. 278383	article	DOI
Abstract: Benign paroxysmal positional vertigo (BPPV), of the horizontal canal, in the apogeotropic form (AHBPPV) was described in 1995. Based on 30 observations of typical AHBPPVs of the horizontal canal, we endeavor to discuss the relevance of physiotherapy. Material and Method. Thirty observations of typical apogeotropic BPPVs of the horizontal canal treated with a 360° barbeque rotation on the BPPV side, reviewed in consultation at 1 and 3 weeks and reevaluated the following year. Results. Our cohort of 30 patients had an average age of 58.6 years. The apogeotropic BPPVs of the horizontal canal, which can be transformed into BPPVs of the posterior canal or into geotropic-type BPPVs of the horizontal canal do not recover more quickly. Patients who follow the positional advice do not recover more quickly than those who do not (P = 0.152). The 15 patients treated on average 13.73 days after the onset of the disease did not recover more quickly after the start of therapeutic treatment than those treated later (P = 0.032). Conclusion. Here, we demonstrate that the direction of rotation during the maneuvers is of no importance for the results. We show that transformability is not a guarantee of rapid recovery and that the therapist's effectiveness is limited when it comes to the short-term results.
BibTeX: @article{Lorin2011, author = {Lorin, Philippe and Foubert, Francois and Debaty, Marie}, title = {Why Treat Apogeotropic BPPVs of the Horizontal Canal? About 30 Observations.}, journal = {International journal of otolaryngology}, year = {2011}, volume = {2011}, pages = {278383}, doi = {https://doi.org/10.1155/2011/278383}, pmid = {21804825} }
Pommer, P.	[BibTeX]	2016	Deutsche medizinische Wochenschrift (1946) Vol. 141(22), pp. 1607	article	DOI
BibTeX: @article{Pommer2016, author = {Pommer, Peter}, journal = {Deutsche medizinische Wochenschrift (1946)}, year = {2016}, volume = {141}, issue = {22}, pages = {1607}, doi = {https://doi.org/10.1055/s-0042-114598}, keywords = {Benign Paroxysmal Positional Vertigo, drug therapy; Betahistine, adverse effects, therapeutic use; Humans; Prevalence; Randomized Controlled Trials as Topic; Treatment Outcome; Vasodilator Agents, therapeutic use; Vertigo, drug therapy, epidemiology}, pmid = {27824413} }